Voiding Posture as a Novel Determinant of Postmicturition Dribble: Insights from a Nationwide Epidemiological Survey

Purpose To investigate factors associated with postmicturition dribble (PMD) across a wide age spectrum of men, with particular emphasis on behavioral and functional determinants beyond conventional mechanisms related to lower urinary tract symptoms (LUTS). Methods This was a subanalysis of a nationwide web-based epidemiological survey conducted by the Japanese Continence Society. Overall, 3,122 men aged 20–99 years were included. PMD was assessed using a standardized questionnaire, and demographic, clinical, lifestyle, and LUTS-related variables, including voiding posture and erectile dysfunction, were analyzed. Multivariable logistic regression analysis was performed to identify independent factors associated with PMD in the overall cohort and in men aged ≤ 50 years. Results PMD was reported by 467 (15.0%) men. Among 1,450 men aged ≤ 50 years, PMD was present in 12.8%, despite low prevalences of benign prostatic hyperplasia (2.3%) and overactive bladder (7.1%). In the overall cohort, older age, frailty, erectile dysfunction, intermittent urinary stream, and abdominal straining at the end of voiding were independently associated with PMD. Multivariable analysis showed that erectile dysfunction (adjusted odds ratio [OR]: 1.40, 95% confidence interval [CI]: 1.07–1.82) and frailty (adjusted OR: 1.76, 95% CI: 1.11–2.78) were significant non–LUTS-related factors associated with PMD. In men aged ≤ 50 years, sitting voiding posture (adjusted OR: 1.59, 95% CI: 1.04–2.45) emerged as an independent PMD predictor. Conclusions PMD is a common multifactorial condition that affects men across age groups. In younger men, PMD appears to be influenced not only by LUTS-related factors but also by behavioral factors, including voiding posture.