Elsevier

European Urology

Volume 69, Issue 3, March 2016, Pages 460-467
European Urology

Review – Incontinence
Preoperative Pelvic Floor Muscle Exercise and Postprostatectomy Incontinence: A Systematic Review and Meta-analysis

https://doi.org/10.1016/j.eururo.2015.11.004Get rights and content

Abstract

Context

Preoperative pelvic floor muscle exercise (PFME) is often prescribed to reduce the severity of postprostatectomy incontinence.

Objective

Systematic review and meta-analysis of evidence regarding the effect of preoperative PFME on postoperative urinary incontinence following radical prostatectomy.

Evidence acquisition

A systematic search was performed of the Cochrane Library, Medline, Embase, and all potential articles from references in relevant articles on 4 October 2014. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Identified reports were critically appraised for quality and relevance. Only studies of preoperative PFME compared with no preoperative PFME were included.

Evidence synthesis

Eleven studies were included based on the selection criteria. The total number of patients included in the final analysis was 739. In seven studies, sufficient quantitative data on postoperative incontinence were available for meta-analysis. At 1 mo, there was no difference in continence rates between the groups (odds ratio [OR]: 0.68; 95% confidence interval [CI], 0.45–1.03). At 3 mo, there was 36% improvement in the preoperative PFME group (OR: 0.64; 95% CI, 0.47–0.88). At 6 mo, there was no difference between groups (OR: 0.60; 95% CI, 0.32–1.15). When examining quality of life measures, four of seven studies demonstrated significant improvement in the preoperative PFME group at 3 mo, and two of these studies demonstrated significant differences at 6 mo.

Conclusions

Preoperative PFME improves postoperative urinary incontinence after radical prostatectomy at 3 mo but not at 6 mo, suggesting it improves early continence but not long-term continence rates.

Patient summary

We reviewed all evidence for preoperative pelvic floor muscle exercise (PFME) in treating urinary incontinence following radical prostatectomy. We found evidence to suggest that preoperative PFME improves early continence rates but not long-term continence rates.

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)

  • M. Van Kampen et al.

    Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: A randomised controlled trial

    Lancet

    (2000)
  • M. Peyromaure et al.

    The management of stress urinary incontinence after radical prostatectomy

    BJU Int

    (2002)
  • P. Grise et al.

    Urinary incontinence following treatment of localized prostate cancer

    Cancer Control

    (2001)
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