Bladder or Urethral Cancer?

[chloe364]

I am obese (280lbs), 6'4'', male, 36;

VERY WORRIED!

I am losing it.

Dec 2005 Micro Hemat at GP. urologist wRkup.  No symps.
Jan 2006, CT Scn Low AbS w contrst, Clear, digital exm, clr, given antbtcs w/out effect. (Dx w/ Non Bact Prostatits)
June 06, Micr Hemat
Aug 2006, Micro Hem, Urine Cytology, Clear, digital, clear
Sept 2006, Micro Hem, 2nd Opinion said do Cysto
BEFORE CYSTO HAD SLIGHT URINARY SYMPTs, JUST START/STOP TYPE
Oct 2006, BLADDR CYSTOSCOPY, Dx Urethral Stricture 2cm very small, bladder clear
Dec 2006, Micro Hem , digital/clear
June 07, Micro Hem, digital/clear
Aug 07, had sympts after long trip (dribbling, slow pee, intermitent, pain, etc):, Perinium Pain, 'uretherl crawling sensation' like urine creeping up penis but no urine there,  penis tip pain, penis tip sensations, frequent urination, dribbling urine, urge w/out urine.
Sept 07, Micro Hem, no blood cells, digital/clear.  Dx w/ Prostatitis, given CIPRO.  No effect.
Feb 08,  Micro Hem present, same sympts as aug 07 but worse.
Digital/Clear, said I have a prostate of a 20 year old.
April 08, little Micro Hem Present.  Symptoms are HORRIBLE (SEVERE DRIBBLING, low stream, stopping starting peeing, feeling of urine retention. SENSATIONS, PAIN, INCONTINENCE, PEE 15 TIMES PER DAY, ETC.)

MAY 08, little micro hemtr, CIPRO and Uroxolox sp? (to open urethra) NO EFFECT!!!

I read Uretheral Cancer b/c so rare is sometimes misdXED as a stricture (like MINE) until too late.  Urologst wants me back in year. THINKS 0 CHANCE OF URETHRL CANCER OR BLADDER CANCER…. THINKS I HAVE NON BACT PROSTATITIS.

i aM CONCERNED ABOUT URETHRAL CANCER or BLADDER CANCER.

?S

1. How often you seen urethral cancer in UNDER 40?
2. your gut feeling To the cause of these symptoms? (recurrent stricture, urethrl cancer, bladder cancer, prostatitis, etc.)
3. What is a differentiating symptom of urethral cancer from a plain stricture
4. MY next step be in this situation?

Please hlp!  do

[chloe364]

hi Dr.

I have been to the urologist 4 times in the last 6 weeks and he is convinced I don't have the cancer which is why I was reaching out to you.

Thank you for your help, and unfortunately, I guess the next step is a cysto.  I was hoping the first one would be enough as the micro hematuria started 11 mos before it in 2006.

Have a nice holiday,

DO

[Stephen Liroff, MD]

Hi!,
Your lack of smoking certainly lowers your risk status for a bladder Ca and you are not likely to have a urethral cancer. The cloudy urine is not a significant finding.
I cannot eliminate your anxiety and tell you everything will be fine. I wish that I could. You are doing good things for yourself in researching your symptoms and asking questions. Now you need to proceed to the next step and get yourself evaluated. See a urologist and allow that person to take care of you.
S.A.Liroff, M.D.

"This information is provided for general medical educational purposes only. It
does not  necessarily reflect the opinions of Henry Ford  Hospital  or the
Vattikuti Urologic Institute.  Please consult your physician for diagnostic
and treatment options pertaining to your specific medical  condition.”

[chloe364]

also my urine has recently turned cloudy, does that make a difference?

[chloe364]

Thank you for your help.  I am still worried, but thank you.

I will just pray it isn't serious, b/c it seems Urethral Cancer is a death sentence.

I am a NON smoker by the way.

[Stephen Liroff, MD]

Certainly you are concerned. Lots of disturbing symptoms that have different significance depending on your age and it's been two years since you  really had a urologic evaluation (if I read your timeline correctly). First, let's start with the hematuria. There are many people with blood in their urine for a lifetime, so this could be a "red herring." (By the way, always give a urine sample from the middle portion of your urinating..a "clean catch" or "mid-stream" sample to make sure that it is most representative of your urine, not just the portion that washed out your urethra.)
The rectal exam is unlikely to tell much about what is happening, but is certainly a necessary part of a urologic exam.
A repeat look into your bladder, a CT urogram (x-ray) and a urine sample looking for cancer cells (urine cytology or, more modern and undoubtedly more expensive, a FISH test of your urine sample) are where the answers lie for the more serious issues. Your stricture may have returned (they often do if just cut or stretched), Bladder and urethral cancers (urethral being the least likely) are possibles and can be identified at cystoscopy. Uretthral cancers have symptoms similar to strictures and can be diagnosed with a urethral biopsy at the time of cystoscopy if your urologist is suspicious. Urethral Ca and bladder Ca are not very common in 36 year olds, but if you are a smoker your risks are seriously increased.
Overall, my gut feeling is that you have perineal muscle myalgia  ("non bacterial prostatitis ") or a recurrent urethral strictue.and once the other diagnoses have been ruled out, will need to take medicine to relieve the symptoms or have your urethra repaired.
So, your next step is to see a urologist and get a work-up. Then have this individual direct your care.
S.A.Liroff, M.D.


"This information is provided for general medical educational purposes only. It
does not  necessarily reflect the opinions of Henry Ford  Hospital  or the
Vattikuti Urologic Institute.  Please consult your physician for diagnostic
and treatment options pertaining to your specific medical  condition.”