title: Preoperative pelvic floor physiotherapy improves continence after radical retropubic prostatectomy.
abstract: OBJECTIVE
  Urinary incontinence is a predictable sequela of radical retropubic prostatectomy, and is most severe in the early postoperative phase. The present study aimed to evaluate the effect of a physiotherapist-guided pelvic floor muscle training program, commenced preoperatively, on the severity and duration of urinary continence after radical retropubic prostatectomy.
  
  
  METHODS
  A retrospective analysis of men undergoing radical retropubic prostatectomy by one high-volume surgeon (n = 284) was carried out. The intervention group received physiotherapist-guided pelvic floor muscle training from 4 weeks preoperatively (n = 152), whereas the control group was provided with verbal instruction on pelvic floor muscle exercise by the surgeon alone (n = 132). Postoperatively, all patients received physiotherapist-guided pelvic floor muscle training. The primary outcome measure was 24-h pad weight at 6 weeks and 3 months postoperatively. Secondary outcome measures were the percentage of patients experiencing severe urinary incontinence, and patient-reported time to one and zero pad usage daily.
  
  
  RESULTS
  At 6 weeks postoperatively, the 24-h pad weight was significantly lower (9 g vs 17 g, P < 0.001) for the intervention group, which also showed less severe urinary incontinence (24-h pad weight >50 g; 8/152 patients vs 33/132 patients, P < 0.01). There was no significant difference between groups in the 24-h pad weight at 3 months (P = 0.18). Patient-reported time to one and zero pad usage was significantly less for the intervention group (P < 0.05). Multivariate Cox regression showed that preoperative physiotherapist-guided pelvic floor muscle training reduced time to continence (1 pad usage daily) by 28% (P < 0.05).
  
  
  CONCLUSIONS
  A physiotherapist-guided pelvic floor muscle training program, commenced 4 weeks preoperatively, significantly reduces the duration and severity of early urinary incontinence after radical retropubic prostatectomy.
authors: Urological Cancer Outcomes Center, Discipline of Surgery, The University of Sydney.
authors: Manish I
authors: MI
authors: Patel
authors: Jinna
authors: J
authors: Yao
authors: Andrew D
authors: AD
authors: Hirschhorn
authors: Sean F
authors: SF
authors: Mungovan
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017773:Pelvic Floor / Q000502:physiology*; D026741:Physical Therapy Modalities; D011300:Preoperative Care / Q000379:methods; D016016:Proportional Hazards Models; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods / Q000534:rehabilitation*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation*
keywords: incontinence; pelvic floor; physiotherapy; preoperative; radical prostatectomy