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Dr. Y.
Dr. Y., Urologist
Category: Urology
Satisfied Customers: 20382
Experience:  Specializing in general urology and reconstructive urology.
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Doctor, past few weeks i was suffering with

Customer Question

Hello doctor, for the past few weeks i was suffering with prostatitis(few occasions of yellowish semen and mild testicular pain) so i have underwent a barrage of test - initial urine cultures showed mixed growths and few WBC, had ultrasounds of my entire tract, showed nothing of ordinary in kidneys or testicles, but prostate had a few calcii deposits, cystoscopy was normal, and blood tests showed kidney functioning was normal. a few days after these initial test i had urinary symptoms still mild and was later diagnosed with UTI and prostatitis due to ecoli. had antibiotics for a few weeks - semen became normal but there were small instances of testicular pain which were on and off. doctor suggested i do a intravenous urogram. which showed a mild UPJ obstruction in my right kidney and no hydroureter. pls note that no pelvicalyecal dilation was discovered in the renal ultra sounds which i had may be 2 months back. the doctor says its not severe and i don't need surgery yet since i don't have any pain/symptoms and the dilation is not big enough. He has asked me to get a check done every year to monitor this. I'm worried since i was born with only a single kidney(right kidney) which is having mild UPJ. I'm 30 years old and this is the first time i had a UTI/prostatitis/any urinary symptoms. i have heard that kidney problem symptoms don't usually show up till the time kidney becomes damaged a lot. so can you please help me understand because I'm very stressed with this. since this is a birth defect and i have been fine so long is it possible that my condition is stable. if the dilation were to worsen, how will i know before my kidney damage is beyond repair?

Submitted: 1 year ago.
Category: Urology
Expert:  Dr. Y. replied 1 year ago.
The only way to tell whether not you truly need to have any intervention on the UPJ obstruction is to have a test called a renal scan done. This will tell whether or not the kidney is truly obstructed. If it is, then you will need to have surgery to protect your only kidney. If it is not obstructed , Then there may have just been an appearance of the UPJ obstruction when there really is not one. As far as your prostatitis goes, if your doctor has not put you on a 4 to 6 week course of antibiotics such as Cipro or an antibiotic that your urine culture shows that will kill the bacteria, this is what I would consider next. Prostatitis is a difficult infection to treat and takes an extended course of antibiotics to clear out. Hope this helps.
Customer: replied 1 year ago.

thank you for your reply doctor. What is this test called? should i ask my doctor for this test because according to the Intravenous Pyelogram he says that i don't need any surgery. i remember during the IVP when the iodine solution was injected and the first X-ray was taken the doctor commented that the kidney looks dilated and said that he will tell me if this was fine only after the exam. Then after 15-20 mins he tried taking different positions X-ray, a bit upright, lying on my belly and then said the above (wait and monitor).

Customer: replied 1 year ago.

thank you for your reply doctor. What is this test called? should i ask my doctor for this test because according to the Intravenous Pyelogram he says that i don't need any surgery. i remember during the IVP when the iodine solution was injected and the first X-ray was taken the doctor commented that the kidney looks dilated and said that he will tell me if this was fine only after the exam. Then after 15-20 mins he tried taking different positions X-ray, a bit upright, lying on my belly and then said the above (wait and monitor).

Also what do you mean if the kidney is truly obstructed or not? the IVP X-rays prints already show dilation, is this not the same?

Expert:  Dr. Y. replied 1 year ago.
There can be very degrees of dilation. To determine whether or not the dilation is truly significant or not you need to test called the renal scan. This is what your doctor needs to order next determine if anything truly needs to be done or not.
Customer: replied 1 year ago.

this is nuclear medicine you are talking about isn't it. if so then doesn't the iodine contrast injected during IVP behave the same as the radioactive isotope injected during renal scan? I've read that if it takes more than 20 mins to remove the radioactive isotope from the kidney then an obstruction is considered. but cant the same sort of calculation be made with an iodine isotope? I'm only asking this because my doctor was timing the X-rays and only at the end of the test did he say that i don't need surgery.

but if you say so i will ask him again to get a renal scan done on me.

can you also comment how long does it take for this condition to progressively worsen till the time that it really affects my kidney. I'm assuming my kidney is working fine based on the blood test and no symptoms

Expert:  Dr. Y. replied 1 year ago.
The time it takes to cause damage here can you completely depends on how obstructed it is. A precise washout time of the dye used to be determined. An estimate can be obtained but you do not want to rely on an estimate to determine the fate of your kidney. This is why the nuclear medicine scan to give the precise washout time.
Customer: replied 1 year ago.

ok doctor, i will ask for this test when i see him next week, also doctor I'm a bit perplexed since nothing showed on my ultrasounds. if the UPJ obstruction was significant, shouldn't it have shown in my ultrasounds a few months back?

Expert:  Dr. Y. replied 1 year ago.
Yes. It most likely so uld have shown up then. This is why I suspect that this is probably not a UPJ obstruction
Customer: replied 1 year ago.

also doctor, since the past few days i have been eating a lot of outside food and my diet has been very very unstable/oily food, which usually gives me gas problems(belching). recently i noticed that i have small discomfort in my right lower back area when i get gas which goes away after i burp. like i said due to gas. Since i have been doing a lot of reading on kidneys, just wanted to ask if this could be kidney pain.

Also doctor if you think this is not UPJ, then what is it?

Expert:  Dr. Y. replied 1 year ago.
This does not sound like kidney pain. It sounds more like gas pain.
Customer: replied 1 year ago.

ok thank you doctor. bit worried if this has already impacted my kidney, can i assume that my kidney is working fine since the blood test showed that there was nothing wrong with its working?

also doctor, i am also scheduled for a CT urogram to see if there is any renal mass at my left(absent) kidney. will this test not be good enough as the renal scan for me to have a 3rd test

Expert:  Dr. Y. replied 1 year ago.
Yes. If your kidney function is ok on blood work, there is no kidney damage.
Again, the renal scan is the only way to tell if something is truly wrong or not.
Please don't forget to leave me a rating. Thanks.
Dr. Y., Urologist
Category: Urology
Satisfied Customers: 20382
Experience: Specializing in general urology and reconstructive urology.
Dr. Y. and other Urology Specialists are ready to help you
Customer: replied 1 year ago.

thank you for your time doctor. i will come back to you with more information as i get from my urologist. i really appreciate your views

Customer: replied 1 year ago.

the only reason for all this confusion is the renal scan is the only way to determine further intervention, then why my urologist was happy only with the results of the intravenous pyelogram. he outright said no for a surgery and has asked me not to worry, but somehow after hearing your replies i do feel a bit concerned

Expert:  Dr. Y. replied 1 year ago.
Based on what you're telling me, it does not sound like there's anything to be concerned about. With normal kidney function on your bloodwork, there's almost certainly nothing serious going on.
Customer: replied 1 year ago.

how often should i get me blood work done doctor. this last blood work i had done late november which came fine. before this blood work i had the ultrasounds which also didn't show as i perviously mentioned. i came to know act this UPJ only last week since my prostatitis wasn't cured with the following course (10 days of Cipro 500mg*2times and then after 3 weeks i had 10 days of Zinat 250mg*10 days) and then the doc asked for the IVP

Expert:  Dr. Y. replied 1 year ago.
I don't think you need any new blood work unless your renal scan shows anything abnormal.
Customer: replied 1 year ago.

ok so that i understand correctly. if my renal scan shows nothing or if the half time is less than 20 minutes, then my obstruction is not considered severe, right?. cause i do have some dilation as per my doc based on the IVP results

Expert:  Dr. Y. replied 1 year ago.
Yes that is correct.
Customer: replied 1 year ago.

thank you doctor, i will come back to you in a week with more info. appreciate your help

Customer: replied 1 year ago.

hello doctor,

i just found out that my doctor during the intravenous pyelogram also did a few hormone test including the PSA test. Given his previous diagnostic of prostatitis won't my PSA levels look a bit abnormal?. I'm only age 29. what level should i have for a normal PSA test to avoid further testing for cancer? also a day before my blood test he had also performed a DRE to examine my prostate which did ache a little when he presses although the pain was a lot lower than the DRE he did before i took antibiotics

Expert:  Dr. Y. replied 1 year ago.
At your age, your PSA should be less than one. However, because you have prostatitis, your PSA could be any number. Because of this reason, we never check a PSA in the presence of prostatitis. At your age, there is no concern for prostate cancer.
Customer: replied 1 year ago.

ok thanks for your reply doctor. i was only wondering why he did my PSA test and was concerned that since the prostatitis which he diagnosed via DRE and urine culture (no prostatitis fluid was tested) was not getting treated with the 10 day cipro and 8 days of another low dose antibiotic. is it possible that his diagnosis of prostatitis is incorrect?

Expert:  Dr. Y. replied 1 year ago.
I can't determine if his diagnosis is correct or not. But it may be prostatitis.
Customer: replied 1 year ago.

doctor also since saturday morning when i went jogging which i did after a long time, i have started having pain in my left testicle. this is not the pain i had in testicles during prostatitis for in the last 2 months which was dull and numbing. this pain is as if i have hurt my testicle. it hurts when i walk or touch it. now what could this be doctor? its been there for the last 2 days with no signs of easing

Expert:  Dr. Y. replied 1 year ago.
This is probably some nerve inflammation. But it sounds like you need to get into see your doctor for an examination to be sure.
Customer: replied 1 year ago.

hello doctor,

i got my uno to check up on the testicle pain. he has just asked me to monitor the pain for a few days cause he didn't find anything suspicious on physical examination.

also doctor have noticed on home dipstick tests that i have started showing some WBC's(70/cmm). i usually get no activity on dipsticks when the urine looks normal, but when i see the urine is a bit foamy i get the above WBC count.

is it possible that my course of 10 day cipro(500mg twice daily) in nov last 2 weeks and 10 day zinat(250mg twice daily) in January, was not sufficient to kill the e-coli detected in the urine in NOV?

i was without symptoms for a few days once i was off the zinc tablets, but off late i have noticed the frothy urine which prompted me to do the dipstick test on which i see the positive dipstick results? other than the worthy urine and the pain in my left testicle(on touch) i do not have any other symptoms i had before.

P.S. i told my doctor about this (dipstick and foamy urine) today morning but he shrugged it off, since he was quite happy with my uroflowmetry(avg 11-13 ml/sec flow rate) and bladder scan results(residual urine in bladder dropped from 50ml to 11ml since the last test in dec) and prostate scan also showed reduction in size of the prostate. my renal scan blood test was done again and all results showed normal renal function. he also mentions that the dilation in my kidneys is not significant at all so i don't need to do the renal scan test for now, he confirmed that it only appears to be like UPJ but it actually isn't and just to get it checked it every year if it increases. my PSA was normal according to him at 1.6

Expert:  Dr. Y. replied 1 year ago.
It's possible that your course of antibiotics was not enough to clear the infection. The only way to tell for sure is to send a repeat urine culture to see if you have residual bacteria. If you do, then you will need to be prescribed a longer course of antibiotics.
Customer: replied 1 year ago.

thats the problem doctor, since my uro thinks that since my recent test have improved his course of antibiotics should have definitely cured my symptoms. I know that my current symptoms other than the occasional foamy urine are not as severe as my symptoms before. but i fear that if my symptoms worsen it can affect my only remaining kidney

Expert:  Dr. Y. replied 1 year ago.
At some Point , you're just going to have to trust your doctor. Your doctor is the one who is best in tune with what is going on with your situation since they know your entire history and can examine you.
Customer: replied 1 year ago.

so assuming my doctor is correct should i ignore my paranoia with the occasional foamy urine for the time being till my symptoms show up? i agree i have grown increasingly anxious and nervous with all the test which have been going on since the past few months

Expert:  Dr. Y. replied 1 year ago.
Yes. I think you are overly anxious about this as there is likely nothing wrong with you at all.
Customer: replied 1 year ago.

thank you for your help doctor

Expert:  Dr. Y. replied 1 year ago.
You're welcome.
Customer: replied 1 year ago.

Hello doctor,

it turns out that the pain in the left testicle was due to inflammation of my epididymis. The doctor had given me an antibiotic injection then put me on a course of amoxycycline and ibuprofen both 500mg 3 times a day for 6 days. the swelling has reduced considerably from the onset, but the pain has returned after the antibiotic had stopped, however not as bad as it previously was before antibiotic treatment.

also the foamy urine continues. i probably think this is because of sperm in the urine, since after sex, the urine tends to be non foamy for 5-6 hours after which it becomes foamy again.

what needs to be done doctor?

Customer: replied 1 year ago.

Hello doctor,

it turns out that the pain in the left testicle was due to inflammation of my epididymis. The doctor had given me an antibiotic injection then put me on a course of amoxycycline and ibuprofen both 500mg 3 times a day for 6 days. the swelling has reduced considerably from the onset, but the pain has returned after the antibiotic had stopped, however not as bad as it previously was before antibiotic treatment.

also the foamy urine continues. i probably think this is because of sperm in the urine, since after sex, the urine tends to be non foamy for 5-6 hours after which it becomes foamy again.

what needs to be done doctor?

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