The term post-micturition dribble (PMD) is used when an individual experiences leakage of urine immediately after finishing urination. PMD is commonly observed as like the other lower urinary tract symptoms (LUTS), and it significantly exacerbates quality of life (QOL) [1]. The aim of this retrospective study is to elucidate the pathophysiology of PMD through analyzing urodynamic study findings and symptoms questionnaire.

We retrospectively evaluated the relationship between the urodynamic study findings and modified International Prostate Symptom Score (m-IPSS) in male patients. The m-IPSS consists of eight sub-score related to LUTS (Incomplete Emptying, Frequency, Intermittency, Urgency, Weak Stream, Straining, Nocturia, and PMD) and one question related to quality of life (QOL). We evaluated the variables, including age, bladder outlet obstruction index (BOOI), bladder contractility index (BCI), and bladder voiding efficiency (BVE). The parameters were calculated as follows; BOOI: PdetQmax-2Qmax, BCI: PdetQmax+5Qmax, and BVE: voided volume/maximum cystometric capacity. The patients with voided volume under 100ml in urodynamic study were excluded. We conducted multivariate regression analysis to investigate which variables affect PMD (0 vs 1－5 points). Moreover, multivariate regression analysis was used to evaluate the association of m-IPSS sub-score with QOL (0-4 vs 5,6).

A total of 138 male patients entered this study. Medications used to treat LUTS were as follows: α-blocker in 74, anti-cholinergic agent or β3-stimulator in 20, 5α-Reductase inhibitor in 11, cholinergic agent in 5, phosphodiesterase inhibitor in 2, and no medication in 53 patients. Univariate regression analysis showed that BOOI is significantly associated with PMD. Furthermore, multivariate regression analysis showed that BOOI is still significantly associated with PMD (Table1). In terms of the relationship between m-IPSS sub-score with QOL, univariate regression analysis revealed that each of the eight questions had significant association with QOL. Nocturia, urgency, and PMD had still significant association with QOL in the multivariate regression analysis (Table2).

The results showed that the relationship between BOOI and PMD was significant. It was speculated that the patients with BOO had residual urine in the urethra owing to poor urine drainage. Minagawa T et al reported that posterior prostatic urethral length was significantly correlated with BOOI. Although posterior prostatic urethral length was evaluated by unusual way of retrograde jelly injection [3], the patients with BOO might have residual urine in their long prostatic urethra soon after urination. The poor urine drainage and long prostatic urethra in patients with BOO might contribute to severity of PMD. According to such speculation, it was hypothesized that α-blocker or PDE5 inhibitor, approved for BPH treatment, could be promising drug for alleviating PMD. A previous research suggested that PDE5 inhibitor was effective for alleviating PMD severity [2]. It was possible that PDE5 inhibitor improved PMD through relieving bladder outlet obstruction. However, this aspect should be prospectively investigated using urodynamic study. Furthermore, PMD affected QOL in this study, and which was in accordance with previous study [1].

BOOI was significantly associated with PMD. Furthermore, PMD exacerbated QOL. It was desired that the treatment like alleviating BOO, such as α-blocker or PDE5 inhibitor, should be investigated in further study.

Low Urin Tract Symptoms. 2019 Apr;11(2):O38-O41.
BJU Int. 2019 Nov;124(5):862-869.
Low Urin Tract Symptoms. 2019 Apr;11(2):O4-O10.