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      Influence of preoperative and postoperative pelvic floor muscle training (PFMT) compared with postoperative PFMT on urinary incontinence after radical prostatectomy: a randomized controlled trial.

      European Urology

      Urodynamics, Adult, prevention & control, physiopathology, etiology, diagnosis, Urinary Incontinence, Treatment Outcome, Time Factors, Risk Factors, Recovery of Function, Quality of Life, adverse effects, Prostatectomy, Prospective Studies, Proportional Hazards Models, Pelvic Floor, Middle Aged, Male, Kaplan-Meier Estimate, Humans, Exercise Therapy, Belgium, Aged

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          The efficacy of preoperative pelvic floor muscle training (PFMT) for urinary incontinence (UI) after open radical prostatectomy (ORP) and robot-assisted laparoscopic radical prostatectomy (RARP) is still unclear. To determine whether patients with additional preoperative PFMT regain urinary continence earlier than patients with only postoperative PFMT after ORP and RARP. A randomized controlled trial enrolled 180 men who planned to undergo ORP/RARP. The experimental group (E, n=91) started PFMT 3 wk before surgery and continued after surgery. The control group (C, n=89) started PFMT after catheter removal. The primary end point was time to continence. Patients measured urine loss daily (24-h pad test) until total continence (three consecutive days of 0 g of urine loss) was achieved. Secondary end points were 1-h pad test, visual analog scale (VAS), International Prostate Symptom Score (IPSS), and quality of life (King's Health Questionnaire [KHQ]). Kaplan-Meier analysis and Cox regression with correction for two strata (age and type of surgery) compared time and continence. The Fisher exact test was applied for the 1-h pad test and VAS; the Mann-Whitney U test was applied for IPSS and KHQ. Patients with additional preoperative PFMT had no shorter duration of postoperative UI compared with patients with only postoperative PFMT (p=0.878). Median time to continence was 30 and 31 d, and median amount of first-day incontinence was 108 g and 124 g for groups E and C, respectively. Cox regression did not indicate a significant difference between groups E and C (p=0.773; hazard ratio: 1.047 [0.768-1.425]). The 1-h pad test, VAS, and IPSS were comparable between both groups. However, "incontinence impact" (KHQ) was in favor of group E at 3 mo and 6 mo after surgery. Three preoperative sessions of PFMT did not improve postoperative duration of incontinence. Netherlands Trial Register No. NTR 1953. Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.

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