The significance of terminal dribbling in men with lower urinary tract symptoms

Objective To determine the relationship between the symptom of terminal dribbling, objective evidence of terminal dribbling on recordings of uroflow, benign prostatic enlargement (BPE) and bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTS). Patients and methods The prevalence of the symptom of terminal dribbling was determined from a symptom questionnaire completed by 165 men presenting with LUTS. Objective evidence of terminal dribbling during voiding was assessed from uroflow recordings and prostate volume was measured by transrectal ultrasonography. Combined pressure-now studies were performed to determine the presence or absence of BOO. Results There was relatively poor agreement between the symptom of terminal dribbling and objective evidence of its presence; 48% of the patients who reported terminal dribbling most or all of the time showed no objective evidence of terminal dribbling on uroflowmetry. The symptom of terminal dribbling was not significantly related to the presence of BOO (P=0.74) and the group-specific urethral resistance factor (URA) did not differ significantly (P=0.79) between those men who complained of terminal dribbling and those who did not (median URA 33 and 31 cmH(2)O, respectively), However, objective evidence of terminal dribbling on uroflow traces was significantly related to BOO (P<0.001) and those patients with objective evidence of terminal dribbling had higher values of URA (median 39 compared with 28 cmH(2)O). Objective terminal dribbling had a specificity of 92% and positive predictive value of 88% for the presence of BOG. Neither the symptom of terminal dribbling nor objective evidence of its presence were significantly related to prostatic enlargement. Conclusion While the symptom of terminal dribbling is probably not related to BOO or prostatic enlargement, objective evidence of terminal dribbling on now curve recording is specific for BOO and as such, its presence could potentially be of value in the assessment of men with LUTS.