Phosphate stone 'stream' causes pain during urination

[charlie]

I'm a 33 yr old male, in good shape physically and mentally.  I've been to several urologists within the state of VA concerning the problem I am mentioning here, but have not found someone who can solve it.  So I thought I would see if you could point me in the right direction for the next step to take.  I don't mind traveling anywhere if I can get this resolved.

History:  Starting around the age of 16, I will sometimes notice a small white "milky" stream of about 2 - 4 inches come through during urination.  If it passes through completely, it really doesn't cause much pain.  Little uncomfortable, but not much.  However, many times this stream comes at the very end, and would 'dribble' out.  In this case, the stream looks "chunky", with small white chunks of a chalky white substance.  I've only been able to catch it once, and it was calcium phosphates I believe.  This causes extreme burning in the tip of the penis, and the severe burning continues for 10 minutes or so.  The pain subsides somewhat, but still continues even after several urinations (I drink tons of water to try to flush my system when this happens).  I've had two cystoscopies by two different doctors and nothing was found.  I've had ultrasound of the kidneys and nothing positive was found (some questionable pockets were noticed that could be stones, but nothing came of it). Doctors tested for STDs, but nothing was found. I've done the 24hr urine sample, but nothing abnormal was found.  Since about the age of 20, I've had a lot of problems with prostititis, which I can describe in another post.  I truly do not believe that they are completely related.  I have found that not eating cheese helps to keep this "stream" from appearing.  Keeping my urine more acidic also helps.  I've thought about trying an acid ash diet (like they have for cats, but I want the people variety <grin>), but I don't have much information on that.

Question: Have you heard of this type of urinary problem?  A white 'stream' that becomes 'chunky' and very painful if it comes at the end of urination and does not clear the urinary tract?  None of the doctors I have been to have known what this is, because they can't see it.  I can't be the only male that has had this, and I don't think it is typical semen because most men do not complain about this being severly painful. I've been straining my urine lately in hope of catching this, but no luck.  Of course I'm not eating cheese, so my diet could be helping keep this problem away.  Any ideas of how to find out how to eliminate this problem once and for all?

[HFHS M.D.-CK]

Dear Charlie,
The abnormalities in the urine that you describe are not common.  As you mentioned, prostatic secretions may be responsible for the white and clumpy urine contents.  A post ejaculatory urinalysis may show the presence of sperm.  If this evidence for retrograde ejaculation is found, the condition can sometimes be cured with medicines such as pseudofed.  
You are concerned about stones in the urine.  A straight forward approach would be to collect the urine for 24 hours.  This 24 hour urinalysis can quantitate the various salts in your urine (calcium, uric acid, oxalate, magnesium etc.) to look for abnormalities.

This information is provided for general medical information purposes only. Please consult  your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available through our department at the Henry Ford Hospital  and its suburban locations (I-800-653-6568).
Sincerely;
HFHS M.D.-CK
  * Keyword: urinalysis

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