A Sexually Active 29-Year-Old Man With a Weak Urine Stream

Liana Meffert; Paul Gellhaus, MD

Disclosures

April 26, 2021

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 29-year-old man presents with a 4-month history of a weak urinary stream. The condition was of sudden onset, with no inciting events. He has no difficulty in starting or stopping his stream, but he feels as if he is unable to empty his bladder completely. He reports urinary straining and increased frequency, without any nocturia or dysuria. He has a score of 20 (severe) on the American Urological Association (AUA) Symptom Index, a questionnaire that quantifies the severity of urinary symptoms.[1]

He says he does not have fever, chills, gross hematuria, or flank pain. He has no history of straddle injury or other trauma to the genital area.

The patient reports that he has been sexually active with one female partner over the past 3 years and that they do not use protection. He states that he has not had any new sexual contacts during the past 6 months. He is in good health and has no history of smoking. He does not regularly drink alcohol or use illicit drugs. His family history is significant for bladder cancer, which was diagnosed in his mother at age 45 years and in his sister at age 30 years. He previously received a diagnosis of gastroesophageal reflux disease. He has no surgical history.

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