Effects of Pelvic Floor Muscle Training Combined With Bladder Training on Some Parametrs of Men With Urinary Frequency

Study Design:

Prospective Single-center Parallel-group 1:1 randomized Assessor-blinded RCT CONSORT-compliant

Inclusion criteria

Male Age 18-65 years Complaint of urinary frequency persisting for at least 3 months

On a 3-day bladder diary:

≥8 voids/24 hours Provision of written informed consent Sufficient cognitive capacity to learn pelvic floor muscle contraction

Exclusion criteria

Active urinary tract infection Prostate cancer Prostate surgery within the last 12 months

Neurological diseases:

Parkinson's disease Multiple sclerosis (MS) Stroke Spinal cord injury Neurogenic bladder due to diabetes mellitus Bladder stones Bladder tumor Urethral stricture

Within the last 3 months:

PFMT (pelvic floor muscle training) Biofeedback PTNS (percutaneous tibial nerve stimulation) Tibial nerve stimulation Recent dose change in antimuscarinic or β3-agonist therapy Randomization Computer-generated block randomization Block size of 4 or 6 Allocation concealment Sealed opaque envelopes

Assessment Time Points T0 = Baseline T1 = Week 6 T2 = Week 12 T3 = 6-month follow-up Primary Outcome 3-day bladder diary 24-hour voiding frequency

Secondary Outcomes OAB-V8 Symptom severity ICIQ-OAB Quality of life and symptom impact PGI-I Patient global impression of improvement

Ultrasound Measurements A) Pelvic Floor Muscle Strength Transabdominal ultrasound

During maximum voluntary contraction:

Bladder neck elevation (mm) 3 repetitions Average will be calculated

B) Pelvic Floor Muscle Endurance Following maximum contraction 10-second hold Duration of bladder neck elevation maintenance or Percentage of elevation maintained over 10 seconds

C) Post-Void Residual Volume (PVR) Via ultrasound Within the first 5 minutes after voiding Recorded in mL

Interventions Group 1 Bladder Training Urge suppression strategies Extending voiding intervals Fluid management Caffeine education ● (placeholder/bullet) Pelvic Floor Muscle Training 8 weeks

1 face-to-face session per week Home exercise program Fast contractions: 10 reps × 3 sets Maximal (sustained) contractions: 10 reps × 10 seconds each Functional contractions: To be performed when urgency is felt

Group 2 Bladder training only Same follow-up frequency Same training duration

Inclusion criteria

• Male sex
• Age 18-65 years
• Complaint of urinary frequency persisting for at least 3 months
• On a 3-day bladder diary: ≥8 voids per 24 hours
• Provision of written informed consent Sufficient cognitive capacity to learn pelvic floor muscle contraction (assessed by clinical judgment)

Exclusion criteria

• Active urinary tract infection
• Prostate cancer
• Prostate surgery within the last 12 months
• Parkinson's disease, Multiple sclerosis (MS), Stroke, Spinal cord injury
• Neurogenic bladder due to diabetes mellitus
• Bladder stones, Bladder tumor, Urethral stricture