Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, randomized, controlled trial

Abstract

Erectile dysfunction (ED) and urinary incontinence are common complications following radical prostatectomy (RP). Although pelvic-floor biofeedback training (PFBT) may improve urinary continence following RP, its effects on the recovery of potency are unknown. Fifty-two patients selected for RP were prospectively randomized for a treatment group (n ¼ 26) receiving PFBT once a week for 3 months and home exercises or a control group (n ¼ 26), in which patients received verbal instructions to contract the pelvic floor. Erectile function (EF) was evaluated with the International Index of Erectile Function-5 (IIEF-5) before surgery and 1, 3, 6 and 12 months postoperatively. Patients were considered potent when they had a total IIEF-5 score 420. Continence status was assessed and defined as the use of no pads. Groups were comparable in terms of age, body mass index, diabetes, pathological tumor stage and neurovascular bundle preservation. A significant reduction in IIEF-5 scores was observed after surgery in both groups. In the treatment group, 8 (47.1%) patients recovered potency 12 months postoperatively, as opposed to 2 (12.5%) in the control group (P ¼ 0.032). The absolute risk reduction was 34.6% (95% confidence interval (CI): 3.8--64%) and the number needed to treat was 3 (95% CI: 1.5--17.2). A strong association between recovery of potency and urinary continence was observed, with continent patients having a 5.4 higher chance of being potent (P ¼ 0.04). Early PFBT appears to have a significant impact on the recovery of EF after RP. Urinary continence status was a good indicator of EF recovery, with continent patients having a higher chance of being potent. 1 The most common long-term complications after prostatectomy (RP) are urinary incontinence and erectile dysfunction (ED).2 ED is estimated to affect 26--100% of patients after surgery. 3,4 The main cause of ED after RP is neurogenic, because of intraoperative injury to the neurovascular bundle.

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

“…At baseline, a complete medical history and physical examination were performed on all patients (including measurements of weight, height, and abdominal and hip circumferences). Patients also answered the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire, which classifies ED into five categories based on the scores obtained: severe (1-7); moderate (8)(9)(10)(11); moderate to mild (12)(13)(14)(15)(16); mild (17)(18)(19)(20)(21); or no ED (22)(23)(24). In the same evaluation, electromyographic recordings of the pelvic floor were obtained using the Miotool Uro device (Miotec®, Brazil), including the average and maximum values of electromyographic activity at rest and during rapid and sustained contraction of the pelvic floor.…”

Preventing Erectile Dysfunction after Radical Prostatectomy: Nerve-Sparing Techniques, Penile Rehabilitation, and Novel Regenerative Therapies

“…given that oral PDE5 inhibitor therapy was withheld during the study. This study provides level 1b evidence supporting the use of post-operative PFMT for erectile function recovery [136]. Optimal schedule and intensity has yet to be determined.…”

“…The impact of PFMT on erectile function after radical prostatectomy has also been examined. Prota et al studied n = 52 patients who underwent open RP and randomized them to PFMT + biofeedback weekly × 3 months (beginning at time of catheter removal) vs. verbal instructions only [136]. Nerve-sparing was performed in a similar proportion of patients in each group (64.7% vs. 68.8%).…”

Erectile dysfunction in robotic radical prostatectomy: Outcomes and management

“…[55] The 12-month potency rates (SHIM > 20) were 47.1% and 12.5% in the treatment and control groups, respectively.…”