Could I have intraurethral warts?
I am a 45 year old male, 5 11 in height and weight 285 pounds. Experienced gross hematuria/fever/UTI in May. Symptoms resolved 7 day course of cipro. CT/US normal including prostate. UTI/fever/micro hematuria recurred 10 days later. Resolved 5 days. Urologist asked for post void US. Initial readings 840 ml pre-/70 ml post void. Report false positive. Second 330 ml pre-/38 ml post. Urologist put me on flomax said bladder not empyting. Urine tests normal for 2.5 months now. Get irritation in bladder every now again. Recently went for groin US in connection with hpv related scrotal SCC cancer and anal warts (treated fully 2 yrs ago) follow up. Radiologist insisted on doing post void US: pre- 300ml/post- 60 ml. Urologist says stricture need urtherogram/cytoscopy. Second urologist sent me to highly reputable radiologist. Did US pre- 600 ml/post- 13ml. But says prostate 44 cc mild enlargement. Confused: do nothing or get invasive diagnostics done? Concern: could I have intrauretheral warts?
A complex of urinary tract symptoms such as this warrants an extensive work up by your urologist. Given your history of HPV related cancer and warts, it is possible that this is contributing to your urinary issues. Intraurethral warts are not as common as a narrowing or stricture of the urethra from infection, or from urethral cancer which can also be related to HPV. A cystoscopy and urethrogram are appropriate tests to perform given your symptoms and history. Your history of urinary tract infection and hematuria are also concerning if your urethra and bladder have not been fully evaluated by cystoscopy and appropriate imaging (contrast studies in addition to ultrasound). There may be a process originating in your bladder leading to your symptoms. Your urologist will be able to assess your bladder during the cystoscopy. There are many other causes that may be effecting your urination and periodic incomplete emptying. Flomax works to relax the smooth muscles of the bladder neck and prostate. Your bladder may not be contracting properly and this keeps your bladder full at times. This can be further evaluated by your urologist. A prostate can obstruct urinary flow no matter the overall size of the gland. There are additional therapies for an obstructing prostate that your urologist can discuss with you. This is a very complex situation given your prior histories and recent infections. A cystoscopy is an appropriate test for further evaluation. You should discuss these possibilities with your urologist.
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