Men with benign prostatic hyperplasia associated lower urinary tract symptoms (LUTS) often report persistent storage symptoms consistent with overactive bladder (OAB) despite alpha1-blocker treatment. Pelvic floor muscle training combined with urgency-suppression techniques (PFMT-st) may improve patient-perceived outcomes. We aimed to identify baseline predictors of clinically meaningful improvement after adding PFMT-st to silodosin, focusing on whether age and baseline storage symptom burden predict higher response.

This post-hoc secondary analysis used data from a multicenter, randomized, parallel-group trial. Men aged over 50 years receiving silodosin were randomized 1:1 to silodosin alone or silodosin plus PFMT-st for 12 weeks. Sample size was based on 80% power and a two-sided alpha of 0.05, assuming a >25% improvement in IPSS symptoms; 63 participants per group were required, with at least 158 overall allowing for 20% attrition. The parent randomized trial was conducted and reported in accordance with CONSORT guidance for randomized controlled trials. The primary endpoint for this analysis was responder status at week 12 defined as Patient Global Impression of Improvement (PGI-I) score of ≤2. A pre-specified multivariable logistic regression model evaluated baseline predictors including treatment arm, age, body mass index (BMI), baseline International Prostate Symptom Score (IPSS), baseline Patient Perception of Intensity of Urgency Scale (PPIUS), baseline OAB-q symptom score, baseline voids/24 h, and baseline nocturia. Model discrimination was assessed by the area under the ROC curve (AUC). Pragmatic cut-offs were explored descriptively, including age <65 years vs ≥65 years and voids/24 h ≤10 vs >10.

Among 142 participants, 54 (38.0%) were PGI-I responders. Response rates were 10.0% (7/70) with silodosin alone versus 65.3% (47/72) with silodosin plus PFMT-st (absolute difference 55.3%). In multivariable analysis, add-on PFMT-st was the strongest independent predictor of response (OR 21.60, 95% CI 7.65–61.00; p<0.001). Higher baseline voiding frequency was inversely associated with response (OR 0.74 per additional void/24 h; p=0.042). Baseline OAB-q symptom score showed a borderline inverse association (OR 0.96 per point; p=0.089), while age, BMI, baseline IPSS, baseline PPIUS, and nocturia were not significant in the core model. Discrimination was good (AUC 0.865). In pragmatic strata, men aged <65 years had higher response rates with add-on PFMT-st than men aged ≥65 years, while clinically meaningful benefit remained evident in both age groups. Absolute benefits were also larger in men with ≤10 voids/24 h (78.4% vs 7.7%) compared with >10 voids/24 h (51.4% vs 12.9%).

Adding PFMT-st to silodosin markedly increased the likelihood of patient-perceived improvement. Lower baseline voiding frequency was associated with higher response, and younger age (<65 years, in stratified analyses) may also have been associated with a higher probability of response, supporting earlier referral to PFMT-st while maintaining use across broader patient subgroups.

PFMT-st added to silodosin substantially improves clinically meaningful outcomes in men with BPH and OAB symptoms. Men younger than 65 years and those with a baseline voiding frequency of ≤10 voids/24 h appear more likely to respond; pragmatic thresholds and age-based prediction require external validation.