Expert: Arthur Goldstein, M.D. - 12/2/2006

Question
Hello I appreciate you taking my question.

I am a 20 year old male and for about a year and a half now I have been experiencing burning while urinating.  It started gradually then I did feel the burn increase sometimes while I held in.  I did not get it checked thinking it was just going to go away but eventually after a few months I experienced pressure in the abdomen.  It  became unbearable and I was afraid it might be Gonorrhea or Chlamydia.  I got tested and they were negative.  I went in  for a UTI test and the doctor said the urine was fine.  Still he prescribed me a lower strength medication which did not work out so well then he prescribed me Ciprofloxacin I believe.  The abdomen pressure went away and never came back , its been almost 6 months.  The urine burn has become light but still noticeable; seems more like a pinch inside towards the bottom of the penis most of the times.  What could this be? There are no other problems so far other than this annoying little thing.  Your response will greatly be appreciated

Thank You  

Answer
ADI, the most common cause of these complaints is an inflammation of the prostate gland, so called prostatitis.  Symptoms that might occur with prostatitis include frequency of urination, slowing of the urinary stream, burning with voiding or ejaculation, burning in the penile tip unrelated to voiding, sexual dysfunction (such as difficulty with erection), aching in the penis, testicles, and discomfort in the lower abdomen, low back, groin, rectum or perineum (the area between the scrotum and rectum (between the wind and the rain).   The passage of blood at the initiation or termination of urination or in the semen can also be noted.  During sexual arousal the prostate gland manufactures fluid that accounts for about 2/3 of the volume of ejaculate.  The seminal vesicles are paired structures located behind the prostate gland that also manufacture fluid.  Sperm from the testicles (which account for only 1-2 of the semen) travel up a series of tubes (epididymis and vas deferens) on each side to join the seminal vesicles forming the paired ejaculatory ducts.  These structures empty into the prostatic portion of the urethra.  At the time of ejaculation, prostatic fluid is discharged into the urethra (urinary canal) where it mixes with discharge from the ejaculatory ducts forming the semen.  The semen volume is in the 2-6 cc range.     It is not uncommon for inflammation and/or infection to spread in a retrograde manner into the vas and epididymis.??en without such spread, prostatic discomfort is?often referred into the testicle.  Too frequent or too infrequent ejaculation, sexual arousal without ejaculation, withdraw at the time of ejaculation, aggressive bike or horse back riding, and excessive spicy foods, alcohol, and caffeine in the diet can predispose you to this.  Sitting for long periods of time, especially in an automotive vehicle, can put undo pressure on the prostate and aggravate the condition.  For the latter, it is best not to sit more than 2-3 hours at a time.  Stop the vehicle periodically, take a short walk and go to the bathroom to urinate.  A thick pad or piece of sponge rubber on your seat will also help to cushion the prostate.  One should avoid any of the above that apply.  Eliminating all of the factors that apply to you are just as important, if not more so, than taking medication!  Ejaculation beyond the tolerance of the prostate to fill and empty may also cause discomfort.  Likewise if one does so infrequently, fluid still builds up from thoughts, dreams, fantasies, etc. and has to be released periodically to decompress the gland and relieve the symptoms.  For most men, ejaculation in moderation, perhaps 1-2 times a week, is reasonable.  A daily warm bath for 10-15 minutes 1-2 times daily also lessens the discomfort.  Attention to sexual activity and warm bathes should be utilized regardless of the type of prostatitis and whether or not medications are prescribed!  
There are several types of prostatitis.  Sometimes prostatitis can be due to an infection of the gland with bacteria.  This usually requires an initial 4 week course of an appropriate antibiotic (the commonest prescribed are the fluoroquinolones, but tetracyclines, sulfas and other agents can also work).  In your case, you apparently had bacterial propstatitis, hence your response to Cipro.  I would suggest retreatment with a 4-6 week course.  Typically, pus cells and bacteria are found in the prostatic fluid.  
Abacterial prostatitis has several varieties.  In one, the prostatic fluid demonstrates pus cells but no bacteria.  In the other, called prostadynia, there are neither pus cells nor bacteria in the fluid, just the symptoms.  In all types of prostatitis, the urinalysis generally is normal unless the infection spreads into the bladder.   Abacterial prostatitis usually responds to the general measures mentioned above.  Medications that sometimes help include the over-the-counter natural supplement saw palmetto 320 mgm daily and alpha-blockers (such as Flomax, Hytrin, Cardur & Uroxatral).  The latter require a prescription from you physician if he thinks it is indicated.  Prostatitis may also be classified as acute (severe), subacute (mild), or asymptomatic.  It may also occur as a single episode, be recurrent or chronic.  Therefore, if symptoms persist, consultation with a urologist should be scheduled.  In cases with recurrent prostatitis or hematuria, it sometimes is necessary to study the urinary tract.  A man should learn to listen to his body.   Good luck!?