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
Authors: Tienforti Daniele , Sacco Emilio , Marangi Francesco , D'Addessi Alessandro , Racioppi Marco , Gulino Gaetano , Pinto Francesco , Totaro Angelo , D'Agostino Daniele , Bassi Pierfrancesco 
Published: February 2012

Study Type – Therapy (RCT)

Level of Evidence 1b

What's known on the subject? and What does the study add?

Peri‐operative pelvic floor muscle training reduces urinary incontinence for men undergoing radical prostatectomy (RP).

A preoperative biofeedback session, combined with postoperative pelvic floor muscle training, and assisted sessions on a monthly basis only, is an effective low‐intensity programme to improve recovery of continence in patients undergoing RP.

OBJECTIVE

To evaluate the efficacy of preoperative biofeedback (BFB) combined with an assisted low‐intensity programme of postoperative perineal physiokinesitherapy in reducing the incidence, duration and severity of urinary incontinence (UI) in patients undergoing radical prostatectomy (RP).

PATIENTS AND METHODS

A prospective, single‐centre, randomized controlled clinical study was designed.

The intervention group received a training session with BFB, supervised oral and written instructions on Kegel exercises and a structured programme of postoperative exercises on the day before open RP. After RP, patients received control visits, including a session of BFB, at monthly intervals only.

The control group received, after catheter removal, only oral and written instructions on Kegel exercises to be performed at home. Patients received control visits at 1, 3 and 6 months after catheter removal.

At each visit the number of incontinence episodes, the number of pads used and patient‐reported outcome measures (International Consultation on Incontinence Questionnaire on Urinary Incontinence [ICIQ‐UI], [ICIQ]‐Overactive Bladder [OAB], University of California, Los Angeles‐Prostate Cancer Index [UCLA‐PCI], International Prostate Symptom Score‐Quality of Life [IPSS‐QoL]) were assessed in both groups. All patients were followed‐up for a period of at least 6 months after catheter removal.

The primary outcome was the recovery of continence, strictly defined as a ICIQ‐UI score of zero.

RESULTS

Overall, 34 consecutive patients were eligible and 32 were available for the final analysis: 16 patients for each study group. The two groups were homogeneous for all pre‐ and intraoperative features examined.

In the intervention group, continence had been achieved by six, eight and 10 patients at 1‐, 3‐ and 6‐month follow‐ups, respectively, vs no patients (P= 0.02), one patient (P= 0.01) and one patient (P= 0.002) in the control group at each follow‐up, respectively.

The analysis of the UCLA‐PCI and ICIQ‐OAB scores, the number of incontinence episodes per week and the number of pads per week showed significant differences in favour of patients in the intervention group at 3 and 6 months.

Patients in the intervention group reported better IPSS‐QoL scores at all follow‐up times but the difference did not reach statistical significance.

CONCLUSIONS

Preoperative BFB combined with a postoperative programme of perineal physiokinesitherapy and assisted sessions on a monthly basis only, is a treatment strategy significantly more effective than the standard care in improving recovery of continence in patients undergoing RP.

The impact on QoL appeared less evident, although a trend for a better QoL was observed in the intervention group.