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