The Effect of Preoperative Pelvic Floor Muscle Training on Incontinence Problems after Radical Prostatectomy: A Meta-Analysis
23 February 2021
Purpose: To evaluate whether additional PFMT, which began before radical prostatectomy and resumes immediately after catheter removal, will significantly improve urinary incontinence after RP.
Materials and Methods: We reviewed articles obtained from MEDLINE, CENTRAL, EBSCOHost, CINAHL, and Elsevier from July – August 2020, which compared preoperative PFMT with postoperative PMFT or non-PFMT, with continence incidence parameters. There were no restrictions on the definition of incontinence, treatment regimens, and radical prostatectomy surgical approach. The risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool. A meta-analysis was also carried out to pool the effect estimates.
Results: We included 12 eligible studies in this review, 11 of which we included in the meta-analysis. The PFMT initiated preoperatively significantly reduced the incidence of persistent urinary incontinence at 1, 3, and 6 months postoperatively with an OR of 0.58 (95% CI, 0.41–0.81), 0.57 (95% CI, 0.43–0.74), and 0.38 (95% CI, 0.17-0.83). There was no difference in improvement in patients' incontinence at 12 months postoperatively [OR = 1.31 (95% CI, 0.65-2.63)].
Conclusion: PFMT initiated before radical prostatectomy significantly reduced the incidence of urinary incontinence in the first, third, and sixth months postoperatively. At 12 months postoperatively, additional preoperative PFMT did not cause a significant difference in urinary incontinence incidence.
- pelvic floor muscle training
- urinary incontinence
- radical prostatectomy
How to Cite
2. Rawla P. Epidemiology of Prostate Cancer. World J Oncol. 2019 Apr;10(2):63–89.
3. Cooperberg MR, Broering JM, Litwin MS, Lubeck DP, Mehta SS, Henning JM, et al. The contemporary management of prostate cancer in the United States: lessons from the cancer of the prostate strategic urologic research endeavor (CapSURE), a national disease registry. J Urol. 2004 Apr;171(4):1393–401.
4. Krupski TL, Saigal CS, Litwin MS. Variation in continence and potency by definition. J Urol. 2003 Oct;170(4 Pt 1):1291–4.
5. Olsson LE, Salomon L, Nadu A, Hoznek A, Cicco A, Saint F, et al. Prospective patient-reported continence after laparoscopic radical prostatectomy. Urology. 2001 Oct;58(4):570–2.
6. Rodriguez E, Skarecky DW, Ahlering TE. Post-robotic prostatectomy urinary continence: characterization of perfect continence versus occasional dribbling in pad-free men. Urology. 2006 Apr;67(4):785–8.
7. Talcott JA, Rieker P, Propert KJ, Clark JA, Kantoff PW, Wishnow KI, et al. Patient-Reported Impotence and Incontinence After Nerve-Sparing Radical Prostatectomy. JNCI J Natl Cancer Inst. 1997 Aug 6;89(15):1117–23.
8. Braslis K g., Santa-Cruz C, Brickman A l., Soloway M s. Quality of life 12 months after radical prostatectomy. Br J Urol. 1995 Jan 1;75(1):48–53.
9. Johansson E, Steineck G, Holmberg L, Johansson J-E, Nyberg T, Ruutu M, et al. Long-term quality-of-life outcomes after radical prostatectomy or watchful waiting: the Scandinavian Prostate Cancer Group-4 randomised trial. Lancet Oncol. 2011 Sep 1;12(9):891–9.
10. Hu JC, Elkin EP, Pasta DJ, Lubeck DP, Kattan MW, Carroll PR, et al. Predicting quality of life after radical prostatectomy: results from CaPSURE. J Urol. 2004 Feb;171(2 Pt 1):703–7; discussion 707-708.
11. Ficarra V, Borghesi M, Suardi N, De Naeyer G, Novara G, Schatteman P, et al. Long-term evaluation of survival, continence and potency (SCP) outcomes after robot-assisted radical prostatectomy (RARP). BJU Int. 2013 Aug;112(3):338–45.
12. Frawley HC, Dean SG, Slade SC, Hay-Smith EJC. Is Pelvic-Floor Muscle Training a Physical Therapy or a Behavioral Therapy? A Call to Name and Report the Physical, Cognitive, and Behavioral Elements. Phys Ther. 2017 01;97(4):425–37.
13. Meyer P. [Algorithms and urinary incontinence in the elderly. Assessment, treatment, recommendations and levels of evidence. Review]. Progres En Urol J Assoc Francaise Urol Soc Francaise Urol. 2017 Mar;27(3):111–45.
14. Santa Mina D, Matthew AG, Hilton WJ, Au D, Awasthi R, Alibhai SMH, et al. Prehabilitation for men undergoing radical prostatectomy: a multi-centre, pilot randomized controlled trial. BMC Surg. 2014 Nov 13;14:89.
15. Prota C, Gomes CM, Ribeiro LHS, de Bessa J, Nakano E, Dall’Oglio M, et al. Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, randomized, controlled trial. Int J Impot Res. 2012 Sep;24(5):174–8.
16. Filocamo MT, Li Marzi V, Del Popolo G, Cecconi F, Marzocco M, Tosto A, et al. Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. Eur Urol. 2005 Nov;48(5):734–8.
17. Anderson CA, Omar MI, Campbell SE, Hunter KF, Cody JD, Glazener CMA. Conservative management for postprostatectomy urinary incontinence. Cochrane Database Syst Rev. 2015 Jan 20;1:CD001843.
18. Centemero A, Rigatti L, Giraudo D, Lazzeri M, Lughezzani G, Zugna D, et al. Preoperative Pelvic Floor Muscle Exercise for Early Continence After Radical Prostatectomy: A Randomised Controlled Study. Eur Urol. 2010 Mar 1;57:1039–43.
19. Burgio KL, Goode PS, Urban DA, Umlauf MG, Locher JL, Bueschen A, et al. Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinence: a randomized, controlled trial. J Urol. 2006 Jan;175(1):196–201; discussion 201.
20. Dijkstra-Eshuis J, Van den Bos TWL, Splinter R, Bevers RFM, Zonneveld WCG, Putter H, et al. Effect of preoperative pelvic floor muscle therapy with biofeedback versus standard care on stress urinary incontinence and quality of life in men undergoing laparoscopic radical prostatectomy: a randomised control trial. Neurourol Urodyn. 2015 Feb;34(2):144–50.
21. Geraerts I, Van Poppel H, Devoogdt N, Joniau S, Van Cleynenbreugel B, De Groef A, et al. Influence of preoperative and postoperative pelvic floor muscle training (PFMT) compared with postoperative PFMT on urinary incontinence after radical prostatectomy: a randomized controlled trial. Eur Urol. 2013 Nov;64(5):766–72.
22. Patel MI, Yao J, Hirschhorn AD, Mungovan SF. Preoperative pelvic floor physiotherapy improves continence after radical retropubic prostatectomy. Int J Urol Off J Jpn Urol Assoc. 2013 Oct;20(10):986–92.
23. Lira GHS de, Fornari A, Cardoso LF, Aranchipe M, Kretiska C, Rhoden EL, et al. Effects of perioperative pelvic floor muscle training on early recovery of urinary continence and erectile function in men undergoing radical prostatectomy: a randomized clinical trial. Int Braz J Urol. 2019 Nov;45(6):1196–203.
24. Aydın Sayılan A, Özbaş A. The Effect of Pelvic Floor Muscle Training On Incontinence Problems After Radical Prostatectomy. Am J Mens Health. 2018 Jul;12(4):1007–15.
25. Bales GT, Gerber GS, Minor TX, Mhoon DA, McFarland JM, Kim HL, et al. Effect of preoperative biofeedback/pelvic floor training on continence in men undergoing radical prostatectomy. Urology. 2000 Oct 1;56(4):627–30.
26. Collado SA, Pellicer CM, Ramirez BM, Dominguez-Escrig J, Rubio-Briones J, Gomez-Ferrer A, et al. 1007 Intensive preoperatory Pelvic Floor Muscle Training reduce duration and severity of stress urinary incontinence after radical prostatectomy: A randomized controlled trial. Eur Urol Suppl. 2013 Mar 1;12(1):e1007–8.
27. Parekh AR, Feng MI, Kirages D, Bremner H, Kaswick J, Aboseif S. The role of pelvic floor exercises on post-prostatectomy incontinence. J Urol. 2003 Jul;170(1):130–3.
28. Tienforti D, Sacco E, Marangi F, D’Addessi A, Racioppi M, Gulino G, et al. Efficacy of an assisted low-intensity programme of perioperative pelvic floor muscle training in improving the recovery of continence after radical prostatectomy: a randomized controlled trial. BJU Int. 2012 Oct;110(7):1004–10.
29. Yoshida M, Matsunaga A, Igawa Y, Fujimura T, Shinoda Y, Aizawa N, et al. May perioperative ultrasound-guided pelvic floor muscle training promote early recovery of urinary continence after robot-assisted radical prostatectomy? Neurourol Urodyn. 2019;38(1):158–64.
30. Leach GE. Post-prostatectomy incontinence: the importance of bladder dysfunction. J Urol. 1995 Mar;153(3 Pt 2):1038.
31. Goluboff ET, Saidi JA, Mazer S, Bagiella E, Heitjan DF, Benson MC, et al. Urinary continence after radical prostatectomy: the Columbia experience. J Urol. 1998 Apr;159(4):1276–80.
32. Aboseif SR, O’Connell HE, Usui A, McGuire EJ. Collagen injection for intrinsic sphincteric deficiency in men. J Urol. 1996 Jan;155(1):10–3.
33. Chao R, Mayo ME. Incontinence after radical prostatectomy: detrusor or sphincter causes. J Urol. 1995 Jul;154(1):16–8.
34. Majoros A, Bach D, Keszthelyi A, Hamvas A, Romics I. Urinary incontinence and voiding dysfunction after radical retropubic prostatectomy (prospective urodynamic study). Neurourol Urodyn. 2006;25(1):2–7.
35. Berghmans LC, Hendriks HJ, Bo K, Hay-Smith EJ, de Bie RA, van Waalwijk van Doorn ES. Conservative treatment of stress urinary incontinence in women: a systematic review of randomized clinical trials. Br J Urol. 1998 Aug;82(2):181–91.
36. Manley L, Gibson L, Papa N, Beharry BK, Johnson L, Lawrentschuk N, et al. Evaluation of pelvic floor muscle strength before and after robotic-assisted radical prostatectomy and early outcomes on urinary continence. J Robot Surg. 2016 Dec;10(4):331–5.
37. Chang JI, Lam V, Patel MI. Preoperative Pelvic Floor Muscle Exercise and Postprostatectomy Incontinence: A Systematic Review and Meta-analysis. Eur Urol. 2016 Mar;69(3):460–7.
38. Wang W, Huang QM, Liu FP, Mao QQ. Effectiveness of preoperative pelvic floor muscle training for urinary incontinence after radical prostatectomy: a meta-analysis. BMC Urol [Internet]. 2014 Dec 16 [cited 2020 Aug 4];14. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274700/
39. Wu M-L-Y, Wang C-S, Xiao Q, Peng C-H, Zeng T-Y. The therapeutic effect of pelvic floor muscle exercise on urinary incontinence after radical prostatectomy: a meta-analysis. Asian J Androl. 2019 Apr;21(2):170–6.
- Abstract Viewed: 0 times
- Just Accepted/6481 Downloaded: 0 times