title: Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, randomized, controlled trial.
abstract: Erectile dysfunction (ED) and urinary incontinence are common complications following radical prostatectomy (RP). Although pelvic-floor biofeedback training (PFBT) may improve urinary continence following RP, its effects on the recovery of potency are unknown. Fifty-two patients selected for RP were prospectively randomized for a treatment group (n=26) receiving PFBT once a week for 3 months and home exercises or a control group (n=26), in which patients received verbal instructions to contract the pelvic floor. Erectile function (EF) was evaluated with the International Index of Erectile Function-5 (IIEF-5) before surgery and 1, 3, 6 and 12 months postoperatively. Patients were considered potent when they had a total IIEF-5 score>20. Continence status was assessed and defined as the use of no pads. Groups were comparable in terms of age, body mass index, diabetes, pathological tumor stage and neurovascular bundle preservation. A significant reduction in IIEF-5 scores was observed after surgery in both groups. In the treatment group, 8 (47.1%) patients recovered potency 12 months postoperatively, as opposed to 2 (12.5%) in the control group (P=0.032). The absolute risk reduction was 34.6% (95% confidence interval (CI): 3.8-64%) and the number needed to treat was 3 (95% CI: 1.5-17.2). A strong association between recovery of potency and urinary continence was observed, with continent patients having a 5.4 higher chance of being potent (P=0.04). Early PFBT appears to have a significant impact on the recovery of EF after RP. Urinary continence status was a good indicator of EF recovery, with continent patients having a higher chance of being potent.
authors.affiliation: Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: C
authors.initials: C
authors.lastname: Prota
authors.forename: C M
authors.initials: CM
authors.lastname: Gomes
authors.forename: L H S
authors.initials: LH
authors.lastname: Ribeiro
authors.forename: J
authors.initials: J
authors.lastname: de Bessa
authors.forename: E
authors.initials: E
authors.lastname: Nakano
authors.forename: M
authors.initials: M
authors.lastname: Dall'Oglio
authors.forename: H
authors.initials: H
authors.lastname: Bruschini
authors.forename: M
authors.initials: M
authors.lastname: Srougi
mesh_terms: D001676:Biofeedback, Psychology; D007172:Erectile Dysfunction / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D009119:Muscle Contraction; D017773:Pelvic Floor / Q000502:physiology*; D010410:Penile Erection / Q000502:physiology*; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000534:rehabilitation*; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy