Review – IncontinencePreoperative Pelvic Floor Muscle Exercise and Postprostatectomy Incontinence: A Systematic Review and Meta-analysis☆
Introduction
Urinary incontinence (UI) is one of the most common side effects of radical prostatectomy (RP) and can substantially affect a man's quality of life (QoL). The rates of UI vary with the type of procedure or surgical technique [1]. Reported rates of UI after RP vary and depend on definition but have been reported up to 87% at 1 mo postoperatively [2]; however, UI generally improves by the 1-yr postoperative mark [3]. The cause of UI is considered to be multifactorial and the result of urethral sphincter deficiency or laxity and the destruction of support mechanisms through surgical injury; detrusor overactivity, impaired bladder sensation, and low bladder compliance can occur [4], [5]. There are many preoperative, intraoperative, and postoperative interventions in current practice for the prevention and treatment of UI for after RP. One of these interventions is pelvic floor muscle exercise (PFME) with or without biofeedback. PFME is often guided by a physiotherapist and can be performed with or without biofeedback. Biofeedback may be given to the patient via auditory, tactile, or visual feedback of their pelvic muscle function.
A Cochrane Review evaluating postoperative PFME reported that the evidence is conflicting, and the value of postoperative PFME following prostatectomy remains uncertain [6]. We aimed to determine the effectiveness of preoperative PFME for improving postoperative UI following RP.
Section snippets
Search strategy
A systematic Medline, Embase, and Cochrane Library search was conducted 4 October 2014. The search strategy keywords used were selected to be as sensitive as possible; iterations and suggested terms were included and used if possible (Supplementary Table 1 and 2). Cited references from selected studies were also retrieved. A total of 44 articles were retrieved from the literature search. One related article that fit the selection criteria was also identified and added to the pool of articles
Included trials
We included 11 studies in this systematic review; however, only 7 studies [7], [8], [10], [13], [14], [15], [17] had sufficient quantitative data on postoperative incontinence available for meta-analysis. Table 2 depicts the characteristics of the studies included. The data on this topic are quite recent because more than half of these studies were published in the past 5 yr.
Quality of included trials
We assessed the risk of bias for each study as per the guidelines of the Cochrane handbook [20] (Table 3). Of the 11
Conclusions
Based on this systematic review and meta-analysis, preoperative PFME may aid early UI recovery and increase the QoL of patients after RP.
References (27)
- et al.
A prospective study of quantification of urinary incontinence and quality of life in patients undergoing radical retropubic prostatectomy
Urology
(1996) - et al.
Effect of preoperative biofeedback/pelvic floor training on continence in men undergoing radical prostatectomy
Urology
(2000) - et al.
Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinence: a randomized, controlled trial
J Urol
(2006) - et al.
Intensive preoperatory pelvic floor muscle training reduce duration and severity of stress urinary incontinence after radical prostatectomy: a randomized controlled trial [abstract 1007]
Eur Urol Suppl
(2013) - 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) - et al.
The role of pelvic floor exercises on post-prostatectomy incontinence
J Urol
(2003) - et al.
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
Int J Surg
(2010) - et al.
Meta-analysis in clinical trials
Control Clin Trials
(1986) - et al.
Patient-reported urinary continence and sexual function after anatomic radical prostatectomy
Urology
(2000) - et al.
Risk factors for urinary incontinence after radical prostatectomy
J Urol
(1996)
Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: A randomised controlled trial
Lancet
The management of stress urinary incontinence after radical prostatectomy
BJU Int
Urinary incontinence following treatment of localized prostate cancer
Cancer Control
Cited by (92)
French AFU Cancer Committee Guidelines - Update 2022-2024: prostate cancer - Diagnosis and management of localised disease
2022, Progres en UrologieCitation Excerpt :Prehabilitation improves functional outcomes after surgery [191,192]. It can include preoperative perineal physiotherapy to improve early return to urinary continence [193]. Oncological neoadjuvant treatments (hormone therapy, chemotherapy, radiotherapy) are not recommended, except in clinical trials.
Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews
2022, British Journal of AnaesthesiaThe significance of transrectal ultrasound and urologist_dually guided pelvic floor muscle exercise in improving urinary continence after radical prostatectomy
2023, European Journal of Medical Research
- ☆
Please visit www.eu-acme.org/europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically.