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Regular Member

Date Joined Sep 2008
Total Posts : 143
   Posted 5/15/2009 10:46 PM (GMT -6)   
By coincidence, I went to my urologist/surgeon today, exactly one year after being in his office for the dreaded biopsy that told me I had PCa. Guess that qualifies as a milestone on this journey.
When I told the nurse practitioner I sometimes have a dual stream of urine, she said it is very common. It may be caused by an obstruction in the bladder neck or urethra, and a cysoscopy may be in my future. Just wondering how common it really is.
Anyone else experience that?
Bill in SD
Age 60 (59 when Dx) PSA 4.4
Biopsy 5/15/08 Gleason (3+3=6)
Bone scan and pelvic CT: clear
HT - 2 mo Casodex, 3 mo Trelstar
RRP Surgery 9/15/08 La Mesa California
Post-OP Gleason 3+4=7, Stage pT2c pN0 MX
Seminal vesicals, perineural margin, 18 lymph nodes, bladder neck: all carcinoma free
Perineural invasion & Distal Margin: Carcinoma present
IMRT adjuvant radiation (35 Treatments) End 1/27/09
PSA (10/13/08): <0.1
PSA (3/13/09): <0.1

Steve n Dallas
Veteran Member

Date Joined Mar 2008
Total Posts : 4849
   Posted 5/16/2009 4:53 AM (GMT -6)   
I've been there a very few times...Mainly a single stream guy.

Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
Catheter in for five weeks.
Dry after 3 months.
10/03/08 - 1st Quarter PSA -> less then .01
01/16/09 - 2nd Quarter PSA -> less then .01
xx/xx/xx   - 3rd Quater skipped
05/14/09  - 4th Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.

Veteran Member

Date Joined Feb 2008
Total Posts : 1858
   Posted 5/16/2009 5:51 AM (GMT -6)   
I personally do not think that anything internal could cause a "duel stream". My reasoning is that you only have the one urethra (consider it a pipe) and there is no way that two split flows are going through and remaining separate as they emerge from of that pipe. I think you will find that the cause is a piece of lint or some other material is stuck either right at the opening or just inside the urethra that splits the flow in two just as it emerges. Beware the widely diverging twin flow can get messy with you not knowing which way to point the equipment.
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01

Post Edited (BillyMac) : 5/16/2009 4:55:23 AM (GMT-6)

Veteran Member

Date Joined Apr 2009
Total Posts : 990
   Posted 5/16/2009 3:39 PM (GMT -6)   
I don't have a dual stream but I do have a thin one, about half of pre-surgery (6 weeks ago) . My guess is that there was some damage to the urethra about halfway to the bladder. I'll talk to my doctor at the next checkup.

By the way, the analogy of the urethra to a pipe is misleading. It is really like a fire hose -- that is, it flattens out when nothing is flowing through it and is often only partially unflattened. This means that the fluid dynamics of the flow are truly nasty. I remember about 40 years ago a researcher published some papers on this because he was trying to design a urinal that was harder to miss! Isn't science grand?
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3 + 4 = 7
CAT scan 1/09 negative, Bone scan 1/09 negative

Robotic surgery 03/03/09 Catheter Removed 03/08/09
Post surgical pathology report. Lymph nodes negative, Seminal vesicles negative
Surgical margins positive, Capsular penetration extensive Gleason 4 + 3 = 7
At 6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.

Regular Member

Date Joined Apr 2009
Total Posts : 179
   Posted 5/17/2009 8:27 PM (GMT -6)   
I have had a split stream for few years and had hoped that the increased flow after RRP would fix the condition but instead I just have to be more careful that I don't pee on my foot.

My doc said that he could roto-root if it was a major problem. He said it is possible for a growth to occur at the opening or even inside the urethra and divide the stream. It can range from a harmless source to viral causes that require treatment.
Age 62, Sex Male
PSA - 3-20-08 2.7; 4-17-08 3.1; 9-18-08 3.6; 1-22-09 3.8
DRE negative
Ultrasound/biopsy 2-12-09, 50cc
4 of 12 samples positive 3+3=6, Right mid-medial <5%, Right mid-lateral 10-20%, Right base medial 10%, Right base lateral 10% adenocarcinoma

open RRP completed 5-5-09
Post surgical pathology report:
Gleason 3+3=6
Lobes involved - left and right
Extraprostatic extension - none
Surgical margins - very small area of margin involvement in right lobe
Seminal vesicles - Free of neoplasm
Vascular/Lymphatic invasion - none
J-P drain, staples and catheter removed on 5-13-09
No incontinence issues, no ED issues.
Surgeon: Dr. Gary B. Bokinsky

Remember, don't let the bastages get you down !!!

Veteran Member

Date Joined Dec 2008
Total Posts : 822
   Posted 5/17/2009 10:22 PM (GMT -6)   
I've had a dual stream occasionally for decades. Usually it was in the morning, right after getting up, and the end of the urethra was slightly stuck to itself. After a few seconds of peeing, it becomes unstuck and I'm back to a single stream. I never know when it's going to happen, so like jack, I have to watch out and aim to make sure that the dual stream zone doesn't hit my foot.

Diagnosis at age 53. PSA 2007 about 2; PSA 2008 4.3
Biopsy September 2008: 6 of 12 cores positive; Gleason 4+3 = 7
CT and Bone scan negative
Da Vinci surgery at City of Hope December 8, 2008
Radical prostatectomy and lymph node dissection
Catheter out on 7th day, replaced on 8th day, out again 14th day following negative cystogram
Pathology: pT2c; lymph nodes negative; margins involved; 41 grams, 8% involved by tumor; same Gleason 4+3=7
PSA 1/22/08 non-detectable! 8-)
4/23/09 still undetectable!

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