Preoperative Pelvic Floor Muscle Exercise and Postprostatectomy Incontinence: A Systematic Review and Meta-analysis

Chang, John; Lam, Vincent; Patel, Manish I.

doi:10.1016/j.eururo.2015.11.004

Cited by 111 publications

(120 citation statements)

References 22 publications

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“…A recent meta‐analysis demonstrated a significant 36% reduced risk of postoperative incontinence at 3 months after RP when preoperative PFME was undertaken. However, preoperative PFME did not make a significant difference at 1 and 6 months . These findings were consistent with a previous meta‐analysis showing no improvement of the resolution of PPUI at early (≤3‐months), interim (6‐months), or late (1‐year) recovery stages .…”

Section: Preoperative Pelvic Floor Muscle Exercisessupporting

confidence: 91%

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How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence‐Research Society 2018

Averbeck

Marcelissen

Anding

et al. 2019

Neurourology and Urodynamics

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Aims: To review current prevention strategies for urinary incontinence among patients undergoing radical prostatectomy (RP). Methods: This is a consensus report of the proceedings of a research proposal from the annual International Consultation on Incontinence-Research Society (ICI-RS), 14 to 16 June 2018 (Bristol, UK): "How can we prevent postprostatectomy incontinence by patient selection, and by preoperative, peroperative, and postoperative measures?" Results: Several baseline parameters were proposed as predicting factors for postprostatectomy urinary incontinence (PPUI), including age, tumor stage, prostate volume, preoperative lower urinary tract symptoms, maximum urethral closure pressure, and previous transurethral resection of the prostate.More recently, magnetic resonance imaging has been used to measure the membranous urethral length and sphincter volume. Peroperative techniques include preservative and reconstructive approaches. Bladder neck preservation improved early (6 months), as well as long-term (>12 months) continence rates.Several prospective studies have reported earlier return of continence following preservation of puboprostatic ligaments, although no long-term data are available. Preservation of the urethral length yielded controversial outcomes.Concerning postoperative strategies, it is probably optimal to remove the catheter in a window between 4 and 7 days if clinically appropriate; however, more research in this regard is still required. Postoperative PFME (preoperative pelvic floor muscle exercise) appears to speed up the recovery of continence after RP.Conclusions: Conservative strategies to prevent PPUI include proper patient selection and PFME. Peroperative techniques have largely shown benefit in the short term. Postoperative complications and timing of trial without catheter can influence continence status. Future research initiatives must assess peroperative and postoperative measures, with longer-term follow-up.

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Section: Preoperative Pelvic Floor Muscle Exercisessupporting

confidence: 91%

“…PFME is thought to improve PPUI . There are a number of studies, with conflicting results on the possible correlation between the preoperative PFME and postprostatectomy incontinence .…”

Section: Preoperative Pelvic Floor Muscle Exercisesmentioning

confidence: 99%

How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence‐Research Society 2018

Averbeck

Marcelissen

Anding

et al. 2019

Neurourology and Urodynamics

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“…An increased length of MUL, which includes a greater amount of smooth muscle fibers and rhabdosphincter, potentially increases the length of the urethral pressure profile. Preoperative and postoperative conditioning of the rhabdoshpincter may also be optimized with a greater membranous urethral length incorporating a greater volume of muscle for training, further improving postoperative continence outcomes [30]. …”

Section: Discussionmentioning

confidence: 99%

Preoperative Membranous Urethral Length Measurement and Continence Recovery Following Radical Prostatectomy: A Systematic Review and Meta-analysis

et al. 2017

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Context Membranous urethral length (MUL) measured prior to radical prostatectomy (RP) has been identified as a factor that is associated with the recovery of continence following surgery. Objective To undertake a systematic review and meta-analysis of all studies reporting the effect of MUL on the recovery of continence following RP. Evidence acquisition A comprehensive search of PubMed, EMBASE, and Scopus databases up to September 2015 was performed. Thirteen studies comprising one randomized controlled trial and 12 cohort studies were selected for inclusion. Evidence synthesis Four studies (1738 patients) that reported hazard ratio results. Every extra millimeter (mm) of MUL was associated with a faster return to continence (hazard ratio: 1.05; 95% confidence interval [CI]: 1.02–1.08, p < 0.001). Eleven studies (6993 patients) reported the OR (OR) for the return to continence at one or more postoperative time points. MUL had a significant positive effect on continence recovery at 3 mo (OR: 1.08, 95% CI: 1.03–1.14, p = 0.004), 6 mo (OR: 1.12, 95% CI: 1.09–1.15, p <0.0001). and 12 mo (OR: 1.12, 95% CI: 1.03–1.22, p = 0.006) following surgery. After adjusting for repeated measurements over time and studies with overlapping data, all OR data combined indicated that every extra millimeter of MUL was associated with significantly greater odds for return to continence (OR: 1.09, 95% CI: 1.05–1.15, p <0.001). Conclusions A greater preoperative MUL is significantly and positively associated with a return to continence in men following RP. Magnetic resonance imaging measurement of MUL is recommended prior to RP. Patient summary We examined the effect that the length of a section of the urethra (called the membranous urethra) had on the recovery of continence after radical prostatectomy surgery. Our results indicate that measuring the length of the membranous urethra via magnetic resonance imaging before surgery may be useful to predict a longer period of urinary incontinence after surgery, or to explain a delay in achieving continence after surgery.

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“…However, inefficient long-term supervision, poor characterisation and low intensity/timing of training may have underestimated the true effect of pelvic floor muscle exercises in the work by Dorey et al 24 and Lin et al ,20 whose patients had the most severe forms of erectile dysfunction. Indeed, a recent meta-analysis28 suggested that preoperative exercises might be more effective versus postoperative training for the recovery of urinary continence in patients with radical prostatectomy because this may facilitate proper pelvic muscle contraction and provide more incentive to continue these exercises after the intervention. Penile haemodynamics is also dependent on endothelial function.…”

Section: Discussionmentioning

confidence: 99%

Physical activity and exercise for erectile dysfunction: systematic review and meta-analysis

et al. 2016

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Preoperative Pelvic Floor Muscle Exercise and Postprostatectomy Incontinence: A Systematic Review and Meta-analysis

Cited by 111 publications

References 22 publications

How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence‐Research Society 2018

How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence‐Research Society 2018

Preoperative Membranous Urethral Length Measurement and Continence Recovery Following Radical Prostatectomy: A Systematic Review and Meta-analysis

Physical activity and exercise for erectile dysfunction: systematic review and meta-analysis

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