A male with hematuria that occurs at the end of the urinary stream most likely has a source from which location?

• A. Renal pelvis.
• B. Bladder neck.
• C. Anterior urethra.
• D. Ureter.

Answer: (B)

Hematuria that appears at the end of urination localizes to structures near the bladder outlet because the final portion of the stream involves the bladder neck as it narrows and closes off the bladder. Bleeding here is most likely to show up when voiding is finishing, since the neck bears the most stress and can bleed with mucosal irritation or inflammation. In contrast, bleeding from the renal pelvis or ureter typically occurs earlier in the stream or intermittently and is often associated with flank pain or colicky symptoms, while bleeding from the anterior urethra more commonly presents with the initial part of the stream. Therefore, bleeding at the end of the stream points to the bladder neck as the source.