Dysfunctional voiding - characterized by an intermittent and/or fluctuating flow due to inadequate or variable relaxation generally of the external sphincter during voiding in neurologically normal men (i.e. no historical, visible or measurable evidence of neurological disease). Incidence dysfunctional voiding 14 to 43% [1], negatively affecting patients' quality of life. The variability of diagnostic criteria does not allow the formation of uniform treatment strategies for patients with dysfunctional urination [2]. To compare the efficacy of high-frequency sacral-perineal neuromuscular electrical stimulation (NMES) and active relaxation techniques in correcting voiding symptoms, urodynamic parameters, and quality of life.

Patients underwent a preliminary comprehensive examination to exclude infectious and inflammatory diseases, as well as anatomical causes of voiding symptoms. A prospective study included 32 men (median age 37 [24–51]) with dysfunctional voiding. Group 1 (n=22) received a course of 10 daily sessions of high-frequency (200 Hz), 20 minute, sacral-perineal NMES. Group 2 (n=10) performed diaphragmatic breathing and pelvic floor muscle (PFM) stretching. Evaluation included IPSS-V (voiding), IPSS-S (storage), QoL, PFM tone, and expanded uroflowmetry. Statistics: Mann-Whitney U and Wilcoxon tests.

At 30 days, Group 1 showed significant superiority over Group 2 (p < 0,01). Total IPSS in Group 1 dropped from 22 to 8. IPSS-V decreased from 14 [12; 16] to 4 [3; 5] г). QoL improved to 1 [1; 2]. In Group 2, IPSS-V remained at 10 [9; 12] and QoL at 3 [2; 4].  Uroflowmetry (Group 1): Qmax increased from 13.8 to 22.4 ml/s (p < 0,01), average flow from 7.9 to 13.6 ml/s (p < 0,01). Time to Qmax ( p < 0,01) decreased from 13.0 to 6.5 s (p < 0,01), and total voiding time from 52 to 27 s (p < 0,01). Group 2 showed no significant changes in temporal parameters.
Post-void residual in Group 1 decreased from 87 to 13 [0; 70] ml (p < 0,01), compared to 59 ml in Group 2. 
At baseline, severe hypertonicity was recorded in all patients — 3 [2; 3] points. In Group 1, normotonia was achieved by day 30 — 1 [0; 1] point (p < 0,01). In Group 2, moderate hypertonicity persisted by day 30 — 2 [1; 2] points (p=0,064 vs Group 1).

The findings confirm that dysfunctional voiding in young men is driven by functional pelvic floor muscle hypertonicity. The superiority of NMES (200 Hz) more effectively than voluntary relaxation (Group 2).

NMES (200 Hz, 10 sessions) is more effective than pelvic floor muscle exercises for functional obstruction in men.
The therapy provides a 64% reduction in IPSS-V score and improves quality of life.
Successful therapy is objectively marked by reduced TQmax and residual urine reduction to 13 ml.

Stephens R, Malde S, Taylor C, Sahai A, Solomon E. Clinical and urodynamic presentations of young men with dysfunctional voiding. Continence. 2022 Sep 1;3:100511.
Tarcan T, von Gontard A, Apostolidis A, Mosiello G, Abrams P. Can we improve our management of dysfunctional voiding in children and adults: International Consultation on Incontinence Research Society; ICI-RS2018. Neurourol Urodyn. 2019;38 Suppl 5:S82-S89