Voiding Pain

[macsmaker]

(I apologize. I'm not an SCI patient. I've posted this other places and no-one seems to have any answers, so I thought I would try here.)

Without going into too much detail, I had a TURP done about 18 months to remove some infected tissue. It left with three new problems:

a. UI: This was fixed with botox injections. Also have some SI, but it's minor enough to live with, at least right now.
b. If I empty completely I get a spasm-like pain that is all of 9-10 on a 10 pt. scale. Fortunately it is short-lived (15 seconds to a minute) and I can control it by not emptying. I don't know exactly where this pain is, but I know it's somewhere in my bladder or prostate. I feel it more in my lower belly than in my perineum.
c. Too explicit to talk about here, but it's also a pain issue.

My original urologist tried me on just about all OAB medications: Detrol, Ditropan, Enablex, etc. My current urologist had me try Flomax, even though I don't have a flow problem. It made no difference. As I said, the Botox fixed my UI, but has done nothing for this pain. (It was injected only into the front wall of my bladder.)
I have developed a theory, but I'm having trouble getting her (my urologist) to really listen. As part of the TURP, I know at least some of my bladder neck was removed. I'm wondering if, when I empty, my bladder neck gets the signal to close, but some afferent nerve endings were removed and are not present to tell my micturition center that it has closed, so my bladder neck continues to squeeze, causing the painful spasms. (I'm wondering if this is also causing problem "3.") Is this even possible? Anyone have ideas for places I could look to gather info for her?
Thanks in advance.

[Lee555]

Although not really knowing what the TURP is, your explanation gives me the idea you had some extensive surgery in the nether regions regarding the plumbing. I've read a lot of stuff on when nerves behave badly regarding my own, and after reading your theory, sounds absolutely plausible to me. Your urologist is not a neurologist unfortunately, unless they have had specific training as a neuro-urologist ( I think there are such doctors out there), so getting to see one of those guys might be better. The other thing you might suggest to her is to do an ultrasound while you empty so as to observe via ultrasound the spasmodic condition of the bladder neck. A good technician should be able to do this, and hopefully they would only have to do it once. You might do a search for a neuro-U doctor in your area, or better yet, go to Mayo clinic. You really don't need your present doctor scratching her head while she contemplates this. She's not the one in pain, you are, and if she tries to discard your idea, tell her you want to go to Mayo. In the meantime, you might take a look at something like Tizanidine or baclofen to deal with the spasms and a nerve pain medicine like neurontin or lyrica. Sometimes a specialist like your doc has a problem with seeing the forest when they're focused on a single tree.