Persistent Urinary Symptoms: When Tests Show No Clear Diagnosis

Urination issues but tests show no problems?

Hello Doctor, I am a male.
I have visited two major hospitals, but neither could identify the issue, and I have only experienced slight improvement.
This all started about six months ago after an incident of unprotected intercourse, which led to a burning sensation while urinating and frequent urination.
Due to a lack of time, I waited two weeks before seeing a doctor.
After listening to my symptoms, the doctor suggested it was urethritis and prescribed medication.
Just as I was starting to feel better, I had unprotected intercourse again, not realizing the seriousness of the situation.
After finishing the remaining medication, I thought I would recover on my own and did not seek further medical attention.
Then one morning, I woke up to find a white-yellow discharge from my glans and discomfort while urinating, which prompted me to visit the second hospital.
By the time I saw the second doctor, six months had passed since my first visit.
After hearing my account, the doctor immediately diagnosed me with gonorrhea, administered an injection (antibiotic), and prescribed oral antibiotics for a few days.
However, since it was late, the lab for urine testing was closed, and I was instructed to return the next day for the test.
A week or two later, after finishing the medication, I still felt some discomfort while urinating.
It wasn't very painful, but there was a sensation.
When I returned for the follow-up and reviewed the urine test results, no bacteria were found.
I wondered if the antibiotics had cleared the infection, leading to a negative result.
The doctor mentioned that it could be urethral stricture caused by gonorrhea, so I underwent cystoscopy.
The doctor confirmed there was no stricture, but inflammation was observed along the entire urethra to the bladder.
I was very worried about the possibility of urethral stricture, which made me anxious.
The doctor reassured me that my concerns were unfounded and that there was no significant issue.
He prescribed medications (Kang Su Long, De Shu Tuo, and Yi Yan Yuan) and advised me to drink 3000cc of water, asking me to return for a follow-up in two weeks.
During these two weeks, I sometimes experienced a split stream while urinating, with sensations primarily in the initial part of urination, while at other times, I felt discomfort throughout.
I was hesitant to masturbate.
After taking the medication for a week without improvement, I finally felt somewhat better by the second week, with fewer sensations.
On the day of my follow-up, I underwent a urine flow test and an ultrasound, and the doctor said everything looked fine and that I was healthy.
However, I still felt some discomfort.
The doctor prescribed the last two weeks of medication and advised me to stop after finishing it.
Doctor, do you think this issue is clinically relevant? Should I undergo any further tests? Could this be a consequence of delaying treatment? Should I consult another specialty? Is it possible that I have chronic urethritis? Would you recommend that I seek evaluation at another hospital, or could this be a psychological issue? Thank you for your attention to these points; this has been a significant concern for me for a long time.

leo, 20~29 year old female. Ask Date: 2018/06/01

Dr. Du Shixi reply Urology

Hello, Doctor.
Is this issue clinically common? -- Yes, it is quite common.
I would like to know if I need to undergo any further tests? -- You've done all the necessary tests.
Could it be that the prolonged duration has caused some sequelae? -- No, it hasn't.
Is it due to unsafe sexual practices, or should I consult another specialty? -- It shouldn't be.
Could it be chronic urethritis? -- You need to pay attention to your lifestyle.
If you have an irregular lifestyle for a long time, low immunity, and frequent infections due to unsafe sexual practices, it could develop into a chronic condition.
Should I go to another hospital for further examination? -- If you decide to go, you should visit a medical center.
What the doctor said is about the same.
Could it be psychological factors? -- If you are experiencing issues in other aspects of life (not just urination), it may be psychological.
Additionally, it is essential to practice safe sex.
Wishing you good health.

Reply Date: 2018/06/01

More Info

Persistent urinary symptoms, especially when tests show no clear diagnosis, can be quite frustrating and concerning. Your situation, characterized by a history of urethral irritation and subsequent symptoms despite multiple evaluations, raises several important considerations.

Firstly, it’s essential to understand that urinary symptoms can stem from a variety of causes, including infections, inflammation, anatomical abnormalities, and even psychological factors. In your case, the initial symptoms of burning and frequency following unprotected intercourse suggest a possible urinary tract infection (UTI) or urethritis, which is inflammation of the urethra. The treatment you received with antibiotics was appropriate for these symptoms, but the persistence of your symptoms after treatment indicates that further investigation is warranted.

1. Chronic Urethritis: One possibility is that you may have developed chronic urethritis, which can occur if the initial infection was not completely resolved or if there is ongoing irritation. Symptoms can include discomfort during urination, a feeling of urgency, and even discharge. Chronic inflammation can lead to changes in the urethra that may not be visible during a standard examination.

2. Urethral Stricture: Although your urologist indicated that there was no stricture, it’s worth noting that sometimes strictures can develop after an infection or injury. If there is any doubt, a repeat cystoscopy or imaging studies may be necessary to rule this out definitively.

3. Psychological Factors: Given the duration of your symptoms and the anxiety surrounding them, psychological factors could also play a role. Conditions such as health anxiety or somatic symptom disorder can manifest as persistent physical symptoms without a clear medical cause. If you find that your symptoms are exacerbated by stress or anxiety, it may be beneficial to consult with a mental health professional.

4. Further Testing: Since you have already undergone several tests, including urinalysis, ultrasound, and cystoscopy, you might consider discussing the following with your healthcare provider:
- Urethral Swab: To check for other sexually transmitted infections (STIs) that may not have been initially tested.

- Urodynamic Studies: These tests assess how well your bladder and urethra store and release urine, which can help identify functional issues.

- MRI or CT Scan: If there is suspicion of anatomical abnormalities that may not be visible on ultrasound.

5. Follow-Up Care: It’s crucial to maintain open communication with your healthcare provider. If your symptoms persist despite treatment, don’t hesitate to seek a second opinion or consult a specialist in chronic pelvic pain or a urologist with expertise in complex urinary symptoms.

6. Lifestyle Modifications: In the meantime, consider lifestyle changes that may alleviate symptoms, such as increasing fluid intake, avoiding irritants (like caffeine and alcohol), and practicing pelvic floor exercises.

In conclusion, while your tests have not revealed a clear diagnosis, the persistence of your symptoms warrants further investigation and possibly a multidisciplinary approach. It’s important to advocate for your health and ensure that all potential causes are thoroughly explored. If psychological factors are suspected, addressing these can also be an essential part of your treatment plan.

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