Dear Doctor

Please find below an overview and sequence of events that may give you further insight into my problem and request your views on the same :

From childhood, Imy flow has always been slower than the rest. but i had no medical issues on that score, except for occasional pain on left testicle in my thirties, that was checked and nothing was found irregular. otherwise things were normal.

A. CYSTOSCOPY ( FIRST TIME ) -2009 :

The first time I noticed that my flow was very bad was in 2009 when I approached a urologist.

The uroflowmetry report was very bad (almost a trickle) . He then chose to do a cystoscopy.

The result showed that while there was no evident blockage, it stated “sphincter spasm? " – this report not shown to you.

He then suspected probable prostatis and put me on alfuzosin and gaiety 500 (antibiotic ), which went on for almost a year .

MY flow returned to my normal limits .

After a while, on one of my checks, he decided that prostatis was not evident any longer and asked me to stop gaiety 500.

B. CYSTOSCOPY ( SECOND TIME – 2011 )

Subsequently, I stopped using ALFUZOSIN once and for all.

Things were normal for a while, but again in 2011 I had another attack, and went to meet him again.

this time, he did another round of cystoscopy , where the report stated that

"? valve like projection starting from distal end of veru on both sides and meeting at 12 0 clock position . Incision done at 5 and 8 o clock position using BUG BEE electrode . Mild terbeculation present . 16 fr.2 way foleys inserted." –this report shown to you.

I wonder why this was not noticed during the first cystoscopy.

However, The uroflowmetry report was better than before, but the doctor was not happy with the flow as it was under normal expectation.(around 7 to 8).

However, after this treatment , I was feeling fine with no disturbances by and large. my stream was also consistent and with no residual feeling.

The flow may have been slow ( compared to normal readings of others ) but it was always continuous, uninterrupted, and there was no hesitation, burning or any residual feeling to suggest that there was any problem.

In between , sometime in June 2013, I had an occasion of burning sensation and reduced flow, that was treated with EPIMAC powder for alkanisation of urine and I quickly returned to normal.

Since then , I have been very comfortable and have had no problems.

PVR was always under 30 cc as an average.

I have also taken up a new assignment and working long hours, but had no problems of any sort.

Recently, on 24th feb 2014, I had an attack of stomach pain and my local doctor GP recommended an ultra sound, where among others, the report stated

“ BLADDER : shows muscular hyper trophy of internal urethral sphincter , Pvr : ist void 42cc and 2nd void 32 cc. – this report shown to you with the images.

Coincidentally , I started having severe burning sensations and reduced flow immediately the next day after this test. i am not aware if this is due to the observation of muscular hyper trophy, but i doubt it because the last cystoscopy was done almost three years ago and there was no problem till now.

however , I started taking citralka syrup and the sensation has subsided to a large extent. The flow has also improved since, but I have a general feeling that all is not as it used to be.

I met a local urologist who saw my reports and commented that a URODYNAMIC test be done immediately to confirm the following:

1. Location of the block and incision at the urethra sphincter

He explained that by cystoscopy , an incision would be done at 6 ‘o’ clock position , thereby opening up the urethra once and for all. The side effect would be retrograde ejaculation, thereby causing no release of sperm for the rest of my life, but other wise things would be normal.

My point is that when we never did find any obstruction in the first place, why would this warrant another incision ?

Is this the only way out ? is there no other approach ?

2. 2. Current observation of the muscular hypertrophy : he said it need not be the reason but would be addressed at the time of cystoscopy.

3. Bladder function

If the bladder was found to be dysfunctional then there was no cure, and that I may have using external catheters and so on.

This is really alarming.


I would like to have your guidance on the way forward.

Personally, I am very worried about the bladder function and the after effects and request your reassurance on this, especially since I do feel that a poor bladder would have had many more side effects and matters would be much worse by now. I personally don’t think this is the reason.

My kidney functions are normal as per abdomen reports .

This is causing me a lot of anxiety, especially since I had no problem for the last two and half years , till only a few days back.

I would like your specific comment on this matter and also your intuition, now that I have explained the case to you in as detailed manner as possible .

Meanwhile, I will be immensely obliged if you could please guide me and let me know what precautions to take and how immediately should I take action. I want to be free from such anxiety that the local urologist has put me through and therefore seek proper counsel from you.

At this juncture, I am keen to find a lasting solution to the problem .

Basically , I am 47, diabetic since approximately last 5 years , medication is janumet twice daily.

Mildly hyper tensive with one dose of telma10 daily. ( 80 – 130 )

Otherwise, quite healthy and active.


Looking forward to your early response and hope to meet with you soon,

Thanks and best regards,



To


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Best Regards,