Prostate cancer patients who perform pelvic floor muscle exercises (PFME) prior to radical prostatectomy (RP) enjoy early recovery of continence and improved quality of life compared with patients not doing these exercises, a new review and meta-analysis suggests.
A 2012 Cochrane review had found conflicting evidence for post-operative PFME, so Manish I. Patel, MBBS, MMed, PhD, and colleagues from the University of Sydney in Australia, conducted a review of preoperative PFME using 11 studies of 739 patients of all ages (published before Oct 2014). Preoperative PFME regimens varied by type, frequency, and duration. Some patients were guided by a physiotherapist and some received biofeedback (auditory, tactile, or visual). PFME typically was performed in the 2–4 weeks prior to RP with sessions lasting from 20-60 minutes twice a week to weekly.
The researchers found that preoperative PFME made no significant difference in postoperative urinary incontinence rates at 1 and 6 months after RP. At 3 months, PFME patients had 36% significantly lower odds of incontinence. Four of the studies assessed quality of life after RP and likewise found improvement in the PFME group at 3 months (two studies also found differences at 6 months).
“This suggests that preoperative PFME may help early continence recovery but may not influence long-term incontinence rates beyond 6 mo,” wrote Dr. Patel and colleagues in European Urology. “This is supported by the literature, as >90% of patients recover urinary incontinence in the longer term.” Preop PFME might be beneficial at 1 month, they added, but the data may be insufficient to detect a difference.
Post-RP urinary incontinence is multifactorial, the researchers emphasized. Incontinence rates vary with the type of procedure and surgical technique. Incontinence can result from urethral sphincter deficiency or laxity and from surgical injury to support structures. Detrusor overactivity, impaired bladder sensation, and low bladder compliance have been reported.
How PFME improves incontinence is not entirely clear. It may enhance rhabdosphincter function and/or the support system through its effect on levator ani, the investigators suggested. The timing of PFME could matter. Preoperative PFME allows men to learn the sensations associated with normal control of their pelvic floor muscles. It will not correct all causes of post-RP incontinence.
The review is limited by the small number of patients, short follow-up, and differences in the definition of PFME, continence, and quality of life tools.