Does pelvic floor muscle training augment the effect of surgery in women with pelvic organ prolapse? A systematic review of randomized controlled trials.
Pelvic floor muscle training (PFMT) is often used as a treatment for pelvic organ prolapse (POP) and can improve function. However, the effectiveness of this modality as an adjunct to prolapse surgery for women with POP is unknown.



To evaluate whether the use of pelvic floor muscle training as an adjunct to prolapse surgery is superior to surgery alone for women with pelvic organ prolapse.



We searched PubMed, Embase, the Cochrane Library, and the Web of Science from their inception dates to June 30, 2014 for data describing randomized controlled trials (RCTs) that compare the efficacy of PFMT with or without lifestyle modification plus surgery versus surgery alone for women with POP. Additional relevant studies were identified by searching the references of retrieved articles and using Google Scholar. Two investigators independently reviewed and selected relevant studies that met the pre-specified inclusion criteria, extracted the data, and assessed the risk of bias in the included studies according to the Cochrane Handbook, version 5.1.0. Due to great heterogeneity in the choice and reporting of outcome measures and the different durations of follow-up among the studies, this analysis is confined to a qualitative systematic review.



Five RCTs involving 591 women were reviewed (treatment group [TG], 292 cases; control group [CG], 299 cases). Generally, the five RCTs exhibited low risk of bias. This study indicated no significant improvement in prolapse symptoms, in quality of life, or in the degree of prolapse for women with POP in the TG compared to those in the CG.



Insufficient evidence was found to support adding perioperative PFMT to surgery over the use of surgery alone in women undergoing surgery for POP. Adequately, powered RCTs with longer follow-up periods are required to evaluate the long-term effect of perioperative PFMT. Neurourol. Urodynam. 35:666-674, 2016. © 2015 Wiley Periodicals, Inc.
The First Clinical Medical School of Lanzhou University, Lanzhou, Gansu, China.|Evidence Based Medicine Center of Lanzhou University, Lanzhou, Gansu, China.|Nursing Department, Gansu Provincial Hospital, Lanzhou, Gansu, China.|Key Laboratory of Evidence Based Medicine and Knowledge Translation of, Gansu Province, Lanzhou, Gansu, China.
Feng-Wa
FW
Zhang
Department of Obstetric, Gansu Provincial Hospital, Lanzhou, Gansu, China.
Fen
F
Wei
The Second Department of Gynecology, Gansu Provincial Hospital, Lanzhou, Gansu, China.
Hai-Lin
HL
Wang
Department of Medical Psychology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China.
Yuan-Qing
YQ
Pan
The Second Department of Gynecology, Gansu Provincial Hospital, Lanzhou, Gansu, China.
Jie-Yu
JY
Zhen
Nursing Department, Gansu Provincial Hospital, Lanzhou, Gansu, China.
Jv-Xia
JX
Zhang
Evidence Based Medicine Center of Lanzhou University, Lanzhou, Gansu, China.|Key Laboratory of Evidence Based Medicine and Knowledge Translation of, Gansu Province, Lanzhou, Gansu, China.
Ke-Hu
KH
Yang
D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D017773:Pelvic Floor / Q000503:physiopathology* / Q000601:surgery; D056887:Pelvic Organ Prolapse / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000379:methods*
gynecological surgery; pelvic floor exercise; physiotherapy; rehabilitation