Slow, Splitting, Intermitent Stream

Naranjo-Ortiz, C.
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The ICS defines slow stream as the report made by the individual as his or her perception of reduced unique flow, usually compared to previous performance or in comparison to others. And the intermittent stream is the term used when the individual describes urine flow which stops and starts, on one or more occasions, during micturition. Patient could report that his or her urine stream is splitting or spraying too. (Abrams et al., 2002)

Lower urinary tract symptoms (LUTS) are associated with lower urinary tract dysfunction. Symptoms are a subjective indicator of a disease. LUTS cannot usually be the only factor to be taken into account to make a definitive diagnosis. LUTS are classified into seven groups, being the most frequent, storage, voiding (obstructive) and postmicturition symptoms. Voiding symptoms, which are caused by lower urinary tract obstruction, include slow stream, splitting or spraying, intermittency, hesitancy, straining, and terminal dribble (Takeda et al., 2003).
Flowmetry consists on measuring urinary flow. The most commonly used parameters are the maximum flow, the medium flow and the residual volume. The flow value depends on the maximum and medium voided volume, age and gender. So flow nomograms have been published for comparison of values ​​of both parameters with the average or median (50th percentile) of their values ​​in the population, taking into account the voided volume, age and gender (Salinas Casado, 2000).
It is very important to discard other possible causes of bladder obstruction other than benign prostatic hyperplasia (BPH), as, for example, prostate carcinoma, bladder neck contracture or urethral stenosis. Furthermore, both the alteration in detrusor contractility and detrusor instability, infectious syndromes or prostatitis can lead to similar symptoms (Dmochowski, 2005; Kingery, Martin, Naegeli, Khan, & Viktrup, 2012; Morant, Reilly, Bloomfield, & Chapple, 2008).

The treatment of lower urinary tract obstruction involves the treatment of the obstruction either pharmacologically, mechanically or surgically, depending on the disease.
In the case of BPH there are several possible pharmacological treatments, although most of them have side effects. The patient must be informed about the pros and cons of the drugs indicated for each case. In brief, we can say that those patients with mild symptoms should be kept under observation, those with moderate discomfort will be treated medically and those who suffer the biggest annoyances or have urinary retention would be candidates for surgical treatments or other alternatives.

Abrams, P., Cardozo, L., Fall, M., Griffiths, D., Rosier, P., Ulmsten, U., & Van Kerrenbroek, P. (2002). The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continente Society. Neurourology and Urodinamics, 21, 167-178.
Dmochowski, R. R. (2005). Bladder outlet obstruction: etiology and evaluation.Rev Urol, 7 Suppl 6, S3-S13.

Kingery, L., Martin, M. L., Naegeli, A. N., Khan, S., & Viktrup, L. (2012). Content validity of the Benign Prostatic Hyperplasia Impact Index (BII); a measure of how urinary trouble and problems associated with BPH may impact the patient. Int J Clin Pract, 66(9), 883-890. doi: 10.1111/j.1742-1241.2012.02960.x
Morant, S. V., Reilly, K., Bloomfield, G. A., & Chapple, C. (2008). Diagnosis and treatment of lower urinary tract symptoms suggestive of overactive bladder and bladder outlet obstruction among men in general practice in the UK. Int J Clin Pract, 62(5), 688-694. doi: IJCP1737 [pii]
Salinas Casado, J. (2000) Urodinámica Aplicada. Formación continuada en urodinámica: Guías urodinámicas.
Takeda, M., Araki, I., Kamiyama, M., Takihana, Y., Komuro, M., & Furuya, Y. (2003). Diagnosis and treatment of voiding symptoms. Urology, 62(5 Suppl 2), 11-19. doi: S0090429503006058 [pii]

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