Pelvic floor muscle training to improve urinary incontinence after radical prostatectomy: A systematic review of effectiveness

OBJECTIVE: To evaluate the effectiveness of pelvic floor muscle training (PFMT) for treating urinary incontinence (UI) after radical prostatectomy (RP) by reviewing evidence from randomized trials. METHODS: Randomized trials published in English were included if they involved men with UI after RP and compared PFMT with a control group. Data were abstracted onto a standardized form using a prospectively developed protocol. RESULTS: Eleven trials randomizing 1028 men (mean age 64 years) met the inclusion criteria; the duration of the trials was 3-12 months. One trial of 300 men found that those assigned to PFMT achieved continence more quickly (after 1, 3 and 6 months) than men not assigned to PFMT. Men receiving biofeedback-enhanced PFMT were more likely to achieve continence or have no continual leakage than those with no training within 1-2 months after RP (relative benefit increase 1.54; 95% confidence interval 1.01-2.34; four trials reporting). The relative benefit increase (1.19, 0.82-1.72; five studies) was no longer significant after 3-4 months. Biofeedback-enhanced PFMT was comparable to written/verbal PFMT instruction. Extracorporeal magnetic innervation (ExMI) and electrical stimulation (ES) were found to be initially (within 1-2 months) more effective than PFMT in one trial, but there were no significant differences between groups at ≥ 3 months. CONCLUSION: Based on available evidence, PFMT with or without biofeedback enhancement hastens the return to continence more than no PFMT in men with UI after RP. Additional trials are needed to confirm whether ExMI and ES are effective conservative treatment options.