Effectiveness of preoperative pelvic floor muscle training for urinary incontinence after radical prostatectomy: a meta-analysis

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Abstract

Background

Radical prostatectomy (RP) is the most common treatment for patients with localized prostate cancer. Urinary incontinence (UI) is a significant bothersome sequela after radical prostatectomy that may dramatically worsen a patient’s quality of life. Pelvic floor muscle training (PFMT) is the main conservation treatment for men experiencing urinary incontinence; however, whether additional preoperative PFMT can hasten the reestablishment of continence is still unclear. The objective of this meta-analysis is to determine whether the effectiveness of preoperative plus postoperative PFMT is better than postoperative PFMT only for the re-establishment of continence after RP.

Methods

A meta-analysis was performed after a comprehensive search of available randomized controlled trials (RCTs). Quality of the included studies was assessed by the Cochrane Risk of Bias tool. Efficacy data were pooled and analyzed using Review Manager (RevMan) Version 5.0. Pooled analyses of continence rates 1, 3, 6, and 12 months postoperatively, using relative risk (RR) and 95% confidence intervals (CIs), were conducted. For data deemed not appropriate for synthesis, a narrative overview was conducted.

Results

Five eligible studies were ultimately included in this analysis. No significant differences in continence rates were detected at the early (1- and 3-month) time points: RR = 1.21, 95% CI = 0.71–2.08, P = 0.48; RR = 1.1, 95% CI = 0.09–1.34, P = 0.34, respectively), interim (6-month time point: RR = 0.98, 95% CI = 0.93–1.04, P = 0.59), or late recovery stage (RR = 0.93, 95% CI = 0.67–1.29, P = 0.66). Outcomes reported were time to continence in two trials and quality of life in three, but results were inconclusive because of insufficient data.

Conclusion

According to this meta-analysis, additional preoperative PFMT did not improve the resolution of UI after RP at early (≤3-month), interim (6-month), or late (1-year) recovery stages. However, the results of time to continence and quality of life were inconclusive because of insufficient data. More high-quality RCTs are needed for better evaluation of the effectiveness of preoperative PFMT on post-prostatectomy UI.

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Most cited references 20

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Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinence: a randomized, controlled trial.

Kathryn L Burgio, Patricia S Goode, Donald A Urban … (2005)

We tested the effectiveness of preoperative biofeedback assisted behavioral training for decreasing the duration and severity of incontinence, and improving quality of life in the 6 months following radical prostatectomy. We performed a prospective, randomized, controlled trial comparing preoperative behavioral training to usual care. The volunteer sample included 125 men 53 to 68 years old who elected radical prostatectomy for prostate cancer. Patients were stratified according to age and tumor differentiation, and randomized to 1 preoperative session of biofeedback assisted behavioral training plus daily home exercise or a usual care control condition, consisting of simple postoperative instructions to interrupt the urinary stream. The main outcome measurements were duration of incontinence (time to continence), as derived from bladder diaries, incontinence severity (the proportion with severe/continual leakage), pad use, Incontinence Impact Questionnaire, psychological distress (Hopkins Symptom Checklist) and health related quality of life (Medical Outcomes Study Short Form Health Survey). Preoperative behavioral training significantly decreased time to continence (p = 0.03) and the proportion of patients with severe/continual leakage at the 6-month end point (5.9% vs 19.6%, p = 0.04). There were also significant differences between the groups for self-reported urine loss with coughing (22.0% vs 51.1%, p = 0.003), sneezing (26.0% vs 48.9%, p = 0.02) and getting up from lying down (14.0% vs 31.9%, p = 0.04). No differences were found on return to work and usual activities or quality of life measures. Preoperative behavioral training can hasten the recovery of urine control and decrease the severity of incontinence following radical prostatectomy.

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Postprostatectomy incontinence: all about diagnosis and management.

Ricarda M Bauer, Patrick J Bastian, Christian Gozzi … (2009)

The ever-increasing number of radical prostatectomies entails an increasing number of patients suffering from postprostatectomy stress incontinence despite improved surgical techniques. We provide an overview of the current diagnosis and treatment of postprostatectomy stress incontinence. To review previous and recent literature on this subject and to assess the current standards of diagnosis and management of postprostatectomy incontinence. The PubMed database was searched, and all articles published since 2000 were evaluated. This review presents the current recommended diagnostic tools and available noninvasive and invasive treatment options. The European Association of Urology (EAU) recommends a two-stage assessment for diagnosis of postprostatectomy incontinence. Noninvasive therapy, pelvic floor-muscle training and biofeedback, is recommended in early postoperative and mild incontinence. Pharmacological treatment with duloxetine is especially effective in combination with physiotherapy, where it synergistically improves the continence rate. For surgical treatment, the insertion of an artificial urinary sphincter, AS-800, is still the gold standard. In recent years, several minimal invasive treatment options have been introduced with different rates of success, but they have not yet surpassed the results of the artificial sphincter.

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The role of pelvic floor exercises on post-prostatectomy incontinence.

A R Parekh, M Feng, D Kirages … (2003)

Post-radical prostatectomy incontinence occurs in 0.5% to 87% of patients. This condition may be attributable to intrinsic sphincteric deficiency, and/or detrusor abnormalities. Previous studies of pelvic floor exercise (PFE) for improving post-prostatectomy incontinence have shown mixed results. We determined whether preoperative and early postoperative biofeedback enhanced PFE with a dedicated physical therapist would improve the early return of urinary incontinence. A total of 38 consecutive patients undergoing radical prostatectomy from November 1998 to June 1999 were randomly assigned to a control or a treatment group. The treatment group of 19 patients was referred to physical therapy and underwent PFE sessions before and after surgery. Patients were also given instructions to continue PFE at home twice daily after surgery. The control group of 19 men underwent surgery without formal PFE instructions. All patients completed postoperative urinary incontinence questionnaires at 6, 12, 16, 20, 28 and 52 weeks. Incontinence was measured by the number of pads used with 0 or 1 daily defined as continence. Overall 66% of the patients were continent at 16 weeks. A greater fraction of the treatment group regained urinary continence earlier compared with the control group at 12 weeks (p <0.05). Three control and 2 treatment group patients had severe incontinence (greater than 3 pads daily) at 16 and 52 weeks. Of all patients 82% regained continence by 52 weeks. PFE therapy instituted prior to radical prostatectomy aids in the earlier achievement of urinary incontinence. However, PFE has limited benefit in patients with severe urinary incontinence 16 weeks after surgery. There is a minimal long-term benefit of PFE training since continence rates at 1 year were similar in the 2 groups.

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Author and article information

Contributors

Wei Wang: wangw2002@163.com

Qing Mei Huang: blesshuang@hotmail.com

Feng Ping Liu: liulaoshiyc@163.com

Qi Qi Mao: uromao@126.com

Journal

Journal ID (nlm-ta): BMC Urol

Journal ID (iso-abbrev): BMC Urol

Title: BMC Urology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2490

Publication date (Electronic): 16 December 2014

Publication date PMC-release: 16 December 2014

Publication date Collection: 2014

Volume: 14

Issue: 1

Electronic Location Identifier: 99

Affiliations

[ ]Nursing Education Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang 310003 People’s Republic of China

[ ]Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang 310003 People’s Republic of China

Article

Publisher ID: 390

DOI: 10.1186/1471-2490-14-99

PMC ID: 4274700

PubMed ID: 25515968

SO-VID: a181842d-0e36-4ac2-901f-4782ab7794ce

License:

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 31 August 2014

Date accepted : 11 December 2014

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ScienceOpen disciplines: Urology

Keywords: pelvic floor muscle training,urinary incontinence,prostate cancer,meta-analysis

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ScienceOpen disciplines: Urology

Keywords: pelvic floor muscle training, urinary incontinence, prostate cancer, meta-analysis

Effectiveness of preoperative pelvic floor muscle training for urinary incontinence after radical prostatectomy: a meta-analysis

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Most cited references 20

Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinence: a randomized, controlled trial.

Postprostatectomy incontinence: all about diagnosis and management.

The role of pelvic floor exercises on post-prostatectomy incontinence.

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