What is the treatment for post-void dribbling (PVD) in men?

From the Guidelines

Post-void dribbling (PVD) in men can be effectively managed with a combination of lifestyle modifications and medical interventions, prioritizing the patient's quality of life and minimizing morbidity and mortality risks. The most recent and highest quality study on the topic is from 2017 1, which provides guidance on the diagnosis and management of urethral stricture, a potential cause of PVD.

Key Management Strategies:

• Lifestyle changes: reducing caffeine and alcohol intake, maintaining a healthy weight, and avoiding constipation can improve symptoms.
• Pelvic floor exercises (Kegels): contract the muscles that stop urine flow for 3-5 seconds, release, and repeat 10-15 times, three times daily.
• Double-voiding: after urinating, wait a moment and try again to empty the bladder completely.
• Urethral milking technique: after urinating, press with fingers behind the scrotum and move forward along the underside of the penis to squeeze out remaining urine.

Medical Interventions:

• Alpha-blockers (e.g., tamsulosin 0.4mg daily) or 5-alpha reductase inhibitors (e.g., finasteride 5mg daily) may help, especially if an enlarged prostate is causing the problem.
• Consult a healthcare provider before starting any medication to determine the underlying cause and recommend appropriate treatment. It is essential to note that the 2003 AUA guideline on management of benign prostatic hyperplasia 1 provides optional diagnostic tests, such as urinary flow-rate recording and measurement of post-void residual urine, which may aid in the selection of an invasive treatment. However, the 2017 study 1 provides more recent and relevant guidance on the management of PVD.

Diagnostic Considerations:

• Urethral stricture should be considered in the differential diagnosis of men with decreased urinary stream, incomplete emptying, dysuria, urinary tract infection, and rising post-void residual.
• Noninvasive measures, such as uroflowmetry and ultrasound post-void residual assessment, may be used in the initial evaluation of suspected urethral stricture.
• Definitive evaluation, such as urethro-cystoscopy, retrograde urethrography, or ultrasound urethrography, is essential for confirmation of the diagnosis and assessment of stricture severity.

From the Research

Treatment for Post-Void Dribbling (PVD) in Men

There are no specific research papers provided that directly address the treatment for post-void dribbling (PVD) in men. However, some studies discuss the treatment of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH), which may be related to PVD.

Treatment Options for LUTS and BPH

• Alpha1-blockers can quickly reduce LUTS to a similar extent as other treatments 2
• 5-alpha-reductase inhibitors can slowly reduce LUTS and the probability of urinary retention or the need for surgery, especially in men with enlarged prostates 2, 3
• Combination therapy with alpha1-blockers and 5-alpha-reductase inhibitors can be effective for treating LUTS secondary to BPH 4
• Transurethral resection of the prostate (TURP) is a common surgical treatment for BPH, but it carries a higher risk of morbidity and complications compared to medical therapy 2, 3

Management of Urinary Retention

• Postoperative urinary retention (POUR) is a common condition encountered during ambulatory surgical procedures, including penile prosthesis implantation 5
• The use of both alpha-blockers and 5-alpha-reductase inhibitors is significantly associated with a greater risk of POUR 5
• POUR can be managed with indwelling catheterization or repeated clean intermittent catheterization (CIC) 5