Intermittent urine output is noted in various types of prostatitis, other prostate diseases, lesions of the seminal tubercle, xerotic balanitis, urethral diverticula, urethral and bladder stones, cystitis in infants. As a rule, it is combined with other dysuric manifestations: pain, cramps, irresistible urges, pollakiuria, stranguria, etc. The cause of the symptom is determined according to the survey, examination, ultrasonography, radiological methods, endoscopy, laboratory tests. Treatment includes drug and non-drug therapy, surgical interventions.
Why is urine output interrupted?
Prostatitis
Intermittent excretion of urine is observed with the following types of prostatitis:
- Spicy. Marked intoxication, general hyperthermia, increasing pain in the perineum, sacrum, above the pubis. Violation is combined with increased miction, weakness of the jet. When the condition worsens, urinary retention is possible.
- Chronic. Patients are concerned about constant aching pains in the area of the perineum, groin and external genitalia, which intensify at the initial and final stages of urination, radiate to the rectum, sacrum, and scrotum. Pollakiuria, nocturia, intermittent or weak stream come to light. Floating threads are visible in the urine. Prostorrhea is possible.
- Calculous. Symptoms are reminiscent of chronic prostatitis. Pain syndrome comes to the fore, aggravated by prolonged walking or sitting, physical exertion, sexual intercourse, defecation. Pollakiuria, prostorrhea, hematospermia, hematuria, erectile disorders are determined.
- stagnant. Characterized by constant discomfort in the perineum, anus, external genitalia. Perhaps increased pain when sitting, irradiation to the hips, coccyx, lower back. The onset of micturition is difficult, the jet is weakened, and urgency incontinence is sometimes observed. Hematospermia often develops.
- Prostatocystitis. Signs of chronic prostatitis are supplemented by frequent urges, lethargy of the jet, a feeling of incomplete emptying of the bladder, and urgent incontinence. The general condition worsens, patients complain of insomnia, myalgia, weakness.
Other prostate diseases
In men, the symptom can be provoked not only by prostatitis, but also by other diseases of the prostate gland, accompanied by an increase in its size or a change in structure, due to which there is an obstacle to the free flow of urine.
- Sclerosis. It develops against the background of chronic inflammation, is a consequence of tumors, acute purulent processes, prostatolithiasis. Sluggishness and discontinuity of the jet predominate. There may be cramps during micturition, hematospermia, intense or dull aching pain in the abdomen and perineum.
- Adenoma. Hyperplasia causes compression of the urethra, because of this, urine output becomes intermittent, and the stream becomes weak. Straining is required to empty the detrusor. The clinical picture is complemented by nocturia, pollakiuria, imperative urges, incontinence.
- Cyst. The symptom occurs with large median formations, combined with difficulties at the beginning of the act of urination, increased frequency of miction, the release of small portions of urine, discomfort in the perineum, in the lower abdomen.
- Prostate cancer. In the early stages, the symptoms are nonspecific, caused by another disease (adenoma, prostatitis). The patient is concerned about the difficulty in the beginning of micturition, a weakened intermittent stream, incomplete emptying, increased urge. Manifestations increase, pain in the lower back, perineum and pelvic region, hemospermia, hematuria, erectile dysfunction join.
In rare cases, intermittent discharge is provoked by malacoplakia with the appearance of growths in the prostate area.
Intermittent urine stream
Other andrological pathologies
Intermittent or sluggish urine output is typical of severe hypertrophy of the seminal tubercle. Combined with imperative urges, straining, soreness during erection, premature ejaculation. In young children, frequent micturition with the release of a small amount of urine, bloating, increased blood pressure, lethargy, crying during urination are observed.
Manifestations of colliculitis increase gradually. There are frequent urges, burning during micturition, sensation of a foreign body in the rectum, discomfort in the scrotum and perineum. Intermittent discharge and weakening of the stream are detected when the disease worsens, supplemented by pathological urethral discharge, streaks of blood in the semen, and sometimes involuntary ejaculation during defecation.
Obliterating xerotic balanitis is characterized by the formation of whitish spots that turn into sclerotic plaques. As the plaques increase in the area of the foreskin and head of the penis, a ring is formed. Due to scarring of the meatus, urine output is intermittent. Manifestations of chronic pelvic pain syndrome in men resemble the clinical picture of prostatitis. The pain can be constant or intermittent, range from moderate to severe, cover the pelvis, lower back, perineum, genitals.
Urological diseases
The most common urological cause of intermittent discharge, difficulty, and pain during urination is a urethral diverticulum. A typical sign of pathology is the terminal leakage of urine after the end of the micturition, due to the accumulation of urine in the diverticulum and its subsequent emptying. Women predominate among the patients.
Small urethral stones are more likely to cause intermittency in urine output in men. In people of both sexes, the symptom is observed when the bladder calculus migrates into the urethra. The clinical picture includes intense pain, sharp and frequent urges, weakening and dispersion of the jet, difficulty in micturition. Acute urinary retention is possible.
neurogenic bladder
This condition develops in violation of the nervous regulation of various origins: after spinal cord injuries, strokes, with tumors of the brain and spinal cord, degenerative diseases, etc. With a hyperactive detrusor, difficulty in the onset and act of micturition, intermittent discharge are associated with the spastic state of the organ. In patients with a hypotonic bladder, the need for straining, delay, intermittency and lethargy of urination are due to insufficient intravesical pressure.
Childhood diseases
In children under the age of 1 year, a weak intermittent stream, combined with crying and restlessness during urination, may indicate the development of cystitis. Increased mictions, small portions of urine, sometimes subfebrile condition are noted. In boys of different age groups, a symptom may indicate the occurrence of prostatitis. The child is worried about pain in the lower abdomen. Urination is frequent, painful, urine is cloudy with mucus impurities.
Diagnostics
Diagnostic measures are carried out by a urologist-andrologist. Children are shown an examination by a pediatric urologist. As part of the survey, the doctor finds out when the intermittent jet appeared, how the symptom changed over time. Clarifies the presence of other manifestations. For a more accurate assessment of the nature and severity of dysuric disorders, patients are asked to keep a diary of urination. Women undergo a gynecological examination to exclude diseases of the reproductive system. Patients are prescribed the following procedures:
- Finger examination of the prostate. Allows you to assess the condition of the prostate gland: its size, density, the presence of infiltrates and tumor-like formations. Produced at the initial stage of diagnosis, allows you to clarify the scope of further examination.
- Ultrasonography. Transabdominal and transrectal ultrasound of the prostate is highly informative in identifying various types of prostatitis, cysts, adenomas, cancer, sclerotic changes. Ultrasound of the urethra is recommended to detect stones in the urethra. Patients with neurogenic dysfunction are shown ultrasound of the bladder with the determination of residual urine, ultrasound of the kidneys and ureters for a comprehensive assessment of the state of the urinary tract.
- X-ray diagnostics. Excretory urography and cystourethrography are prescribed for urolithiasis. They make it possible to confirm the presence of stones in various parts of the urinary system. The main method for diagnosing KSD is multislice CT, during which even X-ray negative and small stones are detected. Urethrography is used to detect diverticula, hypertrophy of the seminal hillock.
- Endoscopic techniques. As indications for ureteroscopy or urethrocystoscopy, lesions of the tubercle, diverticula, and calculi are considered. In the latter case, the purpose of the procedure may be not only diagnosis, but also treatment (stone removal). It is possible to take material for morphological examination.
- urodynamic techniques. They are considered an obligatory part of the diagnostic program for conditions accompanied by a violation of the passage of urine. They are used for neurogenic dysfunction, pathologies of the seminal hillock, diseases of the prostate. The basic study is uroflowmetry. Additionally, cystometry, profilometry, KUDI can be performed.
- Biopsy. Necessary for suspected prostate cancer. Transrectal biopsy is performed through the rectum, saturation - through the perineum. In both cases, samples are taken from 12 or more points. The modern method is Fusion-biopsy. Points are selected based on MRI data of the prostate. The material is taken by the transrectal or transperineal method.
- Laboratory tests. In diseases of the prostate, the level of PSA is determined. The study is of particular importance in the framework of cancer screening. In inflammatory processes, microscopic and microbiological examination is carried out. To exclude STIs, ELISA, PCR are prescribed. With neoplasms, a morphological analysis is carried out.
Uroflowmetry
Treatment
Conservative therapy
Therapeutic tactics are determined depending on the etiofactors of intermittent urine output. The presence of a primary or secondary inflammatory process in the prostate area is an indication for the use of antibacterial drugs. Non-drug treatment includes prostate massage, urethral electrical stimulation, magneto-laser therapy, microclysters. Patients with adenomas are prescribed alpha-blockers.
In colliculitis, antibiotics are used to combat inflammation, to improve the outflow of urine - alpha-blockers, to eliminate pain - NSAIDs, analgesics, antispasmodics, to stimulate local blood supply - phlebotonics. Useful electrophoresis, ultrasound, local thermotherapy, microclysters. The treatment regimen for CPPS is selected depending on the identified pathology. It is possible to use antioxidants, hormones, and other means.
For urinary tract calculi, a special diet combined with medications to maintain an alkaline balance in the urine is sometimes effective. The development of diverticulitis, secondary urethritis and cystitis is considered as an indication for antibiotic therapy.
Surgery
In conditions accompanied by intermittent urination, the following operations are performed:
- Adenoma: transvesical or retropubic adenomectomy, laser techniques, embolization of prostate arteries.
- Prostate cancer: radical or nerve-sparing prostatectomy, cryoablation, and FUS ablation of the prostate.
- Diseases of the seminal tubercle: transurethral resection.
- Cystolithiasis, urethrolithiasis: external urethrotomy, endoscopic stone extraction, percutaneous suprapubic litholapaxy, transurethral cystolithotripsy, suprapubic cystolithotomy.
- Urethral diverticula: marsupialization, surgical excision.