Post-micturition Dribble Research Articles

Post-prostatectomy Incontinence

Summary This case study of a patient suffering from post-prostatectomy incontinence from initial assessment to discharge reflects on the methodology used and explains, challenges and critically analyses each decision. The patient suffered from post-micturition dribble, severe stress incontinence on moving, and enuresis. Treatment consisted of graduated pelvic floor exercises concentrating on the external urethral sphincter. Continence was achieved in six weeks. Examination, assessment and treatment choice were based on relevant research. Much further work needs to be done to evaluate varying methods of assessment and treatment for patients with post-prostatectomy incontinence. The effectiveness of pre-operative pelvic floor exercises concentrating on the external urethral sphincter also needs evaluation.

ABC of Urology: UROLOGICAL MALIGNANCY--1: PROSTATE CANCER

The symptoms and signs of prostate cancer are initially closely similar to those of benign prostatic hyperplasia—obstruction of the urethra by the malignant gland may lead to hesitancy, poor urinary flow, intermittent flow, post-micturition dribbling, and incomplete emptying. Secondary bladder instability may ensue and give rise to urinary frequency, nocturia, and urgency. #### Haemospermia The patient may also present with haematuria, typically reporting that the blood appears at the beginning of an otherwise clear urinary stream. Although this suggests a cause localised to the lower urinary tract, all such patients should be investigated and managed along the lines described for patients with haematuria (see next article in the series). #### Onset Investigations begin in the same way as for patients with benign prostatic hyperplasia—a full history of the main symptoms, followed by a thorough clinical examination and digital rectal examination. There are few clinical signs in early prostate cancer, but digital rectal examination will often detect an early lesion. In prostate cancer either the normal smooth surface of the prostate may be replaced by a hard nodule or the gland itself may be enlarged, hard, and “craggy” to the touch. The normal midline sulcus may be lost. The serum prostate specific antigen level should be established. Normal ranges depend on the assay used. Normal ranges for prostate specific antigen

Voiding Pattern of Men 60 to 70 Years Old: Population Study in an Urban Population

A total of 1,065 men 60 to 70 years old completed a questionnaire regarding the voiding pattern. At the time of the questionnaire 81 men had already undergone an operation for prostatic hypertrophy (postoperatively queried, group 1) and 29 subsequently underwent an operation (preoperatively queried, group 2). The remaining 955 men were not referred for an operation before March 1987 (healthy, group 3).Approximately a third of the healthy men accepted the symptoms of frequency, post-micturition dribbling and weak stream as not requiring special medical attention, while group 1 men had the same symptom frequency as the untreated men and the symptom frequency was considerably higher in group 2. Post-micturition dribbling was not a specific characteristic of prostatism.

Association between Symptomatology and Uroflowmetry in Benign Prostatic Hypertrophy

The symptoms of 128 consecutive patients (mean age 65 years) with benign prostatic hypertrophy were assessed and compared with flowmetry recordings. The 84 patients (65%) with peak flow rates greater than or equal to 2 standard deviations from the mean were considered to have abnormal flowmetry and their symptoms were compared with those of the 44 men with normal peak flows. No significant correlation between peak flow rate and age was found within this group. Symptoms of poor stream, nocturia, post-micturition dribble and nocturnal or full-bladder hesitancy were present in over two-thirds of the whole series. Poor stream, hesitancy and nocturnal or full-bladder hesitancy were found to have significant associations with abnormal flowmetry recordings but also to have a high incidence within the normal flowmetry group. Discriminant analysis was unable to define a symptom complex which would accurately predict those within our group with abnormal peak flows. It was concluded that symptomatology and flowmetry evidence of lower urinary tract obstruction are not associated and subjective and objective evidence must be considered independently in selecting candidates for prostatectomy.

Indications for investigation of post-micturition dribble in young adults.

The endoscopic and urodynamic findings in eight male patients in whom post-micturition urinary dribble (PMD) was either the sole or predominant urinary symptom have been reviewed. In three patients whose only symptom was PMD, both endoscopic and videocystometric examinations were normal. In the remaining five patients with additional urinary symptoms, a functional or anatomical abnormality of the lower urinary tract was found in every patient. We conclude that in the assessment of patients with PMD, endoscopic and/or urodynamic investigation is of value only in those patients with multiple urinary symptoms.

Electromyographic study of bulbocavernosus muscle in 15 patients with postmicturition dribbling

Fifteen patients with postmicturition dribbling were studied with cystourethroscopy and electromyography of the bulbocavernosus muscle. In all patients the bulbocavernosus reflex and activity of the muscle during and after micturition were normal. No abnormality was found to explain the clinical symptoms.

The Significance of the Symptoms Associated with Bladder Outflow Obstruction

The symptomatology and urodynamic findings of 318 male patients (45–84 years) with suspected bladder outflow obstruction have been analysed. Inflow cystometry showed that 57% of patients had unstable bladders and a pressure flow analysis of micturition that 67% had obstructed micturition. The symptoms of urgency, urge incontinence and frequency were associated with bladder instability and not with obstruction. The symptoms of hesitancy and slow stream were significantly related to obstruction. Post-micturition dribble and nocturia were related to neither urodynamic finding in this series.

UroDynamic study of 15 patients with postmicturition dribble

Fifteen patients presenting with postmicturition dribbling as their only symptom were studied in the urodynamic laboratory. Seven of these patients had no urodynamic abnormality but left a significant bulbar residue after micturition. Five patients had normal detrusor function but failed to milk back contrast from the prostatic urethra during voluntary interruption of the stream. Two of these also had a small amount of bulbar residue. The remaining three had unstable detrusor function. One had classic bladder neck obstruction. One had a bulbar residue and the other failed to milk back properly. Despite the various mechanisms for postmicturition dribble, the management is the same in all cases. The patient is instructed to press the bulbar urethra manually in the perineum after micturition and evacuate the residue, and symptomatic relief is almost always obtained. Urodynamic studies in these patients are not justified unless this maneuver fails to alleviate the symptoms.

Recognition and repair of urethral diverticula: A report of 60 cases

1.1. Sixty cases of urethral diverticulum in the female diagnosed and operated upon between July 1956, and January 1964, are presented.2.2. The most important diagnostic symptom was postmicturition dribbling. A urethrogram employing the Davis catheter was the best confirmatory test.3.3. The method of treatment was complete excision of the sac and closure of all openings into the urethra, with indicated vaginal surgery performed at the same time.