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Urology/Post Void Dribble

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Dear Dr. Goldstein,
Let me start off by saying the following: I have severe anxiety disorders. I have OCD, GAD, Panic, MDD, but most importantly hypochondriasis and somatization disorder. I have been to over 100 doctors appointments in the last 9 months. I am 25 years old.

I have had erection issues for 9 months caused by being on an SSRI and by severe anxiety. ALso in the past 9 months I have complained of every ache and pain you could imagine--all psychosomatic. I even had an ECG and a stress test only to find out my heart was perfect after thinking I was going to have a heart attack and die. You get the picture.

2 months ago, I cheated on my girlfriend with a prostitute. Prior to doing this, I had never had urinary issues before ever. The very next time I went to the bathroom after this sexual encounter...bang, I developed post-void dribble.

Since then, I have been tested numerous times for all STD's...nothing (except for gential herpes which I acquired months before and take valtrex for). I have had my prostate examined many times digitally and with ultrasound. Completely normal. My urine flow rate is totally normal and my post-void residual is consistently within normal limits (in a clinical setting, where I am anxious). The only test I have not had for this is a cystoscope, which is not indicated because all the other tests are normal.

So whats going on here? Is this psychosomatic? Could it be caused by the guilt of cheating on my girlfriend with a prostitute? Could it be a result of weak or tense pelvic floor muscles (I can see why I would have tension given my anxiety disorder...I have been to physical therapists who say there IS some tension there, but nothing major)?

What do you think?

Answer
Alex, sorry to learn of all of your problems.  Hopefully, 2013 will be  a better year for you.  As you might imagine, for this type of problem it is not possible for me to make an exact diagnosis or give recommendations over the internet because of the inability to take a more complete history and do a physical examination.  However, I shall try to help you.

Post voiding dribbling is a very common problem.  I think the relationship of your symptoms to your encounter with a prostitute is coincidental.  It is due to trapping of some urine in the urethra which then leaks out after one has finished urinating.  Minor leakage is common in most men.   It is usually due to an obstruction such as from a swollen prostate, a narrowing of the urethra (stricture) or a narrowing at the penile opening (meatus).  The most common causes are from a swollen prostate either an inflammation, so called prostatitis (common) or a benign enlargement of the prostate  BPH (rare at your age).  Prostatitis often occurs even with a "normal" prostate on DRE and ultrasound.  The prostatic fluid needs to be checked for pus cells and bacteria.  In my experience, another frequent cause is in those men who remove their penis through the unzippered fly, void and then put the penis back.  Often, the space is not adequate for total free flow as the lower (bottom) edge of the fly can actually push on the urethra causing urine to be trapped.  This phenomenon can be totally avoided by dropping your trousers and then urinating in the standing or sitting position.  Try the latter and if you are cured, no further evaluation is necessary.  If the dribbling persists but is mild, get in the habit of "stripping" or milking the urethra from just behind the scrotum forward a couple times after voiding and then pat dry.  If the problem persists or is more severe, you need to again see your urologist & arrange for a cystoscopy.  Good luck.

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Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

Experience

I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

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