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Suggestions for better treatment

User
Posted 03 Aug 2023 at 12:00

Constant UIT's and now a lengthy period of prostatitis. Have prostate cancer Stage 1 Gleason 3+3 with a long history of urinary incontinence, renal calculi requiring surgery. Unable to tolerate medication for incontinence and have had intravesical botox in 2015 and 2019. No overall effect.


Ciprofloxacin 500 mg bd for 4/52 has not helped with prostatitis long-term and has so many side-effects.


Any suggestions for more effective treatement?

User
Posted 03 Aug 2023 at 13:08

You need to find a urologist who really specialises in prostatitis to get treatment which works. Many have it on their list of activities, but few really specialise in it. Has it been confirmed it's bacterial prostatitis, and has the bacteria been cultured to identify which antibiotic it's sensitive to? Ciprofloxacin is one of relatively few antibiotics that can work in the prostate, but you do need to know the bacteria is sensitive to it, and not resistant to it. As you hint at, you don't want to take it without knowing it's the right antibiotic as it has potential side effects.


You haven't said what is causing the incontinence, so difficult to comment on that. The use of Botox might suggest you had urgency (unstable bladder).


Repeated UTIs in men are often caused by incomplete voiding when you have a pee (significant urine still in the bladder afterwards which ensures bacteria are continuously retained), or not drinking enough fluids, so there's too little flow through the bladder to be flushing out the small amounts of bacteria which get in there anyway, and they build up. Kidney stones can also be caused by not drinking enough fluids.


If you have several prostate problems including cancer (I'm guessing maybe enlarged prostate in addition to what you've said), that can be a reason to consider having a prostatectomy, even if the cancer itself maybe doesn't merit that alone.


You really need a urologist who's going to take this all on and treat the patient, rather than the issues piecemeal.

User
Posted 05 Aug 2023 at 12:27

Thanks for your detailed reply. Sorry for the delay.


1. There has been no testing to see if the prostatitis is bacterial. Recent UTI's have been reported on via MSU to hospital lab. Appropriate anti-biotic therapy used at the time.


2. I requested a prostatectomy .in 2019. Went before the MDT panel 3x and refused on the basis that my incontinence issues were so significant that to remove the prostate would in the words of the MDT panel "catastrophic effect on the urinary incontinence of patient".


3. Recent PSA back to 6.4 having risen during the past four months to 7.8, 8.2, 10.1,7.8. New urologist indicated last week that it is, in his opinion, clear that the issue is one of infection rather than growth of tumour which is currently encapsulated within the prostate  (classing it as  Stage 1 - Gleeson 3+3).


4. Given the incontinence I have had in-dwelling catheter in past - causing real problems. I have self catheterised but this still doesn't empty the bladder sufficiently not to have to PU anything up to 10x during a 'bad night'. Urology team told me I mustn't be self-catheterising properly!!! I told them I "do not suffer fools" after being an in- and out-patient for over 15 years!


5. Due, yet again, a flexible cystoscopy on 1 September and Urodynamic study 4 September - for the fourth time!


6. I am wondering with TURP surgery would be the way forward or whether it is not appropriate.


 

User
Posted 05 Aug 2023 at 15:32

I suffered from prostatitis  for many years before I had prostatectomy and after my surgery all my symptoms, particularly the pain, disappeared. This was one of the reasons I chose prostatectomy even though my consultant would not say that the surgery will help me to be free from urinary problems. I am not suggesting that you should have surgery. You have to make a choice on the basis of the state of your prostate and advice you get. Good luck.

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate


 


 

User
Posted 05 Aug 2023 at 17:28

Thanks!  However, Urologists have said in the past that a radical prostatectomy was not an option. Following results from my forthcoming cystoscopy and urodynamics he has hinted at possible surgery (??) or ti repeat botox - has been unsuccessful in the past though created problems.

 
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