What could be the reason for a burning sensation on the tip of the penis?
Patient's Query
Hello doctor,
I am a 38-year-old male. I feel a burning sensation on the tip of the penis. When I finish urinating I feel a small amount of urine stuck behind. Even after squeezing the penis, there will always be a few drops that remain stuck at that point, that I would not be able to squeeze out. They will eventually come out on their own in the next 15 minutes as I walk or cross legs. How to treat this condition?
Kindly help.
Hello,
Welcome to icliniq.com.
Please help me with a few details so that we can get to the bottom of your issue and hopefully get you the help you need.
- Have you had any surgeries in the past?
- Are you diabetic or hypertensive?
- Does this problem with urinating happen every time or only on occasion?
- Have you had any infections or trauma to your penis?
- Are you sexually active or masturbating regularly?
- Do you have any pain after or during ejaculation?
- Is there any pain in your perineum?
- Did your doctor start any treatment after the uroflowmetry test? Which I must say is not normal at all. The normal QMax for a healthy male should be about 20 to 25 mL per second.
- When you do pee, do you feel as if your stream has slowed down over the last few months or years?
- Do you have an increased frequency of urination or, urgency?
Please revert back with the details of the above questions, and I will try and do my best to help you.
Patient's Query
Hello doctor,
I appreciate your response and questions. I looking for an explanation for urine being stuck in the distal penis despite not having a stricture and for treatment options for such a condition.
Hello,
Welcome back to icliniq.com.
I had asked the questions so as to understand the issue better as there can be a variety of other issues going on. Nevertheless, I will answer your three questions based on the information you have provided.
- The condition you are suffering from is called post-micturition dribble and affects between 5 to 8 % of men. The most common reason for this condition is men having enlarged prostate, it can happen due to a couple of other reasons as well, such as:
- A pelvic floor muscle causes incomplete, or weak contractions of your perineal area which in turn does not work effectively to push out all the urine.
- This condition is also seen in men suffering from erectile dysfunction.
- A weak urethro-corporo cavernosal reflex. A reflex that can assist in urinary flow and help empty the residual urine out of the urethra.
- The treatment for this involves pelvic floor exercises to strengthen the pelvic floor muscles as well as a perineal massage, immediately after you have passed urine.
- When both of these things are done in combination, roughly 70 to 80 % of men experience great benefits.
- Unfortunately, there is no medication for the treatment of post-micturition dribble but we do occasionally use alpha blockers for the treatment of the same.
I hope this helps.
Patient's Query
Hi doctor,
Thank you for your answer.
As I wrote in my query, "The urine does not dribble.". It Is just being stuck behind a particular point, 2 cm deep from the tip of the penis. This happens every time I urinate, without an exception, for many years. It's always the same point. The urine comes out only when I squeeze it out with my fingers. If I do not do that and just keep standing, the urine will remain stuck there indefinitely!
So the problem is definitely not the "post-micturition dribble" you have mentioned. Since the urine is stuck in the distal penile urethra, I believe that "weak contractions of my perineal area" can also be ruled out as the cause.
I do not suffer from erectile dysfunction.
From what I have just read about the subject, I doubt that a weak urethro-corporo cavernosal reflex can cause my condition.
My questions:
1. Do you agree that urine stuck in the distal penis should at least dribble when the penis points downwards due to gravity?
2. Do you have any other ideas that can explain my condition?
Thank you.
Hello,
Welcome back to icliniq.com.
The distal penile urethra does not have any sphincter mechanism to hold urine.
The only reasons why urine should be held up in the distal penile urethra can be explained by:
1. An anterior urethral valve - which I can’t see in your X-ray
2. A stricture - which I can’t see in your X-ray
3. A sub-meatal narrowing - which I presume they would have diagnosed on the cystoscopy - is not evident on the X-ray either.
4. An uncircumcised person with severe phimosis - where urine gets collected in between the glans and prepuce and comes out later - but I’m presuming you don’t have that either as you would have mentioned it b
If these conditions are absent, urine will not stay in the distal urethra.
From your x-ray, I do notice a large amount of urine still present in your bladder, even after peeing, which is not normal.
Hence, I will go back to the above causes as the reason for your troubles.
The only other thing is an issue with your external sphincter and bladder neck - it is possible that the urine is being trapped between the bladder neck and sphincter and not milking back into the bladder. It leaks once the sphincter has relaxed.
You may interpret this as urine being trapped in the distal urethra, but the problem really lies above it.
This is my opinion, but like I have said before, I need a detailed history to be able to help you with the issue (if that is what you are looking for).
Please let me know if there are any more questions I can help you with.
Thank you.
Patient's Query
Hi doctor,
Thank you for your answer.
When I did the urethrography, there was indeed a large amount of urine still present in my bladder, even after peeing. But that's not usually the case. I think the reason, in that case, was the local anaesthetics. After I did uroflowmetry, the residue volume in the bladder, as measured by ultrasound, was only 32 ml.
Also, a large amount of urine is expelled from the urethra when I squeeze my penis immediately after I finish peeing. So, I do not think it is leaking from the bladder. And even if it was leaking, it should've normally been dribbling out of my meatus and not stuck 2cm deep in my urethra indefinitely, without dribbling at all.
In light of this, and since I also feel a burning sensation in that particular point when I urinate, I'm sure that there is something wrong locally in that point, either with the urethra or the corpus spongiosum, despite not being evident in urethrography and cystoscopy.
My theory is that there is a very small spongiofibrosis at that point. It does not invade the lumen of the urethra, but it does reduce the elasticity of the spongiosum. As a result, there is increased resistance to the flow of urine at that point, as evident by the low Qmax on uroflowmetry. In the terminal stage of urination, as the pressure decreases, it cannot dilate the urethra any longer at the point of the spongiofibrosis, causing the urine to get stuck there.
My questions:
1. Do you think that my theory is possible?
2. Do you think that urethroplasty (specifically EPA) can resolve the problem?
Thank you.
Hello,
Welcome back to icliniq.com.
1. In my opinion, spongiofibrosis, which cannot be seen on an X-ray or cystoscope, is extremely unlikely to cause a hold-up of urine.
2. In my opinion, I would not suggest urethroplasty based on whatever information you have provided. I would offer you some conservative treatment for a while to look for improvement before exploring surgical options.
Hope this helps. Please let me know if there is anything else I can help you with.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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