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Urology/bladder emtpying


Dr. Leslie,

Hello, I am an otherwise healthy, non-diabetic white male, 45.  Also I am very thin - BMI of 20.

Summary of current symptoms:
- burning during urination (but not extreme)
- weak stream (I did rough measurement at home of about 10ml / sec avg. flow rate), and dribbling at the end for about 10 seconds.  Also sometimes at the end it stops, and then if I push the stream goes again for a short time.  Or, I can get the last bit out by squirting a few times.
This is the symptom that has me freaked out - the burning is more of a minor annoyance.
- no leakage of urine or strong urges to go
- urologist checked my prostate w/ DRE - said was normal.  also PSA is 0.4

I can't think of much that's different that happened in the last few weeks, other than I've been drinking more mountain dew and have been more constipated than usual - I have large hard lumpy stools.

Note these symptoms seem to come and go, but have recently progressed from once in a while to now almost all the time.

I went to urologist a couple weeks ago and urine sample came back from lab w/ no infection.  Did say my urine was somewhat alkaline.
Gave me script for uribel but not helping.

Also about a year and a half ago I had severe stomach problems and was on diet of protein shakes (this resolved now, no more shakes).  Had burning symptoms but no emptying trouble.  Went to same urologist in fall of 2011, and he did emptying ultra sound test, and also urodynamics - tested sensation when filling up bladder with water (I think he scoped me also).  Both tests back then were normal. The burning seemed to go away mostly once I got back to a normal diet.

Also, 4 years ago did have 2 kidney stones within a year, but both of these passed w/o getting stuck in kidney, were just in bladder for a few days.  Since then I do drink a lot of water, sometimes I think subconciously I drink more to sooth heartburn - could drinking too much water have messed up my bladder?

Anyway, looking back on it I think my urine flow has slowed down gradually over the years, but nothing like it has in the last few weeks.

I'm not a dr., but sometimes I think that the burning (which I also have at times between urinating), makes me tighten up my bladder sphincter and then it's hard to relax it.  I noticed something like this years ago - sometimes when I really had to go like after driving, it seemed harder to start the stream and stream seemed weaker, but now this is almost all the time.  Also I'd say for as long as I can remember, after a bowel movement additional urine comes out - is this normal?
Another detail is that I wet the bed until I was about 14, and had L4-L5 spinal fusion surgery back in 2002.

Any thoughts on the cause / treatment for my problems?  And what tests if any should I have done?

I see that you're 1 of the best experts on this site, and thanks in advance for your time.



Your situation is complicated with essentially normal exams and a history of spinal surgery.  It can be very difficult to try to fix a sensation (burning) when the tests are all negative.

I think a careful check of the prostate should be done to rule out any prostatitis. A flow test and possibly another cystoscopy (telescope look into penis) may be needed to make sure there is no obstruction.  A neurology exam can see if there are any other signs of possible nerve issues.

You may need to consider getting an opinion from a tertiary university Urology department if you cannot find help locally.


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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