Performing pelvic floor muscle training (PFMT) both before and after radical prostatectomy (RP) is no more effective at reducing postoperative urinary incontinence (UI) than performing the exercises after surgery, report researchers.
In a randomized controlled trial, duration of postoperative UI was no shorter among patients who performed PFMT before and after surgery than among those who only started PFMT 3 days after their operation, say Inge Geraerts (KU Leuven, Belgium) and colleagues.
Of the 180 men who underwent either open RP or robot-assisted laparoscopic RP, 91 received weekly 30-minute sessions of guided PFMT as well as completing daily exercises at home for 3 weeks prior to undergoing surgery (intervention group). After RP, they visited the hospital once a week to perform individual guided PFMT with digital or electromagnetic biofeedback. The control group comprised 89 patients who only participated in this postoperative training and monitoring.
As reported in European Urology, the time taken for patients to reach urinary continence (defined as 3 consecutive days of 0 g urine loss on 24-hour pad test) did not significantly differ between the men in the intervention group and those in the control group after 12 months. Only six patients remained incontinent after 1 year, two from the intervention group and four from the control group. However, those in the intervention group reported better quality of life regarding incontinence impact at 3 and 6 months post-surgery.
Based on the 24-hour test, those in the intervention group had comparable cumulative incidence rates for continence and similar mean amounts of urine loss at 1 month, 3 months, 6 months, and 12 months after RP, as those in the control group.
Furthermore, Cox regression analysis showed no significant between-group difference in time to reaching continence, after adjustment for age and type of RP surgery. Similarly, the point prevalence of urinary continence (defined as ≤ 1 g on the 1-hour pad test and using the visual analog scale) was comparable between the intervention and control group at 1, 3, 6, and 12 months after RP.
Moreover, the team did not record any differences in voiding symptoms between the two groups at any of these timepoints, as assessed by the International Prostate Symptom Score.
"Standard postoperative continence rehabilitation using a strict pelvic floor reduction scheme could not be improved by adding three preoperative sessions of PFMY," concludes the team.
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