Clinically and statistically significant results of intervention.
EFFICACY OF AN ASSISTED LOW-INTENSITY PROGRAMME OF PERIOPERATIVE PELVIC FLOOR MUSCLE TRAINING IN IMPROVING THE RECOVERY OF CONTINENCE AFTER RADICAL PROSTATECTOMY: A RANDOMIZED CONTROLLED TRIAL
Article first published online: 22 AUG 2012
© 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL
Volume 110, Issue 7, pages 1010–1011, October 2012
How to Cite
Goode, P. S. (2012), EFFICACY OF AN ASSISTED LOW-INTENSITY PROGRAMME OF PERIOPERATIVE PELVIC FLOOR MUSCLE TRAINING IN IMPROVING THE RECOVERY OF CONTINENCE AFTER RADICAL PROSTATECTOMY: A RANDOMIZED CONTROLLED TRIAL. BJU International, 110: 1010–1011. doi: 10.1111/j.1464-410X.2012.11451.x
- Issue published online: 6 SEP 2012
- Article first published online: 22 AUG 2012
Tienforti et al. report results of their well-designed trial demonstrating that preoperative pelvic floor muscle training (PFMT) produced clinically and statistically significant differences on validated outcome instruments (ICIQ-UI, UCLA-PCI, and ICIQ-OAB), as well as traditional measures (incontinence episodes on diary and pad counts). This trial adds to a considerable body of evidence (Table 1[1–5]) that peri-operative PFMT for all men undergoing radical prostatectomy improves continence outcomes.
|Study||N||Intervention||Definition of continence||Percent continent: intervention vs control group|
|3 months||6 months||1 year|
|Positive Studies *|
|Filocamo et al., 2005 ||300||PFMT on physical exam in three postoperative sessions, home exercises, bladder control strategies vs usual care||Dry on ICS-Male Questionnaire||23% vs 14%||77% vs 32%||89% vs 68%|
|Burgio et al., 2006 ||125||Single session of preoperative biofeedback-assisted PFMT and home exercises vs usual care||No leakage on Bladder Diary||48% vs 32%||68% vs 48%||6-month study|
|Mariotti et al., 2009 ||60||PFMT via biofeedback and electrical stimulation twice a week for 6 weeks postoperatively vs usual care||≤2 grams on 24 hour pad test and no pad use.||80% vs 33%||97% vs 67%||97% vs 97%|
|Ribeiro et al., 2010 ||73||Biofeedback-assisted PFMT weekly plus home exercises x 3 months or until continent vs brief verbal instructions||No pads||73% vs 39%||88% vs 64%||96% vs 75%|
|Tienforti et al. 2012||32||Preoperative biofeedback-assisted PFMT, monthly postoperative biofeedback-assisted PFMT vs verbal and written instructions for home exercises||Score of 0 on the ICIQ-SF||50% vs 6%||63% vs 6%||6-month study|
|Bales et al. 2000 ||100||Single session of preoperative biofeedback-assisted PFMT vs verbal and written instruction. Both groups encouraged to practise home exercises.||≤1 pad per day||57% vs 62%||94% vs 96%||6-month study|
Research questions do still remain, particularly regarding the intensity of peri-operative therapy necessary. Varying levels of technologies were used in these trials – biofeedback, biofeedback augmented with electrical stimulation, and no technologies – simply PFMT on physical examination –all demonstrated considerable benefit. The negative trial by Bales et al.  showed that biofeedback did not improve the results of verbal and written instruction with encouragement to do home exercises. The message for practice is that even low-tech peri-operative PFMT, combined with home exercises, can improve continence outcomes.
Most men who choose radical prostatectomy are relatively healthy otherwise. The diagnosis of cancer followed by postoperative incontinence can be life-changing – enough to cause some experts to discourage routine PSA testing for men. Regaining continence months sooner is a highly desirable outcome for these men.
As the evidence has mounted, urology practices have begun to include various levels of PFMT for men undergoing radical prostatectomy; however, translation from research to practice has not been optimum. Most men undergoing radical prostatectomy do not receive PFMT. It is time to change practice and implement PFMT into routine peri-operative care for all men undergoing radical prostatectomy.