Influence of preoperative and postoperative pelvic floor muscle training (PFMT) compared with postoperative PFMT on urinary incontinence after radical prostatectomy: a randomized controlled trial.
BACKGROUND
The efficacy of preoperative pelvic floor muscle training (PFMT) for urinary incontinence (UI) after open radical prostatectomy (ORP) and robot-assisted laparoscopic radical prostatectomy (RARP) is still unclear.


OBJECTIVE
To determine whether patients with additional preoperative PFMT regain urinary continence earlier than patients with only postoperative PFMT after ORP and RARP.


METHODS
A randomized controlled trial enrolled 180 men who planned to undergo ORP/RARP.


METHODS
The experimental group (E, n=91) started PFMT 3 wk before surgery and continued after surgery. The control group (C, n=89) started PFMT after catheter removal.


METHODS
The primary end point was time to continence. Patients measured urine loss daily (24-h pad test) until total continence (three consecutive days of 0 g of urine loss) was achieved. Secondary end points were 1-h pad test, visual analog scale (VAS), International Prostate Symptom Score (IPSS), and quality of life (King's Health Questionnaire [KHQ]). Kaplan-Meier analysis and Cox regression with correction for two strata (age and type of surgery) compared time and continence. The Fisher exact test was applied for the 1-h pad test and VAS; the Mann-Whitney U test was applied for IPSS and KHQ.


CONCLUSIONS
Patients with additional preoperative PFMT had no shorter duration of postoperative UI compared with patients with only postoperative PFMT (p=0.878). Median time to continence was 30 and 31 d, and median amount of first-day incontinence was 108 g and 124 g for groups E and C, respectively. Cox regression did not indicate a significant difference between groups E and C (p=0.773; hazard ratio: 1.047 [0.768-1.425]). The 1-h pad test, VAS, and IPSS were comparable between both groups. However, "incontinence impact" (KHQ) was in favor of group E at 3 mo and 6 mo after surgery.


CONCLUSIONS
Three preoperative sessions of PFMT did not improve postoperative duration of incontinence.


BACKGROUND
Netherlands Trial Register No. NTR 1953.
KU Leuven, Department of Rehabilitation Science, Leuven, Belgium. Electronic address: inge.geraerts@faber.kuleuven.be.
Inge
I
Geraerts
Hendrik
H
Van Poppel
Nele
N
Devoogdt
Steven
S
Joniau
Ben
B
Van Cleynenbreugel
An
A
De Groef
Marijke
M
Van Kampen
D000328:Adult; D000368:Aged; D001530:Belgium; D005081:Exercise Therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017773:Pelvic Floor / Q000503:physiopathology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects*; D011788:Quality of Life; D020127:Recovery of Function; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D014563:Urodynamics
Pelvic floor muscle training; Radical prostatectomy; Urinary incontinence