Urethral discharge, constipation, and hemorrhoids. New syndrome with report of 7 cases

A new syndrome in which 7 cases share common clinical features of urethral discharge only at defecation, constipation, and hemorrhoids is reported. The discharge occurred only with constipation. The relationship between urethral discharge, constipation, and hemorrhoids is discussed. The concept that hemorrhoids lead to prostatic venous congestion is put forward. The urethral discharge at defecation seems to be the result of "milking" of the congested prostate by the hard stools. The mechanism of fecal and urinary "milking" of the prostate is discussed. The role of the congested prostate in infertilogenesis is presented. It seems that metabolic accumulation in the prostatic, vesicular, and ampullary secretions affected the spermatogenic activity as it similarly does in varicocele. Permanent disappearance of urethral discharge and improvement of semen quality were achieved on anoprostatic decongestion by medical treatment, hemorrhoid injection, or hemorrhoidectomy. The syndrome of prostatorrhea, constipation, and hemorrhoids should be considered in patients with idiopathic urethral discharge and in infertile patients.