Terminal Leak : Causes, Symptoms, Diagnosis & Treatment

• General Characteristics
• Why Does Terminal Leakage Occur?
• Diseases Of The Urethra
• Infectious Lesions Of The Urethra
• Sclerosis Of The Bladder Neck
• Diseases Of The Prostate
• Pathology Of The Seminiferous Hillock
• Chronic Pelvic Pain Syndrome
• Neurological Disorders
• Diagnostics
• Treatment
• Conservative Therapy
• Surgery

Terminal leakage is a condition in which urine continues to flow after urination is complete. In most cases, men are affected. The symptom is observed with strictures, diverticula and tumors of the urethra, urethritis with damage to the proximal urethra, diseases of the prostate and seminal tubercle, CPPS, neurogenic dysfunction of the lower urinary tract. The cause of development is determined on the basis of anamnesis, complaints, examination results and additional studies. As part of therapeutic measures, medicines are prescribed, physiotherapy is carried out. Operations are sometimes shown.

general characteristics

Terminal leakage is the unintentional loss of urine after micturition is completed. It usually occurs after leaving the toilet. In men, it is caused by insufficiency of the bulbospongiosus muscle, covering the upper and middle parts of the urethra. In the absence of pathology after urination, this muscle contracts and "expels" the remnants of urine.

With inflammation, tumors and other diseases, this process is disrupted, urine is retained in the bulbar region, and then released under the influence of gravity. In women, the urethra is short, there are no conditions for the accumulation of urine in it, so this type of dysuria is very rare in them. An exception is the diverticulum of the urethra, in which a cavity is formed in the organ for the accumulation of urine and its subsequent excretion.

Why does terminal leakage occur?

Diseases of the urethra

Urethral diverticulum is more common in women, but can also be seen in men. Often there is a long asymptomatic course, clinical manifestations occur with the development of complications - diverticulitis, urethral stones, malignancy. The picture includes pollakiuria, pain, cramps, incontinence, jet discontinuity. A characteristic symptom is terminal leakage due to the accumulation of urine in the cavity of the diverticulum and its subsequent emptying.

The formation of urethral strictures is associated with damage to the organ as a result of injuries, foreign bodies, inflammation (often specific), careless manipulations (catheter placement, bougienage, etc.). Weakness and splashing of the jet, the need to strain the abdominal muscles, a feeling of incomplete emptying, terminal leakage of urine are noted. Possible infectious complications, urinary retention.

For benign tumors, a long absence of symptoms is typical. Neoplasia increases slowly, so the manifestations increase gradually. Itching, burning, discomfort, urethrorrhagia, deviation or splashing of the jet, partial incontinence are found. With cancer of the urethra, difficulty urinating first comes to the fore. In the future, urethrorrhagia, pain, an increase in regional lymph nodes, swelling of the penis and scrotum join.

Infectious lesions of the urethra

Urine leakage is sometimes detected in specific and nonspecific urethritis. Pathology is manifested by painful mictions, swelling of the external opening of the urethra. With the spread of inflammation to the posterior urethra with terminal leakage of urine, there is often an increase in body temperature, signs of general intoxication. The nature of the discharge depends on the type of pathogen. Along with nonspecific urethritis, the disorder is found in the following pathologies:

• gonorrhea;
• trichomoniasis;
• mycoplasmosis;
• ureaplasmosis;
• chlamydia.

Sclerosis of the bladder neck

The occurrence of cervical sclerosis is determined in approximately 1% of men who have undergone surgery for prostate adenoma. In addition to the terminal leakage of urine, lethargy of the jet and difficulty urinating are noted. Subsequently, a feeling of incomplete emptying of the detrusor appears and grows. Violations of the outflow of urine are progressing, a complete delay is not excluded.

Terminal leak

Diseases of the prostate

A possible etiological factor in terminal leakage is prostatitis. The symptom is observed in the severe course of the acute form of the disease, accompanies long-term chronic processes, becomes especially noticeable with an increase in decompensation phenomena. Complemented by dysuria, pain syndrome, sexual disorders. Other possible causes of leakage include:

• BPH. Gradual development is characteristic, the presence of two groups of signs: obstructive and irritative. The first group includes micturition difficulties, a sluggish intermittent stream, the need for straining, an increase in the duration of urination. If left untreated, the kidneys are affected due to deterioration in the passage of urine. At the final stage, paradoxical ischuria is noted.
• Sclerosis of the prostate. It occurs as a result of allergic reactions, autoimmune processes, infectious lesions, prostatolithiasis, medical and diagnostic procedures, atherosclerotic changes. Accompanied by lethargy of the jet, pain, pain in the lower abdomen, testicles or perineum. In the later stages, urine is excreted drop by drop.
• Prostate cancer. As a rule, it is formed against the background of other diseases of the prostate gland. It is manifested by frequent urges, difficulty in micturition, weakness and intermittency of the jet, pain during urination, pain in the lower abdomen and lower back, hematuria, hematospermia. Subsequently, anemia, weight loss, lymphostasis in the lower extremities are noted.

Pathology of the seminiferous hillock

Terminal leakage of urine is detected in patients with colliculitis. Pathology develops against the background of local disorders of blood circulation and innervation or becomes a consequence of other urological and andrological pathologies (vesiculitis, prostatitis, posterior urethritis), often due to STIs. Manifested by discomfort in the scrotum and perineum, increased urge, burning during miction, sensation of a foreign object in the rectum.

Hypertrophy of the seminal tubercle is congenital, during life it develops against the background of inflammation, stagnation of blood in the veins of the small pelvis, stones of the urethra. Symptoms appear with a significant increase in the anatomical formation, include imperative urges, lethargy of the jet, the need for straining, a feeling of incomplete emptying, pain during erection, premature ejaculation.

Chronic pelvic pain syndrome

It is considered a polyetiological condition, it occurs due to ischemia, venous stasis, latent infections (including specific ones), neurological diseases, after operations and manipulations. The clinical picture resembles chronic prostatitis, in some cases with terminal urine output. At the same time, CPPS in men is characterized by the presence of constant or periodic pain of varying intensity - from moderate to severe.

Neurological disorders

In patients with complicated spinal injuries, intervertebral hernias, disorders of the spinal circulation, developmental anomalies and other neurological pathologies, the formation of a neurogenic bladder is possible. Clinical manifestations are variable and may be constant, intermittent or episodic. Terminal leakage is complemented by incontinence, pollakiuria, imperative urges, and frequent micturition.

Diagnostics

The cause of the development of terminal leakage of urine is established by the urologist-andrologist. Patients with suspected oncological diseases are referred for a consultation with a urologist. As part of the survey, the doctor determines the moment of the onset of a symptom, other manifestations, changes in the clinical picture over time. During a physical examination, the specialist reveals external changes: edema, hyperemia, lymphadenopathy, the presence of pathological secretions and palpable tumor-like formations in the urethra. An additional examination is carried out using the following methods:

• Finger examination of the prostate. It is carried out through the rectum. The doctor evaluates the size and density of the organ, detects infiltrates and nodes. The method allows you to confirm the presence of changes in the prostate gland, but does not make it possible to accurately differentiate between hyperplasia, prostatitis and a malignant tumor, therefore, other studies are prescribed to clarify the diagnosis based on the results of this procedure.
• Ultrasonography. In diseases of the prostate, ultrasound of the prostate gland is performed by transabdominal or transrectal access. All patients with impaired urodynamics due to mechanical obstruction of the flow of urine or disorders of the nervous regulation undergo an ultrasound of the bladder with the determination of residual urine. With a secondary lesion of the upper parts of the urinary system, ultrasound of the kidneys is indicated.
• Urodynamic research. Patients with urodynamic disorders on the background of an andrological or urological disease undergo uroflowmetry. If necessary, the scope of diagnostic procedures is expanded, including profilometry, cystometry, sphincterometry, video urodynamic study.
• Beam methods. X-ray techniques include retrograde urethrography, survey and excretory urography, descending voiding cystourethrography. In cervical sclerosis, MSCT cystourethrography is informative. Patients with lesions of the prostate gland are prescribed MRI of the prostate to exclude oncological diseases, to determine the nature of the pathological process.
• Endoscopy. Urethroscopy is recommended for patients with diverticula, strictures and neoplasias of the urethra, colliculitis and tubercle hypertrophy. With cervical sclerosis, CPPS, cystoscopy is necessary. In some cases, cystoscopic examination is performed in patients with prostate pathologies. According to indications during the procedure, a biopsy is taken.
• Laboratory tests. A general urine test is indicative, in which, depending on the nature of the disease, bacteria, leukocytes, and erythrocytes are determined. To detect STIs, PCR, ELISA are performed, microscopy is performed, and the discharge is sown on nutrient media.

Urologist's consultation

Treatment

Conservative therapy

Therapeutic tactics are chosen taking into account the cause of the terminal leakage of urine. The following methods are applied:

• Infectious and inflammatory processes. Antimicrobial therapy is indicated for patients with urethritis, prostatitis and colliculitis. The drug is selected taking into account the type of pathogen, it is possible to use antibacterial, antifungal, antiprotozoal agents. Patients with andrological pathologies are prescribed antispasmodics, NSAIDs, prostate massage, physiotherapy.
• BPH. Conservative therapy is recommended at the initial stage of the disease and when surgical intervention is not possible. Treatment is carried out with the use of alpha-blockers, herbal remedies, antibiotics to fight infection, vasodilators to improve local blood circulation and a more active flow of drugs into the gland tissues.
• SHTB. Depending on the etiology of the pain syndrome, antimicrobial agents, hormones, alpha-blockers, antioxidants, antiplatelet agents, angioprotectors, neuroprotectors, muscle relaxants, vitamin preparations are prescribed. Apply electroacupuncture, laser therapy, magnetotherapy, drug electrophoresis, vibration exposure. According to indications, psychotherapy is carried out.
• neurogenic dysfunction. Drugs are recommended to activate blood circulation, reduce muscle tone and combat hypoxia. It is possible to carry out botulinum therapy, intravesical administration of irritants. Patients are advised to normalize their diet, conduct detrusor training, and perform special exercise therapy complexes. Additionally, hyperbaric oxygen therapy, electrical stimulation, and other physiotherapeutic methods are prescribed.

Surgery

Patients with terminal leakage undergo operations such as:

• Non-tumor diseases of the urethra: bougienage and stenting of strictures, internal urethrotomy, resection of the urethra with plastic replacement of the defect, diverticulectomy, marsupialization of the diverticulum.
• Urethral neoplasias: minimally invasive methods of removal and surgical excision of benign tumors, transurethral or circular resection for early stages of cancer, amputation of the penis and cystectomy for advanced forms of malignant neoplasia.
• Andrological diseases: transvesical and retropubic adenomectomy, transurethral resection, laser techniques, embolization of prostate arteries, laparoscopic, radical and nerve-sparing prostatectomy, brachytherapy, testicular enucleation in hormone-dependent cancer, TUR of the seminiferous hillock in hypertrophy.
• Neurogenic dysfunction: incision of the external sphincter of the bladder, plastic surgery to increase the capacity of the detrusor, cystostomy drainage.