Post-micturition drip

Specialty: Nephrology and urology.

• late terminal drip
• loss of urine after urinating
• drip from the urethra at the end

Why it occurs

• Benign prostatic hyperplasia (emptying of the bulbar urethra is ineffective due to prostatic compression)
• Hypotonia of the pelvic floor muscles (the bulbocavernosus muscles do not contract with sufficient force to expel residual urine from the urethra)
• Urethral diverticulum (saccular dilation of the urethral wall, more common in women, where urine accumulates and drips when moving)
• Distal urethral stricture (urine flow slows and is retained in the proximal urethra, dripping slowly due to gravity after completing urination)
• Obesity or pelvic organ prolapse (extrinsic compression and alteration of the urethrovesical angle)

Initial workup

Physical examination with careful palpation of the ventral urethra (to rule out diverticula or masses); urinary flowmetry with measurement of postvoid residual; urethrosonography or pelvic MRI if complex urethral diverticulum is suspected in women; urethrocystoscopy.

Standard management

• Tamsulosin — 0.4 mg orally daily to optimize emptying of the urethral canal and bladder neck
• Pelvic floor muscle strengthening exercises — Kegel exercises under the supervision of a physiotherapist) associated with the post-micturition manual urethral milking technique (manual upward pressure on the perineum from behind the scrotum towards the meatus at the end of urination
• Urethral diverticulum resection surgery if its existence is confirmed.