Post-micturition dribble (PMD), the involuntary leakage of urine shortly after voiding, is a common concern among adult males. While the condition is often secondary to prior urethral or prostatic surgeries, many men experience primary PMD, occurring without any history of such interventions. Despite the condition's prevalence, there remains limited clarity on its underlying causes and a lack of strong evidence guiding effective treatment approaches. This study aimed to systematically review the existing literature on treatment strategies for primary PMD in adult males and evaluate their effectiveness through meta-analysis where possible. This is the first systematic review and meta-analysis to investigate PMD therapies.

A comprehensive literature search was performed using four major electronic databases -- Scopus, PubMed, ScienceDirect and the Cochrane Library Database--  covering studies published from inception through 2023. The literature search was concluded in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were original studies evaluating treatment interventions specifically for PMD in adult males without previous surgery to the urethra or prostate. The quality and risk of bias in each study were assessed using validated tools. Data extracted included study design, patient demographics, treatment modalities, outcome measures (both objective and patient-reported), and effectiveness. Meta-analysis was conducted when comparable data were available; otherwise, findings were synthesized narratively.

Out of 335 screened studies, four met the inclusion criteria—all randomized clinical trials—comprising a total of 344 male patients. Two of these trials evaluated physical or behavioral interventions, specifically pelvic floor muscle exercises (PFMEs) and urethral milking. The remaining two investigated pharmacologic therapy using phosphodiesterase type 5 (PDE5) inhibitors—tadalafil and udenafil.

All included studies were assessed as being of good methodological quality. However, the trials involving physical and behavioral therapies presented some risk of bias, primarily due to variations in outcome measurement tools. Because of this heterogeneity, meta-analysis was not feasible for these studies. Instead, narrative synthesis revealed that both PFMEs and urethral milking reduced PMD volume compared to counseling alone, with PFMEs demonstrating superior efficacy. Additionally, one study reported that PFMEs were more effective than counseling in reducing patient-reported symptoms of PMD.

In contrast, the two PDE5 inhibitor trials used consistent and comparable outcome measures, allowing for quantitative synthesis. Meta-analysis showed a large effect size favoring PDE5 inhibitors over placebo in reducing PMD volume (Hedges’ g = −0.86; 95% confidence interval [CI]: −1.75 to 0.02; p = 0.05), although with substantial heterogeneity (I² = 88%). Furthermore, patient-reported outcomes, assessed using the Hallym Post-Micturition Dribbling Questionnaire, significantly improved with PDE5 inhibitors, showing a mean reduction of 1.06 points compared to placebo (95% CI: −1.65 to −0.47; p = 0.0004), with no observed heterogeneity (I² = 0%).

Despite the high prevalence of post-micturition dribble (PMD) in males, evidence guiding its management remains scarce. This review identified only four randomized trials assessing treatments for primary PMD. Pelvic floor muscle exercises (PFMEs) showed encouraging results in reducing PMD volume and improving patient-reported symptoms, while urethral milking demonstrated some benefit but was less studied. Phosphodiesterase type 5 (PDE5) inhibitors, including tadalafil and udenafil, significantly improved symptom scores and reduced PMD volume, showing strong therapeutic potential.

The evidence base for the management of PMD remains limited. To strengthen this, future studies should employ validated and consistent outcome measures, along with improved methods for assessing pelvic floor function and symptom severity. Larger, high-quality trials are essential to establish clear and effective treatment pathways for this common but under-addressed condition.