Immediate terminal drip

Specialty: Nephrology and urology.

• immediate post-micturition drip
• loss of urine just after finishing urinating in men

Why it occurs

• Moderate benign prostatic hyperplasia (the prostatic urethral canal is partially collapsed by the prostate, retaining urine at the end of urination)
• Stricture of the bulbar urethra (urine is trapped behind the stricture and descends by gravity immediately when the abdominal press is relaxed)
• Pelvic floor muscle sagging (weakness of the perineal portion of the deep transverse and bulbocavernosus muscles that prevents active compression to empty the bulbar urethra)
• Diverticulum of the anterior or bulbar urethra (saccular dilation of the urethral wall where urine is lodged and drips immediately after the main stream)

Initial workup

Simple urinary flowmetry with assessment of the flow pattern; pre- and post-void vesicoprostatic ultrasound; urethrosonography or retrograde urethrography to evaluate bulbar urethral strictures or diverticula; diagnostic cystoscopy.

Standard management

• Tamsulosin — 0.4 mg daily orally to reduce prostatic urethral obstruction
• Pelvic floor muscle rehabilitation exercises (male Kegel) with focus on the contraction of the perineal muscles when finishing urinating, associated with the ascending manual urethral milking technique
• Surgical correction of urethral stricture or resection of the diverticulum if anatomical pathology is confirmed.