I. Post-micturition dribble is not a voiding problem. It is a storage-phase incontinence event with a voiding-phase address. The bladder cycle has already switched. The urine is residual fluid sitting in the bulbar urethra, not output from a contracting bladder. Treating it as weak voiding leads clinicians to recruit harder. Recruiting harder is often what created it.

II. The bulbospongiosus is not the same muscle as the deep pelvic floor. It does not generate urethral pressure. It empties the last horizontal segment of the urethra. When you train a post-prostatectomy patient to squeeze hard and squeeze often, the deep layers hypertrophy, the bulbospongiosus weakens from chronic co-contraction and disuse, and the last few drops have nothing left to expel them. Stress incontinence resolves. Dribble appears. You did both.

III. Hard squeezing is the wrong dose for the wrong target. A strong contraction raises urethral pressure, which the patient does not need once voiding is finished. It also makes full relaxation harder, which the patient does need. For dribble, the intervention is a gentle pump of the superficial layer at the end of the void, plus manual compression of the bulbar urethra. Anything more is iatrogenic.

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2 QUOTES FROM OTHERS

I. "First, do no harm." — Hippocrates The intervention you reach for to fix one symptom is the same intervention that produces the next one. The maxim is not about big errors. It is about the small, well-intended ones.

II. "The cure can be worse than the disease." — Francis Bacon A strong pelvic floor is not a neutral outcome. It is a clinical decision with downstream consequences. Choose the layer, choose the dose, and watch what appears after the original complaint resolves.

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For your post-prostatectomy patients who have stopped leaking with cough but now dribble after voiding, are you treating a new problem, or watching the consequences of how you treated the old one?

With care,

Team IPC

Further reading: https://bladderdiaries.com/journal/post-void-residual