Improvement of Continence Rate with Pelvic Floor Muscle Training Post-Prostatectomy: A Meta-Analysis of Randomized Controlled Trials

Objective: The aim of this meta-analysis was to evaluate the evidence of the effect of pelvic floor muscle training on urinary incontinence after radical prostatectomy. Methods: A bibliographic search was conducted in four databases. Studies were grouped according to the intervention program (muscle training versus control and individual home-based versus physiotherapist-guided muscle training). Results: Eight studies were selected for meta-analysis after satisfying the selection criteria. The data show that pelvic floor muscle training improves continence rate in the short (RR = 2.16; p < 0.001), medium (RR = 1.45; p = 0.001) and long term (RR = 1.23; p = 0.019) after surgery. The number of randomized controlled trials and the heterogeneity in the study population and type of pelvic floor muscle training were the main limitations. Conclusion: Programs including at least three sets of 10 repetitions of muscle training daily appear to improve continence rate after radical prostatectomy. Our meta-analysis shows that muscle training programs for urinary incontinence provide similar results to those of physiotherapist-guided programs, therefore being more cost- effective.

[1]  K. Hunter,et al.  Conservative management for postprostatectomy urinary incontinence. , 2004, The Cochrane database of systematic reviews.

[2]  J. Gajewski,et al.  2012 update: guidelines for adult urinary incontinence collaborative consensus document for the canadian urological association. , 2012, Canadian Urological Association journal = Journal de l'Association des urologues du Canada.

[3]  N. Maffulli,et al.  Conservative management of midportion Achilles tendinopathy: a mixed methods study, integrating systematic review and clinical reasoning. , 2012, Sports medicine.

[4]  N. Maffulli,et al.  Conservative Management of Midportion Achilles Tendinopathy , 2012, Sports Medicine.

[5]  C. Ramsay,et al.  Conservative treatment for urinary incontinence in Men After Prostate Surgery (MAPS): two parallel randomised controlled trials. , 2011, Health technology assessment.

[6]  D. Roth,et al.  Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy incontinence: a randomized controlled trial. , 2011, JAMA.

[7]  H. Bruschini,et al.  Long-term effect of early postoperative pelvic floor biofeedback on continence in men undergoing radical prostatectomy: a prospective, randomized, controlled trial. , 2010, The Journal of urology.

[8]  R. Bosch,et al.  The recovery of urinary continence after radical retropubic prostatectomy: a randomized trial comparing the effect of physiotherapist‐guided pelvic floor muscle exercises with guidance by an instruction folder only , 2010, BJU international.

[9]  J. Ferlay,et al.  Estimates of cancer incidence and mortality in Europe in 2008. , 2010, European journal of cancer.

[10]  C. Dubeau,et al.  Fourth international consultation on incontinence recommendations of the international scientific committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence , 2010, Neurourology and urodynamics.

[11]  J. Ioannidis,et al.  The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration , 2009, BMJ : British Medical Journal.

[12]  J. Ioannidis,et al.  The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration , 2009, Annals of Internal Medicine [serial online].

[13]  G. Herbison,et al.  Return to continence after radical retropubic prostatectomy: a randomized trial of verbal and written instructions versus therapist-directed pelvic floor muscle therapy. , 2008, Urology.

[14]  S. Lydersen,et al.  Does physiotherapist-guided pelvic floor muscle training reduce urinary incontinence after radical prostatectomy? A randomised controlled trial. , 2008, European urology.

[15]  F. Valent,et al.  Contribution of early intensive prolonged pelvic floor exercises on urinary continence recovery after bladder neck‐sparing radical prostatectomy: Results of a prospective controlled randomized trial , 2007, Neurourology and urodynamics.

[16]  L. Siminoff,et al.  Effects of combined pelvic floor muscle exercise and a support group on urinary incontinence and quality of life of postprostatectomy patients. , 2007, Oncology nursing forum.

[17]  W. See,et al.  Quantifying the natural history of post-radical prostatectomy incontinence using objective pad test data , 2007, BMC urology.

[18]  J. Ferlay,et al.  Estimates of the cancer incidence and mortality in Europe in 2006. , 2006, Annals of oncology : official journal of the European Society for Medical Oncology.

[19]  E. Sacco,et al.  Urinary incontinence after radical prostatectomy: incidence by definition, risk factors and temporal trend in a large series with a long‐term follow‐up , 2006, BJU international.

[20]  G. Nicita,et al.  Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. , 2005, European urology.

[21]  Ziding Feng,et al.  5-year urinary and sexual outcomes after radical prostatectomy: results from the prostate cancer outcomes study. , 2005, The Journal of urology.

[22]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[23]  Catherine Sherrington,et al.  Reliability of the PEDro scale for rating quality of randomized controlled trials. , 2003, Physical therapy.

[24]  G. Sonke,et al.  Biofeedback vs verbal feedback as learning tools for pelvic muscle exercises in the early management of urinary incontinence after radical prostatectomy , 2002, BJU international.

[25]  Magnus Fall,et al.  The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. , 2003, Urology.

[26]  H. Feys,et al.  Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: a randomised controlled trial , 2000, The Lancet.

[27]  K. Moore,et al.  The early post-operative concerns of men after radical prostatectomy. , 1999, Journal of advanced nursing.

[28]  George Davey Smith,et al.  Misleading meta-analysis , 1995, BMJ.

[29]  D. Mandelstam.  The pelvic floor. , 1978, Physiotherapy.

[30]  M. Cowie.  National Institute for Health and Care Excellence. , 2015, European heart journal.

[31]  Oxford Centre for Evidence-based Medicine Levels of Evidence (January 2001) , 2014 .

[32]  N. Taylor,et al.  Music interventions and physical activity in older adults: a systematic literature review and meta-analysis. , 2012, Journal of rehabilitation medicine.

[33]  C. Lawton.  Behavioral Therapy With or Without Biofeedback and Pelvic Floor Electrical Stimulation for Persistent Postprostatectomy Incontinence: A Randomized Controlled Trial , 2012 .

[34]  K. Hunter,et al.  Conservative management for postprostatectomy urinary incontinence. , 2007, The Cochrane database of systematic reviews.

[35]  P. Goode,et al.  Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinence: a randomized, controlled trial. , 2006, The Journal of urology.

[36]  H. Huland,et al.  Urodynamic evaluation of changes in urinary control after radical retropubic prostatectomy. , 1997, The Journal of urology.