Splashing Urine Stream When Urinating : Causes, Symptoms, Diagnosis & Treatment

• Why Does Splashing Of Urine Occur When Urinating?
• Urethral Strictures
• Urethritis
• Tumors Of The Urethra
• Hidden Penis
• Urethral Valves
• Epispadias
• Gynecological Diseases
• Diagnostics
• Treatment
• Conservative Therapy
• Surgery

Spraying of the urine stream during urination is observed when there are obstacles to the flow of urine or a change in the anatomical structure of the urethra. Revealed with strictures, valves, benign and malignant tumors, epispadias, hidden penis, urethro-vaginal fistulas, vaginal relaxation. Often combined with dysuric disorders. The cause of the development of the symptom is established on the basis of the data of the survey, examination, hardware and laboratory methods. Treatment is often surgical. Some patients are shown antibacterial drugs, hormone therapy, special exercises.

Why does splashing of urine occur when urinating?

Urethral strictures

They are more often diagnosed in men, in the vast majority of cases they are acquired in nature, develop as a result of injuries, inflammatory processes, manipulations and operations on the genitourinary organs. Patients with strictures are concerned about the weakening and splashing of the jet, the need for tension in the abdominal muscles during urination, the feeling of incomplete emptying of the detrusor, urine leakage. Possible complications are urinary infections, urinary retention.

Urethritis

Spraying the jet is not a mandatory symptom of urethritis. It is more often observed in the representatives of the stronger sex, due to edema, "gluing" of the external opening and the distal part of the urethra. Itching, cramps, burning, pathological discharge are noted. Difficulty urinating is possible. The disorder can also be detected in the torpid form of the disease, complemented by scanty discharge in the morning and slight reddening of the meatus.

Tumors of the urethra

Significant variability of symptoms is characteristic of benign neoplasms. Common early signs are itching, burning, and discomfort when urinating. Subsequently, progressive dysuric disorders occur: bifurcation, spraying or jet deflection, imperative urges, episodes of incontinence. Typical urethrorrhagia. With a significant amount of neoplasia, urinary retention is possible. The most common are epithelial tumors:

• Condylomas. Type of viral warts. Caused by the human papillomavirus, sexually transmitted. They are soft exophytic formations that merge with each other, forming groups similar to cauliflower inflorescences. When located in the urethra, men experience discomfort, difficulty urinating.
• Polyps. They are the second most common after genital warts. Most often formed after 45 years. Initially, there is a slight dysuria, which patients take for manifestations of urethritis or cystitis. Subsequently, difficulties arise and increase during micturition, pain when walking and sexual intercourse. Stress incontinence, urethrorrhagia, infectious complications, urinary retention join.
• Caruncles. They are a type of polyp. They are found only in women, as a rule - in the period of menopause. Manifested by spraying jets, burning and pain during urination and after it, increased urge. Urine turbidity is noted, blood impurities are often detected in urine. Pathology is often complicated by persistent severe cystitis, prone to chronicity.

In urethral cancer, the symptom, as in the cases listed above, is more pronounced and more common in men. Other manifestations of cancer of the male urethra are difficult urination, urethrorrhagia, purulent discharge, later on - pain in the perineum and urethra, swelling of the external genitalia. In women, dysuric disorders are noted, with the spread of neoplasia to the vagina, vaginal bleeding and pain in the lower abdomen.

Spraying urine stream

hidden penis

Pathology is the result of an anomaly of development, during life it is formed with obesity, swelling of the scrotum. Splashing of the jet is characteristic of a completely hidden penis. Urination occurs in a sitting position, according to the female type. Sexual contacts become impossible. Due to the constant contact of the tissues of the head with urine, the impossibility of high-quality washing of the penis, maceration occurs, inflammatory processes develop.

Urethral valves

Like the previous pathology, valves can be congenital or acquired (after injuries, operations). There is an absolute predominance of men among patients. Spraying is combined with lethargy of the jet, moderate pain during urination, nocturia. Pollakiuria, blood in the urine, daytime and nighttime incontinence are less common. Possible hypertrophy of the bladder, the addition of inflammation and the development of an ascending infectious process.

epispadias

Clinical manifestations in the splitting of the wall of the urethra in boys are determined by the severity of the pathology. With capitate epispadias, spraying of the jet is insignificant or absent, sometimes a mild curvature of the penis is detected. Patients with stem epispadias due to significant splashing have to urinate while sitting, deformity of the penis, episodes of incontinence are detected. In girls, the symptom is practically not expressed.

Gynecological diseases

Spraying of the jet is sometimes seen in women with urethro-vaginal fistulas. The main symptom of pathology is the excretion of urine from the vagina. Distal fistulas are manifested by dysuric disorders while maintaining control over the discharge of urine from the urethra. With the localization of the pathological anastomosis in the middle or upper part of the urethra, dysuria is supplemented by incontinence.

Vaginal relaxation syndrome occurs after complicated childbirth, with an increase in intra-abdominal pressure, a lack of estrogen. The latter factor explains the significant increase in the number of cases at the onset of menopause, especially medical or surgical at a young age. Weak jet, splashing and stress incontinence are found in 20-40% of patients. The clinical picture also includes abnormal sounds during movements and sexual intercourse, dyspareunia. Constipation or fecal incontinence may occur.

Diagnostics

In case of acquired diseases of the urinary organs, diagnostic measures are carried out by a urologist. Women with pathologies of the reproductive system need to consult a gynecologist, children with congenital anomalies - an examination by a pediatric urologist. During the interview, the specialist finds out when the spray of the jet appeared, with what other symptoms it is combined, how the clinical picture of the disease has changed over time.

Women collect an obstetric history, reveal the presence of operations on the genitals. In men, as part of an external examination, visual signs of epispadias and a hidden penis are determined. The additional examination program includes such diagnostic procedures as:

• Gynecological examination. Large fistulous passages are clearly visible and palpable from the side of the vagina. For small fistulas, colposcopy, probing from the urethra may be required. In patients with vaginal relaxation, the vaginal walls are atonic, descend when straining, the genital slit is not completely closed. To increase the information content, vaginodynamic studies are carried out.
• Ultrasonography. In patients with strictures and valves, an ultrasound of the bladder is indicated to detect residual urine. Patients with an acquired hidden penis are recommended ultrasound of the scrotum and dopplerography of the vessels of the penis. In case of congenital anomalies, a comprehensive examination is performed, including ultrasound of the kidneys, bladder, scrotum (in boys), and pelvic organs (in girls). Vaginal relaxation requires transvaginal and transperineal ultrasound.
• Radiography. As part of the examination, depending on the nature of the disease, urethrography, antegrade cystourethrography, excretory urography may be prescribed. The techniques make it possible to detect valves, constrictions, diverticula, and tumor-like formations. Patients with congenital malformations may require x-ray of the symphysis pubis.
• urodynamic methods. Indicated for strictures, urethral valves, urethro-vaginal fistulas. According to uroflowmetry, in the first case, the presence of a plateau phase and an increase in the duration of urination are determined, in the second, the causes of urinary incontinence are established, and the function of the sphincters is assessed. Among other methods, profilometry, filling and emptying cystometry, video urodynamic study can be used.
• Endoscopy. During ureteroscopy, the presence of valves, strictures, caruncles, polyps and other tumors, urogenital fistulas is determined. During the study, localization, prevalence, visual characteristics of the zone of pathological changes are established, according to indications, a biopsy is taken. If a bladder infection is suspected, a cystoscopy is performed.
• Laboratory tests. To determine the causative agent of urethritis, microscopy is performed, sowing on nutrient media. To exclude specific inflammation or confirm infection with the papillomavirus, PCR, ELISA are used. Assessment of the morphological structure and degree of differentiation of tumors is carried out by histological or cytological examination.

Urethral stricture

Treatment

Conservative therapy

Most of the causes of the formation of a symptom during urination are eliminated by surgical methods. The exceptions are urethritis and vaginal relaxation. Patients with inflammation of the urethra are prescribed antimicrobial agents and drugs to stimulate the immune system, perform instillations of silver nitrate and collargol. In addition, antibiotic therapy and other methods aimed at combating inflammation are necessary in the development of infectious and inflammatory complications of other pathological processes (strictures, valves, etc.).

Women with vaginal weakness are shown special complexes of physiotherapy exercises (gymnastics according to Atarbekov, Kegel). Patients who experience significant difficulties in mastering active techniques are recommended electrical muscle stimulation using portable devices. The disadvantage of EMS is the occurrence of discomfort when using vaginal electrodes. With hypoestrogenism, hormonal therapy is carried out.

Surgery

The operative technique is chosen taking into account the nature and severity of the pathological process that provokes spraying of the jet:

• Valves: endourethral resection, perineal surgery in young children, urethrocystoanastomosis or augmentation cystoplasty if complications are present.
• Hidden penis: plastic interventions with the release of the shaft of the penis and excision of pathological ligaments in the true form, liposuction or the elimination of provocative diseases in case of a secondary violation.
• Epispadias: urethroplasty, penile curvature correction, bladder sphincteroplasty.
• Urethral-vaginal fistula: fistula closure by vaginal access, vaginoplasty, sling operations for urinary incontinence.
• Strictures: stricture bougienage, urethral stenting, urethrotomy, urethral resection, urethroplasty.
• Benign tumors: excision of neoplasms, chemical destruction, surgical removal, radiosurgery, laser treatment, cauterization with liquid nitrogen or electrocoagulation of genital warts.
• Urethral cancer: transurethral resection or electroexcision, excision of the urethra and surrounding anatomical structures, cystectomy, amputation of the penis.