Physiotherapy for continence and muscle function in prostatectomy: a randomised controlled trial

BJU Int. 2024 Sep;134(3):398-406. doi: 10.1111/bju.16369. Epub 2024 Apr 24.

Abstract

Objective: To assess the effectiveness of pre- and postoperative supervised pelvic floor muscle training (PFMT) on the recovery of continence and pelvic floor muscle (PFM) function after robot-assisted laparoscopic radical prostatectomy (RARP).

Patients and methods: We carried out a single-blind randomised controlled trial involving 54 male patients scheduled to undergo RARP. The intervention group started supervised PFMT 2 months before RARP and continued for 12 months after surgery with a physiotherapist. The control group was given verbal instructions, a brochure about PFMT, and lifestyle advice. The primary outcome was 24-h pad weight (g) at 3 months after RARP. The secondary outcomes were continence status (assessed by pad use), PFM function, and the Expanded Prostate Cancer Index Composite (EPIC) score.

Results: Patients who participated in supervised PFMT showed significantly improved postoperative urinary incontinence (UI) compared with the control group (5.0 [0.0-908.0] g vs 21.0 [0.0-750.0] g; effect size: 0.34, P = 0.022) at 3 months after RARP based on 24-h pad weight. A significant improvement was seen in the intervention compared with the control group (65.2% continence [no pad use] vs 31.6% continence, respectively) at 12 months after surgery (effect size: 0.34, P = 0.030). Peak pressure during a maximum voluntary contraction was higher in the intervention group immediately after catheter removal and at 6 months, and a longer duration of sustained contraction was found in the intervention group compared with the control group. We were unable to demonstrate a difference between groups in EPIC scores.

Conclusion: Supervised PFMT can improve postoperative UI and PFM function after RARP. Further studies are needed to confirm whether intra-anal pressure reflects PFM function and affects continence status in UI in men who have undergone RARP.

Keywords: continence; intra‐anal manometry; pelvic floor muscle function; pelvic floor muscle training; physiotherapy; randomised controlled trial; robot‐assisted laparoscopic radical prostatectomy; urinary incontinence.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Exercise Therapy / methods
  • Humans
  • Male
  • Middle Aged
  • Pelvic Floor* / physiopathology
  • Physical Therapy Modalities
  • Postoperative Care / methods
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Prostatectomy* / adverse effects
  • Prostatectomy* / methods
  • Prostatic Neoplasms* / surgery
  • Single-Blind Method
  • Treatment Outcome
  • Urinary Incontinence* / etiology
  • Urinary Incontinence* / physiopathology
  • Urinary Incontinence* / prevention & control