Prostate Surgery

Q:  I am a diabetic (insulin dependent) who takes 40 units every morning and 18 units in the evening. After my prostate was operated on through the urethra, I have had problems urinating. It hurts especially when I start and the stream is small.

Also my testicles are very painful. I have a throbbing pain that can be felt on either side of my abdomen all the way to the kidneys. My urologist and family physician don't know what my problem is. Perhaps you can help me. Thank you in advance.

A:  You did not mention your age or the reason you had prostate surgery, but I am assuming that it was for benign (not cancerous) enlargement. Men usually become aware of prostate enlargement by difficulty in initiating or maintaining a full urinary strain. How frustrating it must be to end up with the same problem after the operation! You had what is called a TURP, short for transurethral resection of the prostate, in which the prostate is operated on through the urethral opening in the penis.

Chanderbhan Choithani, MD, Assistant Professor of Urology at the Medical College of Wisconsin, informed me that narrowing or stricture of the bladder opening occurs in about 8-10% of TURPs (trans-urethral resection of the prostate). Retention of urine may cause infection that can backtrack into the testicles. The ensuing infection and inflammation of the testicles could cause the pain that you are describing. You should see a urologist soon to investigate this as the cause. Because you are a diabetic, you are also more prone to infections.

Another possibility is that the source of your pain is in your abdomen, and because of nerve connections in the body, you are also feeling pain down in the scrotal area. Diabetics who have difficulty controlling their blood sugars may be more prone to pain in various nerves.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.