Effect of Two Different Standing Urination Positions onClinical Assessment in Patients With Lower UrinaryTract Symptoms: A Significant Factor or a NegligibleDetail?

Background: This study aims to evaluate whether urinating by pulling down the trousers vs. unzipping the trousers only has an effect on maximum flow rate (Qmax), average flow rate (Qave), voiding time and post-void residual urine (PVR) in patients with lower urinary tract symptoms (LUTS) secondary to benign prostate obstruction (BPO). Methods: Patients receiving alpha-blocker therapy and habitually voiding in a standing position were prospectively enrolled. Each participant underwent uroflowmetry (UF) in two separate sessions, with one session involving voiding by pulling the trousers down to the knees and the other involving voiding by unzipping the trousers only. Qmax, Qave, voiding time and PVR volume were recorded and compared between the two positions. Results: A total of 74 patients were included in the analysis. The mean Qmax was 10.80 ± 3.20 mL/s in the unzipping position and 13.10 ± 4.04 mL/s in the pulling-down position. The Qave, voiding time and PVR in the unzipping position were 5.01 ± 2.57 mL/s, 70.80 ± 50.40 s and 63.99 ± 38.11 mL, respectively, and those in the pulling-down position were 5.89 ± 3.09 mL/s, 58.20 ± 26.90 s and 53.38 ± 38.96 mL, respectively. Statistically significant differences were observed in Qmax (p < 0.001), Qave (p < 0.001), PVR volume (p < 0.001) and voiding time (p = 0.006). Conclusions: In patients with LUTS secondary to BPO who void in a standing position, the specific subposition (pulling down trousers vs. unzipping) significantly affects UF parameters and PVR volumes. These findings demonstrate that standing voiding should not be considered as a single, uniform posture. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT06260917; available at https://clinicaltrials.gov/study/NCT 06260917.