Sorry for your troubles. Sounds like it could be BPH and, yes, it could
develop anytime. Mine began around 48 years old (ten years ago.) But, it
could also be some other malady including kidney stones. I assume that the
tests you've had could or should rule out some other causes.

If it's not BPH than you should definitely find out what it is. Also, don't
expect good, complete, direct communication from your doctors. I don't find
that this is a reasonable expectation. Get all of the information you can
for yourself so that, at least, you'll know your options.

Also, it would appear that you should learn to self-catheterize. In that way
you'll at least be able to get the urine out and spare yourself some major
discomfort. It's not bad once you get the hang of it. What, at first, feels
like pain is very soon recognized as merely an intense, sharp, sensation -
not really pain at all.

Hope this helps.
Kevin

No you are not being unreasonable in seeking a second opinion. I
developed bph in my mid to late forties. Due to my age this went
undiagnosed as the physician discounted bph. It was only diagnosed
when I went into acute urinary retention and was referred to a uro.
Yes you are probably young for bph but that does not mean that you
don't have it. You must speak frankly with the new uro and make sure
that he/she answers your questions.

I never had what you described as "flank pain". Are you referring to
an area around the kidney? I would be thinking of some sort of urinary
tract infection which is why they gave you Cipro.

With all the workups that you have had I think that you would have
been diagnosed. Maybe the first uro was not very talkative; make sure
the 2nd is!

Jerry:

Run, don't walk to the second urologist.  You have been ill served by
the first one.  I hope you get some relief quickly.  Keep us posted.

Terry

I read the other postings to that responded to yours and there is a lot of
good advice.

Is this BPH?   Could be.   Can you develop BPH at 42?   Could...depending on
your DHT levels.  However, I'd bet you have Prostatitis rather than what we
affecionately call BPH.   Though the symptoms are eerily similar.

If you don't have Prostatitis, Diabetes, or cancer and your DHT is too high,
you need to find out why.   That would be unusual for a person of 42.   So,
you wanna get onto whatever other gland that is crapping out and see if you
can do something about that as early as possible.   This will require that
you to go to an endocrinologist after your blood work from your Uro reveals
DHT is way above the upper levels. (I'm not a doctor...so this is a
non-medical opinion.)

Diabetes, and Prostatitis,can contribute to the sensations that are like
BPH.  Typically, though, BPH is more about size of the Prostate due to DHT
sensitivity, or too much DHT.  It's the DHT that causes the Prostate to
grow, or so the theory goes...It's the enlarged prostate due to
non-cancerous reasons, that is encompassed by the term, BPH.   Prostatitis
(infection) can contribute to symptoms that feel LIKE BPH.

Do you have BPH?   BPH typically refers to an enlarged Prostate.   30 grams
is about normal.   What size is your prostate?   What did your urologist
tell you?   BPH can occur when Prostate grows above 30 grams but usually not
until close to double in size when one really starts the struggle--serious
difficulty urinating, etc. If yours is even bigger than that you MIGHT get
blockage.   If left too long, you could be in very serious trouble and
typical "roto-rooter" operations may not suffice.    Get it looked at again
by a competent urologist if you don't know the answers to these kinds of
questions.

To begin the diagnosis for BPH:
You would have had blood work for diabetes, DHT, and PSA.   Your Urologist
would have massaged your prostate to examine the fluid under a microscope to
rule out high white blood cell count.   If high white blood cells, then it
indicates a possible infection of the prostate.   If infection of prostate,
(called Prostatitis),  then MANY MONTHS course of anti-biotics such as
Tequin or Doxcycycline or both, and your sex partner would have been
prescribed about a 6 week course of same anti-biotics...in my non-medical
opinion.

Ruling out infection, cancer and diabetes...then the urologist would look at
your DHT blood results.   If within normal range, may have prescribed
5-Alpha Reductase (DHT) inhibitors such as Avodart or Proscar, while putting
you on an Alpha Blocker (urinary tract and prostate relaxers) such as
Flomax, Uroxatrol, Hytrin, or Cardura to help you pee until the DHT
inhibitors kick in.  DHT inhibitors can take from 2 months to 14 months to
kick in before you notice any beginnings of relief.   In some men they don't
work at all.  In others, they do work but there are undesirable side
effects.

If DHT is well above the upper limit then he/she would refer you to a
competent endocrinolgist to find the gland that is causing that abnormally
high DHT.  The endocrinologist would have you do blood work ups and that
would require about 6 to 8 more vials of blood and rpeating the DHT tests.
Likely after all that, the endo will be able to tell you what gland is
crapping out, and whether or not it is treatable.  If treatable, you'll
enjoy meds for that particular gland, and that in turn will help to reduce
DHTs, which ought to help maintain your prostate in good shape.

If it is too late for any of the above, then your uro will send you for a
"roto-rooter", (TURP) or equivalent, such as PVP, TUMT, etc. Some men only
need one such operation.

The clots likely resulted from the invasive procedure, but should have only
lasted a couple of days while progressively getting better.  Since they are
scraping a very sensitive channel it is typical to have bleeding and some
blood flowing into the bladder to clot, etc.

I think your invasive procedure caused an infection that leads to fever and
flank pain.  Not surprising.  Infections are common with any invasive
procedure, especially as the sterile fields are compromised as the day wears
on in a hospital--ped traffic, touching/moving of instruments, and doctors
who notoriously shave time off scrubbing or other sterilization procedures.
Cipro should have been administered IMMEDIATELY upon completion of the
invasive procedure and at least one more about 12 hours later...in my
non-medical opinion...to prevent an infection from taking hold in the first
place.

Wishing you good health...

"Jerry" <jcampbell73134@yahoo.com> wrote >I am a 42 year old that has had
frequent urination and urgency for the

According to the BMJ,  BPH can start in your 30's:
Derek.
Symptoms of benign prostatic hypertrophy can begin as early as the third
decade of life. They increase with age, until about a fifth of men aged
40-64 and two fifths of men aged 65-79 have urinary symptoms or a urinary
flow rate below 15 ml/sec.5 As many as half of men aged 60 have histological
hypertrophy, rising to 88% in men aged 80.1 The degree of discomfort and
inconvenience from these symptoms may be measured by a formal symptom
scoring scale such as that developed by the American Urological
Association.6 The total score represents the overall severity of symptoms
(0-7 mild; 8-19 moderate; 20-35 severe), and the scale has been shown to be
a useful means of quantifying symptoms and measuring changes over time.7

Selective 1 adrenoceptor antagonists (such as indoramin, prazosin,
terazosin, alfuzosin, tamsulosin, and doxazosin) work by relaxing smooth
muscle in the bladder neck and prostate. Although titration of the dose is
necessary, most patients respond to treatment within weeks.8 Side effects
include orthostatic hypertension, tiredness, dizziness, and headache.8 9 A
randomised trial showed a 32-44% improvement in symptoms in patients treated
with terazosin compared with a 23% improvement in the control group. There
is no evidence that  blockers reduce complication rates or the eventual need
for surgery.

5 Reductase inhibitors such as finasteride block the conversion of
testosterone to dihydrotestosterone -the form of testosterone found in the
prostate gland, which is thought to be responsible for the development of
benign prostatic hypertrophy. The drug, taken orally, reduces the size of
the prostate and leads to an increase in peak urinary flow rate and a
reduction in symptoms.10 11 The improvement in symptoms takes place over six
months. Side effects include decreased libido, problems with ejaculation,
and impotence. There has also been some concern about treatment with
finasteride leading to a halving of prostate specific antigen levels, which
could possibly mask early prostate cancer.12 There is no evidence that 5
reductase inhibitors reduce complication rates or the need for surgery.

Since 5 reductase inhibitors and  blockers work by different mechanisms it
has not been possible to assess their relative efficacy or their potential
to work synergistically. However, a recently published study compared
finasteride, terazosin, and a placebo against each other and in
combination.4 The study screened 1686 men aged 45-80 for benign prostatic
hypertrophy and recruited 1229 who fulfilled the criteria, which included an
American Urological Association score of at least 8 and a peak urinary flow
rate of no more than 15 ml/sec and no less than 4 ml/sec. After a four week
run in period with placebo, patients were randomised by telephone to four
groups with a mean age of 65, 80% of white race, a mean score of 16, a peak
urinary flow rate of 10.5 ml/sec, and a mean prostatic volume of 36 cm3. At
one year, the placebo, finasteride, terazosin, and combination groups showed
mean decreases in symptom score of 2.6, 3.2, 6.1, and 6.2 respectively; mean
increases in peak urinary flow rates of 1.4, 1.6, 2.7, and 3.2 ml/sec
respectively; and changes in prostatic volume of an increase of 0.5 cm3, a
decrease of 6.1 cm3, an increase of 0.5 cm3, and a decrease of 7.0 cm3
respectively.

These results show that, in this group of men with moderate prostatic
symptoms, terazosin was significantly better than both finasteride and
placebo at relieving symptoms. Despite finasteride causing the prostate to
shrink, the increase in peak urinary flow with this drug was only just
better than with placebo and much less than with terazosin.

Blockers remain the drug of first choice for the medical management of
benign prostatic hypertrophy, whereas 5 reductase inhibitors do not seem to
be as effective at relieving symptoms, although there may be a benefit when
there is substantial prostatic enlargement.13 For patients who have not
developed complications (such as hydronephrosis, recurrent urinary tract
infection, and chronic urinary retention), there is still a choice between
drug or surgical treatment. The uncertainty about the long term outcomes of
drug treatment and the effectiveness of surgery in providing rapid relief of
symptoms offers the opportunity for involving patients in decisions about
their management.14

It could be more than 1 problem (including BPH) but "severe flank pain, high
fever, blood and clots in urine" could very well be kidney stone induced.  I
have had 4 episodes of K/S 10 to 15 years ago. It was a bitch ! You might
try Cranberry Juice - the real stuff without sugar and usually found in
health stores. It has been known to help defeat the bacteria that causes
urinary tract infections. Also look at your diet and consume lots of water.
Reduce or eliminate coffee, alcohol and stress...

Sorry to read about your problems. I think you received from the
group a lot of interesting stuff including some really good advice.
I have a similar problem although I am older than you are. My
prostate is a bit enlarged, the left lobe, that is.

I have had a lot of small problems over the years that recently
culminated in continuous although not unbearable pelvic pain. I
had problems with urination for some years now. I got into a
"Urology Wellness Clinic" that has a few people specializing
in treating prostate problems. It was established I suffer from
prostatitis caused by an inflammation and possibly infection of
the prostate.

After some testing etc I was bombarded with a cocktail of antibiotics
for about a month and a few prostate massages. My condition did not
change much but I acquired a lot of new problems that I attribute to
the massages and in particular a drug called Levaquine. The massages
were given not only to acquire the sample of prostatic liquid for testing
but also with the intention of draining out "the bad stuff".

I had a cystoscopy that I could follow on a monitor and there were
blood clots no doubt caused by the procedure itself. Had some
problems afterwards but they subsided in a couple of days.

The side pain I had in the past and it was definitely related to kidney
stones.

Recently they abandoned the massages and heavy drug treatment which
to me meant they admitted they were barking up the wrong tree without
actually saying so.

Now I am taking pure cranberry juice, yogurt with wild bluberries, uva ursi
tea (two weeks on, two weeks off), and two herbal remedies: Prosta Ease and
Prostaphil-2. I also take sitz baths in my bath tub. I feel much better but
not
completely okay.

Make sure you find out if you are, like many others including yours truly,
sensitive to fluroquinole drugs such as Levaquin, Pequin, Cipro etc. If you
are and you still take them you will wish you never even heard of them. I
actually rebelled and refused to take them after noticing all kinds of side
effects. Now they apparently agree with me i.e. I am sensitive to those
drugs
and should not be taking them.

Good Luck!!

As a follow up to my original posting.  I met with a new Urologist and
he thinks this might be prostatitis that was brought on by the
original biopsy.  He prescribed 6 weeks of bactrim which I have
started and have taken now for 5 days.  No improvement yet.  I drove
five hours for business today and had a lot of difficulty getting a
stream started after waiting till the next rest stop.  My wife
suggested I carry a portable urinal.  :-(  Thanks to everyone for all
the advice.  Hopefully the bactrim will help.