Post-micturition dribble
Luis Abranches-Monteriro

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Post micturition dribble (PMD) is the term used when an individual describes the involuntary loss of urine immediately after he or she has finished passing urine, usually after leaving the toilet in men, or after rising from the toilet in women. [1] It differs from Terminal dribble mainly in a temporal way since this latter is the term used when an individual describes a prolonged final part of micturition, when the flow has slowed to a trickle/ dribble [1].


Hence, post micturition dribble is clearly separated from micturition. It is an involuntary loss of urine being then a form of incontinence.


A survey was conducted to investigate postmicturition dribble in the general adult male population. A questionnaire was sent to 3,034 clerical workers between 20 and 50 years of age living in urban areas of Hokkaido and Tokyo, and it was returned by 2,839 men (93.5). The incidence of postmicturition dribble in the men in their 20s, 30s, 40s and 50s, was 11.5, 13.2, 19.4 and 26.9%, respectively. The overall incidence was 17.1%. Of those who had experienced postmicturition dribble; 14.0% dribbled almost daily but the degree of postmicturition dribble was limited to spotting or wetting of the underwear in 93.2%. Therefore, 2.3% of all respondents answered that they had experienced postmicturition dribble almost daily. It is concluded that postmicturition dribble is fairly common in adult men. [2]

A Finnish study showed that half of the 30-year-old men and two-thirds of the men aged 60-80 years had postmicturition dribble. Dribbling into trousers increased with age but as a severe symptom, it was rare (0.5%). [3]

In 1987, Corcoran and al investigated eight male patients with post micturition dribble, and concluded that when PMD is a sole symptom, both endoscopic and videocystometric examinations were normal. When in conjunction with other symptoms a functional or anatomical abnormality of the lower urinary tract was found in every patient [4]
The mechanisms are diverse. Some patients have a hyperactive detrusor while others show a urine bulbar residue, even in the absence of a urethral stenosis. [5] [6]. When the cause is an urethral stenosis

In these cases, the more distal and severe the stenosis, the more likely to present a post micturition dribble.


The overall prevalence of post-micturition symptoms was 10%, with 11.8% of men and 8.5% of women reporting a feeling of incomplete emptying or post-micturition dribble. [7].
In a recent series, in a total of 3727 individuals (62.4%) participated (53.7% female). The LUTS with the greatest population-level burden were urgency (7.9% with at least moderate bother), stress urinary incontinence (SUI) (6.5%), nocturia (6.0%),postmicturition dribble (5.8%), [8]

Post-void milk-out of the urethra is often absent in the early postoperative period after radical prostatectomy and that this is associated with post-micturition dribble. Aside from detrusor and sphincter dysfunction, urethral dysfunction, i.e. the absence of urethral post-void milking, seems to be an additional cause of incontinence following radical prostatectomy. [9]

It is a multi-mechanism symptom, ranging from the result of post micturition detrusor contractions, to delayed emptyng of urethral residues due to any difficulty in emptying, like a distal urethral stenosis.


References

[1] Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A; Society., Standardisation Sub-committee of the International Continence, “The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society,” Neurourol Urodyn., Vols. 21(2):167-78., 2002;.

[2] Furuya S, Ogura H, Tanaka M, Masumori N, Tsukamoto T., “[Incidence of postmicturition dribble in adult males in their twenties through fifties,” Hinyokika Kiyo, pp. .;43(6):407-10., 1997 Jun.

[3] Pöyhönen A1, Auvinen A, Koskimäki J, Hakama M, Tammela TL, Häkkinen JT., “Prevalence and bother of postmicturition dribble in Finnish men aged 30-80 years: Tampere Ageing Male Urologic Study (TAMUS).,” Scand J Urol Nephrol., pp. ;46(6):418-23, 2012 Dec.

[4] Corcoran M, Smith G, Chisholm GD., “Indications for investigation of post-micturition dribble in young adults.,” Br J Urol. , pp. ;59(3):222-3, 1987 Mar.

[5] Stephenson TP, Farrar DJ., “Urodynamic study of 15 patients with postmicturition dribble.,” Urology. , pp. 9(4):404-6., 1977 Apr;.

[6] Furuya S, Yokoyama E., “Urodynamic studies on postmicturition dribble,” Hinyokika Kiyo., pp. ;29(4):395-400., 1983 Apr.

[7] Maserejian NN, Kupelian V, McVary KT, Doshi M, Link CL, McKinlay JB., “Prevalence of post-micturition symptoms in association with lower urinary tract symptoms and health-related quality of life in men and women,” BJU Int. , pp. 108(9):1452-8, 2011 Nov.

[8] Agarwal A1, Eryuzlu LN1, Cartwright R2, Thorlund K3, Tammela TL4, Guyatt GH5, Auvinen A6, Tikkinen KA7., “What is the most bothersome lower urinary tract symptom? Individual- and population-level perspectives for both men and women,” Eur Urol., pp. ;65(6):1211-7, 2014 Jun.

[9] Wille S1, Mills RD, Studer UE., “Absence of urethral post-void milking: an additional cause for incontinence after radical prostatectomy?,” Eur Urol., pp. ;37(6):665-9., 2000 Jun.

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