Effects of perioperative pelvic floor muscle training on early recovery of urinary continence and erectile function in men undergoing radical prostatectomy: a randomized clinical trial

Abstract

Aims: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction (ED), which negatively impact quality of life (QoL). This study aimed to evaluate the effects of a perioperative pelvic fl oor muscle training (PFMT) program versus usual care on early recovery of urinary continence and erectile function after RP. Materials and Methods: Of 59 eligible men, 31 were randomly allocated into 2 groups: Group 1 (Control, N=15) received usual post-RP care; and Group 2 (Physical therapy, N=16) received two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were used to evaluate UI and ED, respectively. Results: Demographic characteristics were similar in both groups. Three months after RP, the UI rate was 72.7% and 70.0% in Groups 1 and 2, respectively (P >0.05). The severity and frequency of UI and its impact on QoL were evaluated by the ICIQ-Short Form, with scores of 6.9±6.26 in Group 1 and 7.0±5.12 in Group 2 (P >0.05). The IIEF-5 scores were similar in Groups 1 and 2 (5.73±7.43 vs. 6.70±6.68, respectively) (P >0.05). Conclusion: Our pre-RP protocol of two physical therapist-assisted sessions of PFMT plus instructions did not signifi cantly improve urinary continence or erectile function at 3 months after RP.

Quality Analysis of YouTube Videos Presenting Pelvic Floor Exercises after Prostatectomy Surgery

“…Although mortality after RP is low (5-year survival: 95%), morbidity is high [ 3 ]. Surgical treatment involving the removal of the prostate may result in temporary or permanent erectile dysfunction (ED) and urinary incontinence (UI), with considerable impact on quality of life (QoL) [ 4 , 5 , 6 , 7 ]. While the postoperative incontinence rate is 1% in patients undergoing prostatectomy for benign reasons, a rate between 2% and 66% has been reported after RP [ 7 ].…”

“…Depending on how continence is defined, almost 80% of men experience incontinence after RP [ 3 ]. ED affects 26% to 100% of patients after RP, and the main cause is known to be injury to the neurovascular bundles [ 5 ].…”

Is it Worth Starting Sexual Rehabilitation Before Radical Prostatectomy? Results From a Systematic Review of the Literature

“…In the intervention group, counseling content was education about prostate cancer, menopause, and sexuality; behavioral homework including increasing expression of affection and non-demanding sexual touch; challenging negative beliefs about prostate cancer, aging, and sexuality; and helping the couple choose a medical treatment for erectile dysfunction (ED) and integrating this into their sexual relationship. Three study protocols were based on pelvic floor muscle training (PFMT): in one case, the study only involved the use of total body exercise before RP (15); in the other two studies, the study plan included a pre-and post-intervention treatment (14,16).…”

“…Surgical technique of RP was not mentioned in the studies by Chambers and Lira (13,14 Follow-up ranged between 3 and 12 months. Sexual outcomes were assessed by the International Index of Erectile F unction (IIEF) in one study (13), the short form 5-item IIEF (IIEF-5) in three studies (14)(15)(16), question 2 and 3 of the sexual encounter profile (SEP) questionnaire in one study (17), and EF domain of the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) in one study (16). In the study by Chambers et al based on the counseling protocol, psychological scale and couple's assessment were also used.…”

Effect of routine duloxetine administration in the early postoperative period on postprostatectomy stress incontinence in patients undergoing laparoscopic radical prostatectomy

“…Although it has been reported that the majority of such patients recover continence within three months after surgery, 7-25% of patients have been shown to have persistent urinary incontinence following radical prostatectomy (Holm et Pelvic floor exercises (PFE) constitute the primary step in PPI treatment (Sandhu et al, 2019). Patients are recommended to perform these exercises both before and immediately after radical prostatectomy (de Lira et al, 2019). However, for patients that do not benefit from these exercises, there are limited pharmacotherapy options and thus surgical intervention (bulking agents, male slings, or artificial urinary sphincters) may be needed (Nambiar et al, 2018;Nestler et al, 2019).…”