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

We thank the editorialist for the thoughtful and balanced commentary on our study.1 We agree that dysfunctional voiding in young men has historically been misattributed to chronic prostatitis, frequently resulting in repeated and ineffective antibiotic therapy. As emphasized, appropriate pelvic floor relaxation is fundamental to normal voiding, and pelvic floor physical therapy (PFPT) remains the cornerstone of management.2 Our rationale for incorporating oral baclofen alongside PFPT was to explore whether a skeletal muscle relaxant could augment or accelerate symptom improvement, given the limited pharmacologic data available for male pelvic floor dysfunction. While intravaginal diazepam has shown modest benefit in female patients, comparable evidence in men is lacking.3 Baclofen's established role in treating spasticity provided a physiologically plausible adjunct. We acknowledge the key limitation of our retrospective single-arm design, which precludes isolation of baclofen's independent effect beyond PFPT alone. Nevertheless, the observed conversion from interrupted to continuous uroflowmetry patterns in a substantial proportion of patients suggests improved pelvic floor relaxation and represents a clinically meaningful finding.4 We view our results as hypothesis-generating and agree that prospective, randomized, placebo-controlled studies are necessary to define the role of pharmacologic adjuncts in this setting. Future progress will likely depend on collaborative, multidisciplinary efforts integrating urology, pelvic floor physiotherapy, and clinical research to better delineate optimal treatment strategies for this underrecognized condition.