Influence of preoperative and postoperative pelvic floor muscle training (PFMT) compared with postoperative PFMT on urinary incontinence after radical prostatectomy, "Beyond the Abstract," by Inge Geraerts

BERKELEY, CA (UroToday.com) - Several studies attempted to investigate the effect of preoperative pelvic floor muscle training (PFMT) on the duration and severity of urinary incontinence after radical prostatectomy.[1, 2, 3, 4, 5, 6] A positive effect of preoperative PFMT was found at one month, [5, 6] 6 weeks,[1] 3 months,[2, 5, 6] 6 months,[4, 6] and 12 months after surgery.[1] Bales, et al. could not confirm this and found an equal continence rate at 1, 2, 3, 4 and 6 months after surgery between both groups.[3] However the results must be interpreted with caution. The methodological quality of these studies varied considerably and showed some limitations: first, all studies investigated the effect of preoperative PFMT in patients after open radical prostatectomy and not after robot- assisted radical prostatectomy.[1, 2, 3, 4, 5, 6] Second, time of follow up differed among the studies: 4 studies only investigated short term outcomes of continence until one, 3, and 6 months after surgery, respectively.[4, 5, 6] Sueppel, et al. and Parekh, et al., on the contrary, also compared continence outcomes at twelve months.[1, 2] Third, a wide range of continence criteria and outcome measures was used among the different studies, which made it difficult to compare the results. Finally, there was considerable variability in pre- and postoperative treatment regimens.[1, 2, 3, 4] Parekh, et al. (2003), Burgio, et al., (2006) and Tienforti, et al. (2012) altered the treatment of the control and the experimental group in both the preoperative and the postoperative phases, which made it difficult to draw any definitive conclusions on the effect of preoperative pelvic floor muscle training.[2, 4] Bales, et al. (2000) compared the effect of 2 different pre-operative treatments and Sueppel, et al. compared one preoperative session with a control group who completed PFMT 6 weeks after surgery.[1, 3] The latter, however, used a relatively small sample size and therefore data analysis was restricted to descriptive statistics only.[1] Furthermore, in the 6 studies found, comparing preoperative and postoperative vs postoperative PFMT, no information about inclusion or exclusion of preoperative incontinent patients was given,[1, 3, 6] and often preoperative incontinent patients were excluded.[2, 4, 5]

Consequently, although several studies have been conducted to evaluate the additional effect of preoperative PFMT, there still seemed a paucity of well-designed studies. The main objective of our study was to determine whether patients with additional preoperative pelvic floor muscle training (PFMT) regained urinary continence earlier than patients with only postoperative PFMT after open and robot radical prostatectomy. One-hundred-eighty consecutive patients were randomly assigned to the experimental group, who started pelvic floor muscle training 3 weeks before surgery, or to the control group. Patients in the control group only started pelvic floor muscle training after catheter removal. In both groups, postoperative PFMT was continued as long as any degree of urinary incontinence persisted. After catheter removal, all patients recorded, daily, their urine loss during 24 hours (24h pad test) until continence (3 consecutive days of 0 gram urine loss) was achieved. Additionally, all patients were assessed preoperatively and again at one, 3, 6 and 12 months after surgery, with the 1h pad test, a visual analogue scale (VAS), and various questionnaires (IPSS and KHQ). Results showed that patients who performed PFMT before and after radical prostatectomy had no shorter duration of postoperative urinary incontinence than patients who performed PFMT only after catheter removal. Only 6 patients of the total group remained incontinent after 1 year, with a urine loss ranging from 6-167 grams/day. Secondary analyses revealed that the 1h pad test and the VAS did not significantly differ between both groups. The median time to urinary continence and the median amount of first-day UI were approximately the same for both groups. Additionally voiding symptoms did not differ between both groups. However, quality of life was in favour of the experimental group at 3 and 6 months after surgery, concerning the impact of incontinence.

References:

  1. Sueppel C, Kreder K, See W. Improved continence outcomes with preoperative pelvic floor muscle strengthening exercises. Urol Nurs. 2001;21(3):201-10.
  2. Parekh AR, Feng MI, Kirages D, Bremner H, Kaswick J, Aboseif S. The Role of Pelvic Floor Exercises on Post-Prostatectomy Incontinence. Journal of Urology. 2003;170(1):130-3.
  3. Bales GT, Gerber GS, Minor TX, et al. Effect of preoperative biofeedback/pelvic floor training on continence in men undergoing radical prostatectomy. Urology. 2000;56(4):627-30.
  4. Burgio KL, Goode PS, Urban DA, et al. Preoperative Biofeedback Assisted Behavioral Training to Decrease Post-Prostatectomy Incontinence: A Randomized, Controlled Trial. Journal of Urology. 2006;175(1):196-201.
  5. Centemero A, Rigatti L, Giraudo D, et al. Preoperative Pelvic Floor Muscle Exercise for Early Continence After Radical Prostatectomy: A Randomised Controlled Study. European Urology. 2010;57(6):1039-44.
  6. Tienforti D, Sacco E, Marangi F, et al. Efficacy of an assisted low-intensity programme of perioperative pelvic floor muscle training in improving the recovery of continence after radical prostatectomy: a randomized controlled trial. BJU International. 2012;110(7):1004-10.

 

Written by:
Inge Geraerts as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

KU Leuven, Department of Rehabilitation Science, Leuven, Belgium

Influence of preoperative and postoperative pelvic floor muscle training (PFMT) compared with postoperative PFMT on urinary incontinence after radical prostatectomy: A randomized controlled trial - Abstract

More Information about Beyond the Abstract