Q. I get burning sensation while passing urine with frequent urination at night. Please help.

Answered by
Dr. Samer S J Altawil
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Nov 07, 2020

Hello doctor,

I have a burning sensation while passing urine, and I get frequent urination at night.

My USG abdomen and pelvis show:-

Prostate is enlarged in size and measures 80-90 cc in volume.

Median lobe of prostate is seen projecting into the bladder base.

Visualized bowel loops are non-dilated and show normal peristalsis.

No ascites is noted.

Urinary bladder (UB) is well distended.

UB wall is normal.

No visual calculus are seen.

Pre void volume is 725 cc.

Post void volume is 90-100 cc - significant.

My HbA1c is 5.5 %. My present problem is burning sensation in the urinary bladder and urethra until the exit point.

I was on the following medications for about a month now.

Norflox 400 1-0-1, Levofloxacin 750 1-0-0, Potrate MB6 10-10-10 ml, Tamsulosin 0-0-1, Pulmocef 500 1-0-1, and Cystone forte 1-0-1.

Urine routine:

Colour - pale yellow.

Specific gravity - 1.015.

Appearance - clear.

pH - 6.00.

Urobilinogen - normal.

Epithelial cells - 1-2.

Pus cells - 0 - 1.

RBC, carts, crystals, budding yeast cells, bacteria - absent.

Leucocytes, urine protein, ketone, nitrile, urine glucose, bile pigments, blood, and bile salts - negative.

Urine culture shows occasional pus cells. No org seen, pus cells, epithelial cells, RBC counts based on direct uncentrifuged specimen centrifuge sediment.

Blood test

PSA-2.18.

Sugar PP-141.

I have burning in urethra and glans region, which starts in the morning and remains until evening. I also have burning while passing urine and frequent urination at night. And I do not get sleep after 02.30 AM. Kindly help.

#

Hi,

Welcome to icliniq.com.

Your presentation and investigations (attachment removed to protect patient identity) showed a prostate enlargement with median lobe enlargement, which makes it difficult for him to empty his urine completely, causing urinary infection. Therefore he was treated with multiple courses of antibiotics leading to yeast (fungal) infection. He is also taking Tamsulosin which is an alpha-blocker. His residual volume is about 100 ml, and PSA (prostate-specific antigen) is 2.8.

The management can be by combination treatment of Tamsulosin and Dutasteride 0.5 mg once daily which is indicated for the prostate of more than 30 gm and PSA more than 1.4. It can give improvement over three to six months, but it is a bit costly treatment. Suppose the patient cannot afford it or is really annoyed with symptoms. In that case, going for a surgical option is better to resolve the issue done by endoscopic operation of one hour, and the results will be dramatic.

You can deal with fungal infection by tablet Fluconazole 150 mg once daily for two weeks. Start combination treatment as mentioned above. Maintain proper hydration and avoid constipation. If you want immediate relief, then surgery is preferred.

Please follow up after three months with uroflow, bladder scan, urine analysis, and culture.

I hope this helps.


Investigations to be done:

Urine analysis and culture. Uroflow and post-void bladder scan.


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