The Role of Pelvic Floor Exercises on Post-Prostatectomy Incontinence

Abstract

PFE therapy instituted prior to radical prostatectomy aids in the earlier achievement of urinary incontinence. However, PFE has limited benefit in patients with severe urinary incontinence 16 weeks after surgery. There is a minimal long-term benefit of PFE training since continence rates at 1 year were similar in the 2 groups.

An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

“…Interventions were implemented 1 to 2 weeks (n = 9), 1 to 5 days (n = 2), 1 month (n = 2), 3 weeks (n = 1) and the day preceding treatment (n = 1). Three studies did not specify the time frame of intervention implementation prior to treatment [16][17][18]. Standard care varied according to individual institutions whereby verbal or written instructions were given [15,[19][20][21], physical activity was delivered in the rehabilitation setting post-treatment [22,23], generic risk management and active mobilisation was given [18] or fast-track surgery was implemented [24].…”

“…For example, at 1 month post-treatment, there was a significant benefit on recovery of continence for patients undertaking PFMT compared to controls (intervention (IV) 44.1% (n = 26) versus control (C) 20.3% (n = 12), p = 0.018) [28]. Compared to controls, patients who underwent PFMT had significantly shorter median time to continence recovery (IV 12 weeks versus C 16 weeks, p < 0.05) [16]. At 1 and 6 months post-treatment, there was a significant benefit of PFMT on the proportion of patients who achieved continence compared to the control group (6 versus 0, p = 0.02; 10 versus 1, p = 0.002, respectively) [19].…”

“…A meta-analysis of three studies (of low, moderate and high risk of bias ratings, respectively) [16,19,28] indicated that patients who undertook PFMT were over three times significantly more likely than patients who received usual care to recover urinary continence at 3 months post-surgery (OR = 3.29, 95% CI = 1.57-6.91, I 2 = 15%) (see Fig. 1).…”

“…Four studies investigated the effects of PFMT versus usual care on continence-related outcomes [16,19,21,28], QoL [21,28], lifestyle and functional ability [21] and satisfaction [28]. Studies were rated as having high [16,21], moderate [19] and low [28] risk of bias.…”

Physical exercise programs following cancer treatment

“…In "home-based programs", patients receive a training program and exercise independently without therapeutic support. Studies show that "home-based programs" are not as effective as supervised therapy concepts [12,13]. Furthermore, investigations show that unsupervised exercises bring about more adverse events or unwanted complications [9].…”