Constant pain in penis due to small capacity bladder. Need second opinion on the treatment.

Question

Dear doctor,

I am a 62 year old male. I get constant pain in my penis and get the feeling of my bladder bursting which I try to relieve by urinating, but when I attempt to urinate, I have to apply a lot of pressure to relieve a minimum of only 30 ml or less of urine. Therefore I am forced to sit on the toilet and pass urine as it reduces the amount of pressure I have to put as compared to standing. While seated and urinating, the pressure I apply also results in me passing bits of stool chips.

I have undergone a prostate test whose results are normal, as well as a urine culture test again resulting reports are normal. The report also mentions that the normal capacity of a bladder is about 400 ml whereas my bladder's capacity is only 70 ml stating that my bladder has shrunk.

The frequency of my urination is about every 25 to 30 minutes. I get minimal relief from this pain by consuming buttermilk, water or antacid tablets.

I have been prescribed to take Urimax 0.4 and Comfora (three capsules a day) for the past six months. On second opinion, I have been suggested to take Solitral 10D. I have also undergone a cystoscopy test and the results are as follows:

1. Pertinent Investigative Data: - Urine routine normal. - Urine culture negative. - Sr. Creatinine 0.8 - Sr. PSA 0.4 - USG suggestive of pre-void 102 cc. Post-void 10 cc. - Urine culture for Koch's negative. - IVP normal. - MCU suggestive of left VUR and a small capacity bladder.

2. Clinical History: Irritative lower urinary tract segment.

3. Gross: Received 4 grey white mucosal soft tissue bits measuring 0.6x0.6x0.2 cm, bladder biopsy.

4. Microscopic: Sections show partially ulcerated bladder mucosa with dense lymphoplasmacytic infiltrate and an occasional lymphoid follicle. There are submucosal concretions noted with a giant cell reaction. No fungal elements seen. No granulomas seen. No epithelial atypia noted.

Diagnosis: Follicular cystitis

Request you to please shed light on the medication that I am taking and if there are any alternatives that I should look at. Also, I would like to know if I need to undergo any tests again.

Answer 1

Hi,

Welcome to icliniq.com.

You have a small capacity bladder with irritative and obstructive symptoms. You may require a uroflow to see if your prostate is obstructing or not.

I assume that your IVP study is normal and urine AFB has been done on three consecutive days so that tuberculosis has been excluded.

Next, you need a full dose of medicines to relax your bladder. Solitral has half the dose of Solifenacin.

You also need to make a bladder volume diary. Your cystoscopy if done under anesthesia would have revealed your true bladder capacity.

If the capacity is more than 150 cc then, you can undergo botox injections.
- If the capacity remains under 150 cc, you may require surgery.
Meanwhile, a full dose of drugs, bladder training, and restricted fluid intake will help.

If your prostate is obstructive, endoscopic surgery for prostate will help you to void easier. Take care.