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QUESTION: Hi,

Im 22 years old and have had a sensation of needing to urinate for about a year that is relieved for only a few minutes after urinating. I have had a cystoscopy with no finding. The sensation I have is similar to having urine stuck in the urethra. I have noticed also that in the beginning of an ejaculation it is urine, then followed by actual ejaculate.

ANSWER: Ashton:

You didn't ask a question but I suppose you want some advice.  

First, I doubt very much that you are expressing urine before ejaculation.  Most likely it is pre-ejaculate which is quite normal.  When getting ready for ejaculation, the internal sphincter closes tight which would prevent any urine from leaking out.  This is to express all the semen into the penis and outside.

It's very difficult to treat or diagnose a sensation when testing and diagnostic examinations are negative.  A CMG test might be helpful.  You may need to talk to your urologist about what maybe happening or get a second opnion.

---------- FOLLOW-UP ----------

QUESTION: Hi,

I am 99% sure it is urine, I know the different textures of pre ejaculate and urine. I have also passed a little bit of urine during intercourse without knowing (I don't ever leak during day to day life). It is a must I go to the toilet immediately before intercourse, even if I just went 20 minutes ago.

The intercourse sensation is different when its urine as well. During intercourse the 'good' sensation is replaced by a building urine sensation. I have seen two urologists who have no diagnoses for me.

Is it possible my mild lumbar scoliosis is putting pressure on my bladder causing this? Is it possible that urine is getting trapped somewhere after it leaves the bladder without any urethral obstruction?
I don't know where to go from here, it was fine for about 6 months after first noticing it but once iv become sexually active its become worse and worse. I have nocturia as well, once a night. The impact on my day to day life is quite severe, I can't go to the movies or any activity without feeling like I need to go constantly and can't enjoy intercourse as much. Oxytrol patches/vesicare help minimally if at all.

Thank you for your help.

Answer
Ashton:

While almost anything is possible, lumbar scoliosis (especially mild) is highly unlikely to put any pressure on the bladder and even if it did, the symptoms would be quite different.

You should probably have CMG test and see a urology specialist in pelvic floor/bladder disorders.  For example, there is a new medication called myrbetriq that might work well for this.

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Stephen W. Leslie, MD

Expertise

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

Experience

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.

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

Publications
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.

Education/Credentials
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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