Pelvic floor muscle training to improve urinary incontinence after radical prostatectomy: a systematic review of effectiveness.
OBJECTIVE
To evaluate the effectiveness of pelvic floor muscle training (PFMT) for treating urinary incontinence (UI) after radical prostatectomy (RP) by reviewing evidence from randomized trials.


METHODS
Randomized trials published in English were included if they involved men with UI after RP and compared PFMT with a control group. Data were abstracted onto a standardized form using a prospectively developed protocol.


RESULTS
Eleven trials randomizing 1028 men (mean age 64 years) met the inclusion criteria; the duration of the trials was 3-12 months. One trial of 300 men found that those assigned to PFMT achieved continence more quickly (after 1, 3 and 6 months) than men not assigned to PFMT. Men receiving biofeedback-enhanced PFMT were more likely to achieve continence or have no continual leakage than those with no training within 1-2 months after RP (relative benefit increase 1.54; 95% confidence interval 1.01-2.34; four trials reporting). The relative benefit increase (1.19, 0.82-1.72; five studies) was no longer significant after 3-4 months. Biofeedback-enhanced PFMT was comparable to written/verbal PFMT instruction. Extracorporeal magnetic innervation (ExMI) and electrical stimulation (ES) were found to be initially (within 1-2 months) more effective than PFMT in one trial, but there were no significant differences between groups at > or = 3 months.


CONCLUSIONS
Based on available evidence, PFMT with or without biofeedback enhancement hastens the return to continence more than no PFMT in men with UI after RP. Additional trials are needed to confirm whether ExMI and ES are effective conservative treatment options.
MacDonald
Roderick
R
Minneapolis Veterans Affairs Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417, USA.
Fink
Howard A
HA
Huckabay
Chad
C
Monga
Manoj
M
Wilt
Timothy J
TJ
D005081:Exercise Therapy / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D017773:Pelvic Floor; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy*