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

Autor: Albakr A; Urology Department, Hamad Medical Corporation, Doha, Qatar., El Ansari W; Department of Surgery, Hamad Medical Corporation, Doha, Qatar.; Weill Cornell Medicine, Doha, Qatar.; Department of Postgraduate Medical Education, College of Medicine, Qatar University, Doha, Qatar., Mahdi M; Urology Department, Hamad Medical Corporation, Doha, Qatar.; Department of Surgery, Division of Urology, McGovern Medical School at UTHealth, Houston, Texas, USA.; Department of Urology, MD Anderson Cancer Center, Houston, Texas, USA., Megahed H; Department of Surgery, Hamad Medical Corporation, Doha, Qatar., Lock M; Division of Exercise Science, Health and Epidemiology, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar., Arafa M; Urology Department, Hamad Medical Corporation, Doha, Qatar.; Weill Cornell Medicine, Doha, Qatar.; Andrology Department, Cairo University, Cairo, Egypt., Hothi HA; Urology Department, Hamad Medical Corporation, Doha, Qatar., Ghafouri A; Urology Department, Hamad Medical Corporation, Doha, Qatar.; Weill Cornell Medicine, Doha, Qatar.
Jazyk: angličtina
Zdroj: Neurourology and urodynamics [Neurourol Urodyn] 2024 Sep; Vol. 43 (7), pp. 1686-1698. Date of Electronic Publication: 2023 Nov 30.
DOI: 10.1002/nau.25337
Abstrakt: 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; I 2  = 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; I 2  = 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.
(© 2023 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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