Preoperative pelvic floor muscle exercise for early continence after radical prostatectomy: a randomised controlled study.
BACKGROUND
Despite improvements in surgical techniques, urinary incontinence (UI) is not uncommon after radical prostatectomy (RP), and it may dramatically worsen quality of life (QoL).


OBJECTIVE
To determine the benefit of starting pelvic floor muscle exercise (PFME) 30d before RP and of continuing PFME postoperatively for early recovery of continence.


METHODS
A randomised, prospective study was designed. Men with localised prostate cancer (PCa) who underwent an open radical retropubic prostatectomy (RRP) at our department of urology were included.


METHODS
Patients were randomised to start PFME preoperatively and continue postoperatively (active group: A) or to start PFME postoperatively alone (control group: B).


METHODS
The primary outcome measure was self-reported continence after surgery. Secondary outcome measures were assessed by degree of UI based on a 24-h pad test and QoL instruments (International Continence Society [ICS] male short form [SF]).


CONCLUSIONS
Of 143 men evaluated for the study, 118 were randomised either to start PFME preoperatively and continue postoperatively (group A; n=59) or to start postoperative PFME (group B; n=59). After 1 mo, 44.1% (26 of 59) of patients were continent in group A, while 20.3% (12 of 59) were continent in group B (p=0.018). At 3 mo, 59.3% (35 of 59) and 37.3% (22 of 59) patients were continent in group A and group B, respectively (p=0.028). The ICS male SF mean score showed better results in group A than in group B patients at both 1 mo (14.6 vs 18.3) and 3 mo (8.1 vs 12.2) after RP (p=0.002). In age-adjusted logistic regression analyses, patients who performed preoperative PFME had a 0.41-fold lower risk of being incontinent 1 mo after RP and a 0.38-fold lower risk of being incontinent 3 mo after RP (p≤0.001).


CONCLUSIONS
Preoperative PFME may improve early continence and QoL outcomes after RP. Further studies are needed to corroborate our results.
Department of Urology, Vita-Salute University, San Raffaele Turro Hospital, Milan, Italy.
Antonia
A
Centemero
Lorenzo
L
Rigatti
Donatella
D
Giraudo
Massimo
M
Lazzeri
Giovanni
G
Lughezzani
Daniela
D
Zugna
Francesco
F
Montorsi
Patrizio
P
Rigatti
Giorgio
G
Guazzoni
D000368:Aged; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017773:Pelvic Floor / Q000502:physiology*; D011300:Preoperative Care / Q000379:methods*; D011468:Prostatectomy / Q000009:adverse effects* / Q000534:rehabilitation; D011471:Prostatic Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D011788:Quality of Life / Q000523:psychology*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000517:prevention & control / Q000534:rehabilitation*