Effect of udenafil administration on postmicturition dribbling in men: a prospective, multicenter, double-blind, placebo-controlled, randomized clinical study

Voiding With Less Strength of Desire to Void Is a Risk Factor for Post Micturition Dribble

OBJECTIVE

To clarify what urinary condition causes post micturition dribble (PMD) in non-elderly healthy men. We focused on men with PMD who do not have PMD every time they void. We clarified what urinary condition was associated with PMD in individuals to prevent PMD.

MATERIALS AND METHODS

Twenty healthy volunteer men who had experienced PMD were included in the study between 2018 and 2021 using a portable uroflowmeter for 48 hours. They recorded symptoms of PMD and strength of desire to void (none, weak, normal, or strong) for each void. We investigated the risk factors of PMD and the correlation between strength of desire to void and PMD or parameters measured by uroflowmeter.

RESULTS

The mean age of the volunteer men was 35.9 ± 6.9 years. During the study, 20 volunteers experienced a total of 208 episodes of voiding. Of them, 57 (27%) were associated with PMD. Lower voided volume than usual was a significant risk factor for PMD in univariate analysis (P <.01). There was a statistically significant correlation between the strength of the desire to void and the voided volume (P <.01). The voiding with none or weak desire to void significantly caused PMD compared to voiding with normal or strong desire to void (36% vs 21%, P = .03).

CONCLUSION

Lower voided volume than usual and voiding with less strength of desire to void are risk factors for PMD. Instructing male patients with PMD to refrain from voiding when the desire to do so is ambiguous can contribute to preventing PMD.

Postmicturition dribble in men with no previous urogenital surgery: Systematic review and meta-analysis of treatment modalities

INTRODUCTION

Postmicturition dribble (PMD) is common in males. Little is known about PMD etiology, but it is either secondary to urethral/prostatic surgery or primary (no previous surgery). Despite PMD's high prevalence, the effectiveness of its treatment modalities remains lacking.

OBJECTIVE

To undertake a systematic review of the available treatments for primary PMD in adult males and meta-analysis of their effectiveness.

MATERIALS AND METHODS

We searched four electronic databases from inception to 2023 for original articles that evaluated PMD treatments in male adults without previous urethral/prostatic surgery (PROSPERO protocol CRD42023444591). Study quality and risk of bias were evaluated using established tools. We extracted a range of variables including treatment modality used and its effectiveness on PMD volume and patient complaint. Meta-analysis was undertaken where feasible, and where this was not feasible, narrative synthesis was conducted.

RESULTS

Out of 335 studies, four were included (four clinical trials, n = 344 patients). Two trials used physical/behavioral therapy (pelvic floor muscle exercises [PFMEs], urethral milking); the other two employed phosphodiesterase (PDE5) inhibitors (tadalafil, Udenafil). All studies were of good quality, but physical/behavioral therapy studies had some risk of bias. As the two physical/behavioral therapy studies used heterogenous outcome measures, narrative synthesis showed PMD volume improvement with PFMEs more than with urethral milking, both modalities were more effective than counseling, and in one study, PFMEs were effective in reducing PMD self-reported complaint than counseling. Meta-analyses of the two PDE5 inhibitors studies showed a large effect size with high heterogeneity for decreased PMD volume favoring PDE5 inhibitors over placebo (g = -0.86, 95% confidence interval [CI] -1.75; 0.02, p = 0.05; I2 = 88%); and a significant improvement equivalent to -1.06 points on the Hallym PMD Questionnaire score with no discernable heterogeneity (95% CI -1.65; -0.47, p = 0.0004; I2 = 0%), favoring PDE5 inhibitors compared to controls.

CONCLUSIONS

Physical/behavioral therapy and PDE5 inhibitors are effective primary PMD treatments. PMD management studies in males with no previous urethral/prostatic surgery are very scarce and lack the use of consistent/comparable outcome measures. Further studies addressing these deficiencies would benefit this very thin evidence base.

Effect of tadalafil 5 mg on post-micturition dribble in men with lower urinary tract symptoms: a multicentre, double-blind, randomized, placebo-controlled trial

OBJECTIVES

To compare the effects of taking tadalafil 5 mg and placebo once daily on post-micturition dribble (PMD) in men with lower urinary tract symptoms (LUTS).

PATIENTS AND METHODS

Our prospective, randomized, double-blind, placebo-controlled, multicentre trial enrolled 102 men with PMD and other LUTS. PMD was assessed using the Hallym Post-Micturition Dribble Questionnaire (HPMDQ) and according to PMD volume. Over a 12-week period, patients took either tadalafil 5 mg (n = 51) or placebo (n = 51) once daily and their HPMDQ and PMD volume results were evaluated. Adverse events (AEs) were also reported.

RESULTS

Over the course of 12 weeks, total HPMDQscores and PMD volumes improved significantly more in the tadalafil group than in the placebo group (reduction of total HPMDQ score of ≥2 points in the tadalafil and placebo group in 68.8% and 31.9% of patients (P < 0.001) and decreased mean PMD volume in the tadalafil and placebo group at 0.48 mL and 0.22  mL, respectively (P = 0.046). Specifically, PMD frequency decreased and quality of life increased significantly more in the tadalafil group than in the placebo group (P = 0.029 and P < 0.001, respectively). Furthermore, 66.7% of the tadalafil group reported moderate and significant PMD improvement, whereas only 4.2% reported that tadalafil was ineffective. Treatment-emergent AEs did not significantly differ between the groups (all P > 0.05), and no serious AEs were observed.

CONCLUSION

Taking tadalafil 5 mg once daily reduced PMD symptom severity and PMD volume in men with PMD, without inducing serious AEs, more effectively than placebo, suggesting that taking tadalafil 5 mg once daily may be an effective and well-tolerated PMD treatment.

A current perspective on post-micturition dribble in males

Post-micturition dribble (PMD) is the involuntary loss of urine immediately after urination. It is classified as a post-micturition symptom and is more common in males. Traditionally, PMD has been considered to be part of the aging process, to have a low prevalence, and to be less bothersome than other lower urinary tract symptoms (LUTS). However, recent evidence suggests that PMD is not less common and does not elicit less discomfort compared with other LUTS in males. Also, PMD seems to commonly overlap with other LUTS and to be associated with erectile dysfunction. Although the etiology of PMD is not fully understood, a weakness or failure of the pelvic floor muscles is considered to be the most important factor. Although bulbar urethral massage and pelvic floor exercises are known to be effective in treating PMD, pharmacologic treatment has not yet been introduced. Recently, the possibility of treating PMD with phosphodiesterase-5 inhibitor has been suggested.