Terminal painful urination

Specialty: Nephrology and urology.

• terminal dysuria
• burning at the end of urination

Why it occurs

• Acute trigonal cystitis (localized inflammation in the bladder trigone intensifies painfully at the end of urination, when the walls of the bladder collapse and come into intimate contact)
• Bladder lithiasis (calcium or uric acid stone settles in the bladder neck at the end of urine evacuation, causing acute stabbing pain and interruption of the stream)
• Acute or chronic prostatitis (the final contraction of the pelvic and prostate muscles when finishing urinating mechanically squeezes the swollen gland)
• Genitourinary schistosomiasis (chronic parasitic infection with Schistosoma haematobium that mainly affects the bladder wall and urinary trigone)

Initial workup

Microbiological analysis of urine with sediment and urine culture; complete bladder ultrasound with suprapubic and transrectal transducer in men to evaluate the trigone, the prostatic base and look for free intravesical stones; diagnostic cystoscopy with biopsy (especially important to rule out squamous cell carcinoma or schistosomiasis if there is a history of exposure); Urinary sedimentation test to look for Schistosoma eggs if it comes from an endemic area.

Standard management

• Butylscopolamine bromide — 10-20 mg every 8 hours orally or intravenously as a bladder spasmolytic
• Ciprofloxacin — 500 mg every 12 hours PO if suspicion of bacterial trigonal cystitis is high
• Praziquantel — 40 mg/kg in a single divided dose, specifically indicated if genitourinary schistosomiasis is documented
• Phenazopyridine (100 mg every 8 hours PO for a maximum of 48 hours as a topical urothelial anesthetic).