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

Liana Meffert; Paul Gellhaus, MD

Disclosures

April 26, 2021

Physical Examination and Workup

Upon physical examination, the patient is alert and oriented, with no evidence of acute distress. He is afebrile. His heart rate is 74 beats/min, with a regular rate and rhythm, and his blood pressure is 118/75 mm Hg. His lungs are clear to auscultation bilaterally. He exhibits no costovertebral angle tenderness on examination. He is circumcised, with a patent urethral meatus.

The patient's urine is clear and straw-colored. Urinalysis reveals the following:

  • Urine pH level: 6 (normal value, < 9)

  • Specific gravity: 1.0101 (reference range, > 1 to < 1.03)

  • Glucose, ketones, and protein: negative

  • Blood: 1+ without red blood cell (RBC) casts

  • Urobilinogen level: Normal

  • Bilirubin, leukocyte esterase, and nitrites: negative

Urine microscopy demonstrates 0-2 white blood cells per high-power field (HPF), 3-10 RBCs per HPF, and rare bacteria in the urine. Tests for sexually transmitted infections are negative, and the urine culture shows no growth.

A uroflow study reveals a voiding curve with a pattern of start/stop stream and near-complete bladder emptying.

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