Pelvic floor muscle training after prostate surgery

Abstract

Cathryn Glazener and colleagues1Glazener C Boachie C Buckley B et al.Urinary incontinence in men after formal one-to-one pelvic-floor muscle training following radical prostatectomy or transurethral resection of the prostate (MAPS): two parallel randomised controlled trials.Lancet. 2011; 378: 328-337Summary Full Text Full Text PDF PubMed Scopus (80) Google Scholar report on a multicentre randomised controlled trial of formal one-to-one pelvic-floor muscle training compared with standard care for urinary incontinence after prostate surgery. Formal pelvic-floor muscle training had no significant advantage. Of note, almost 70% of men who underwent radical prostatectomy had urinary incontinence at 6 weeks after surgery. Although urinary incontinence is a common consequence of radical prostatectomy, such a high proportion deserves comment. First, urinary incontinence rates are dependent on the definition used. Glazener and colleagues defined urinary incontinence as any positive response to one of two questions on the International Consultation on Incontinence Questionnaire—Urinary Incontinence Short Form. However, this questionnaire is not sex-specific, encompasses all types of urinary incontinence, and is not always thought to be clinically meaningful during follow-up.2Tannenbaum C Corcos J Outcomes in urinary incontinence: reconciling clinical relevance with scientific rigour.Eur Urol. 2008; 53: 1151-1161Summary Full Text Full Text PDF PubMed Scopus (31) Google Scholar Second, postprostatectomy urinary continence is greatly affected by surgical technique and surgeon's experience. The high rate of postoperative urinary incontinence seen in this study might suggest that this procedure should be done only in high-volume centres and by skilled surgeons.3Vickers A Savage C Bianco F et al.Cancer control and functional outcomes after radical prostatectomy as markers of surgical quality: analysis of heterogeneity between surgeons at a single cancer center.Eur Urol. 2011; 59: 317-322Summary Full Text Full Text PDF PubMed Scopus (101) Google Scholar Additionally, the experience of the person teaching patients how to exercise might have an effect on the final result.4Moore KH O'Sullivan RJ Simons A Prashar S Anderson P Louey M Randomised controlled trial of nurse continence advisor therapy compared with standard urogynaecology regimen for conservative incontinence treatment: efficacy, costs and two year follow up.BJOG. 2003; 110: 649-657Crossref PubMed Google Scholar Finally, we showed in a randomised trial5Centemero A Rigatti L Giraudo D et al.Preoperative pelvic floor muscle exercise for early continence after radical prostatectomy: a randomised controlled study.Eur Urol. 2010; 57: 1039-1043Summary Full Text Full Text PDF PubMed Scopus (133) Google Scholar the benefit of pelvic-floor muscle exercise started preoperatively and continued postoperatively in patients undergoing open radical prostatectomy. At 3 months, 35 of 59 patients who did exercises preoperatively and postoperatively were continent versus 22 of 59 who did the exercises only postoperatively (p=0·028). This concept of conditioning pelvic-floor muscles in the preoperative period might foster further research in the field. Pelvic-floor muscle exercise might still be beneficial for patients undergoing radical prostatectomy; the experience of the surgeon doing the procedure and of the health-care professional teaching pelvic-floor muscle exercise might be the key to success. We declare that we have no conflicts of interest. Pelvic floor muscle training after prostate surgery – Authors' replyMen were taught to tighten both their deep and superficial muscles by imagining stopping the flow of urine, preventing wind from escaping, and observing penile and testicular lift. Pelvic-floor muscle training was not used to strengthen the external sphincter, but to compensate for its reduced function by preventing the passage of urine using the pelvic floor muscles to constrict the urethra at or below the level of the external sphincter. Our outcome of interest was whether this was successful in preventing urine leakage. Full-Text PDF