Decrease of urinary stream

Overview
Decrement in urinary flow is a common complaint that is accompanied by anxiety due to potential prostate problems. In addition, dribbling and incomplete emptying are complaints also made by patients.

Differential Diagnosis of Causes of
In alphabetical order.


 * Benign prostatic hyperplasia
 * Bladder neck contracture
 * Bladder Neck Cancer
 * Bladder stones
 * Chronic Urethritis
 * Neuropathic bladder
 * Posterior urethral valves
 * Prostate Cancer
 * Urethral or bladder foreign body
 * Urethral Cancer
 * Urethral polyps
 * Urinary Tract Obstruction

Physical Examination

 * Note: STD

Other

 * After full history, examine abdomen, back and genitals
 * examine genitals for tenderness

Laboratory Findings

 * Catheterization of urethra to rule out obstruction and residue (normal = <100 mL)
 * BUN / Creatine
 * CBC
 * electrolytes
 * Urinalysis
 * Urine culture

MRI and CT

 * Abdominal / pelvic CT to detect any cancers

Echocardiography or Ultrasound

 * Renal ultrasound to rule out stones

Other Diagnostic Studies

 * rectal exam
 * neurologic exam

Chronic Pharmacotherapies

 * BPH
 * beta blockers


 * Chronic urethritis / [[prostatitis]
 * Antibiotics (long term)


 * Neuropathic bladder
 * parasympatholytic medications

Surgery and Device Based Therapy

 * Benign prostatic hyperplasia
 * TURP


 * Prostate cancer
 * Prostatectomy


 * Urethral Stricture
 * open surgical repair


 * Neuropathic bladder
 * section of sacral nerve roots
 * artificail sphincter
 * uretral diversion


 * Bladder cancer
 * radical cystectomy in late disease

Acknowledgements
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