I am a 52-year-old male, married and with a son. My basic complaint is recurrent UTI, poor urine flow and chronic testicular pain. I was down with kidney infection since past five months and had to be treated with Magnex Forte for five days. A CT scan showed mild perinephric stranding. I was put on low dose Niftran for three months. A follow-up CT scan with contrast revealed normal kidneys and function. Since my urine flow has always been poor, I did an ascending urethrogram a month back. The report indicated no obvious abnormality. There was bleeding and excruciating pain for two days post procedure. Four days later, I again developed severe UTI for which I had to take injections of Amikacin 750 mg for five days. I have once again been put on Niftran 100 mg twice daily.
The urologist has suggested a bladder neck incision as he feels that my bladder neck is not opening fully and that there is a slight narrowing of the prostatic urethra. My prostate is slightly enlarged at 26 gm. The urologist is planning to widen neck and if required, scoop out prostate tissue that is blocking the passage. I have been on treatment for chronic testicular pain for last eight to nine years. I also have grade 2 varicocele, mild burning pain on tip of the penis. Earlier, I used to get burning pain in penis after ejaculation. One doctor suspects that I have chronic non-bacterial prostatitis. I am currently seeking advice that will help prevent upper UTI, increase urine flow and relax the bladder muscles. My average urine flow is only about 0.16 to 0.2 fluid ounce/sec.
My medicines include Saw palmetto and Quercetin, Mildfil 5 mg, Silodosin 8 mg, Tapentadol 75 mg twice daily, Valium 5 mg and Duzela 20 mg. The last three are prescribed by a pain specialist. My urologist is planning to do a BNI including parts of the prostate (laser), varicocelectomy and a cystoscopy. There is a certain improvement in urine flow after I started taking Silodosin. It seems to be more effective than Tamsulosin and Alfuzosin (10 mg). The only drawback is complete retrograde ejaculation. Can I shift to Silodosin 4mg? Is it fine to do varicocelectomy and BNI at the same time? More importantly, will BNI offer excellent outcome as the X-ray does not indicate an obvious abnormality?