Two streams of urine?

Dear Alice,

I am a 19-year-old male. Over the past three years whenever I urinate, my urine stream splits in two (one continuous stream and one stream which is basically drops of urine.) Is there something wrong??? I also have another question. My grandfather has prostate cancer. I was just wondering when I should begin checks for this type of cancer.

Thanks for your time,
Am I normal?

Dear Am I Normal,

Two questions, one for each stream — how interesting. To start, there are many reasons why you are noticing two streams of urine, so it might be helpful start by ruling-out two rare, but possible, causes. Both are known as congenital abnormalities, otherwise known as birth defects.

In one possible case, a passage developed between your urethra (tube that carries urine from bladder to opening at then end of penile shaft) and the penile skin. This birth defect is called congenital urethral fistula. And, during urination, two streams of urine can be seen—one stream comes from the urethral opening, and the other comes from the abnormal passage between the urethra and penile skin (this is called the fistula). Another cause for the two streams is a birth defect known as urethral duplication. Males with this condition may have two urethras, with one or two openings (for outflow of urine), or two urethras with one joined opening. Those with two openings may notice two streams of urine and it's common for one opening to become infected and clogged, requiring medical attention. 

Additionally, it's possible for a growth to occur at the opening of the urethra, or even inside the urethra and divide the urine stream. If this is the problem it can range from a harmless source to viral causes that require treatment.

Speaking of treatment… only your health care provider can evaluate your urinary situation to tell you exactly why you've got a split stream. Your provider may diagnose a treatable condition. There's also a chance that they will tell you it's a harmless quirk. Maintaining a good, communicative relationship with your provider is a great idea.

Looking at your second question about the right time to begin screening for prostate cancer, for the average guy, without a family history of prostate issues, regular screening is recommended starting around age 50. For people, like you, with some family history, it's a good idea to begin screening around age 45. Also, doctors recommend that African American men, with or without family history, begin screening around age 45 because African American men have a higher risk of developing prostate cancer than Caucasian men. Keep in mind that the rate of prostate cancer in individuals under 40 is one in 10,000, but that rate jumps to 1 in 38 between the ages of 40 and 49. So, you've got quite some time until you get into the "risky" ages for prostate cancer. Still, keep in mind that new research and guidelines are frequently rolled out and your health care provider will let you know if, and when, you need to be screened.

To schedule an appointment to talk about your risk for prostate cancer and for an evaluation of your urinary situation, you could contact your health care provider, school health center, or other local health care center for a workup or referrals.

It takes courage to reach out for information on topics like this. It takes even more courage to follow-through with making a medical appointment and going for an evaluation. Through this, you'll likely get some peace of mind.

Last updated Jun 16, 2015
Originally published Nov 01, 1993

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