Editorial Comment: Efficacy of Multimodal Therapy for Dysfunctional Voiding in Young Adult Males: A Retrospective Observational Study

For many years, dysfunctional voiding in male patients was addressed as chronic prostatitis, and patients received an absurd number of antibiotic courses never achieving a successful outcome. The pelvic floor has an essential role in micturition, and its adequate relaxation is the initial step in successful voiding. Pelvic floor physical therapy (PFPT) therefore is a crucial part in treatment of these patients.1 Pharmacological aids on relaxing the pelvic floor are poorly investigated, and intravaginal diazepam has shown some improvement in dyspareunia and pelvic floor hypertonicity in small trials.2 Baclofen is widely used as a skeletal muscle relaxant, mainly for neurological problems in which spasticity is a significant problem (cerebral palsy, spinal cord injury). This interesting study by Mittal et al3 combines PFPT (standard treatment) with oral baclofen and showed a significant improvement in symptoms and noninvasive urodynamic parameters. The change from an interrupted flow to a continuous curve in 72% of cases is probably one of the most meaningful findings because it reveals a better relaxed pelvic floor. Unfortunately, this was a single-arm retrospective study, which makes it impossible to isolate the additional effect of baclofen on top of PFPT, especially since physiotherapy alone has shown improvement in around 80% of patients; however, it sets the idea on developing a placebo controlled trial to answer this question. Any pharmacological aid that can improve outcomes or accelerate results of physical therapy would be a great therapeutic advantage in this group of patients, this could be a promising approach to this idea.