Physiotherapy for continence and muscle function in prostatectomy: a randomised controlled trial

Mifuka Ouchi; Takeya Kitta; Hiroki Chiba; Madoka Higuchi; Yui Abe-Takahashi; Mio Togo; Naohisa Kusakabe; Sachiyo Murai; Hiroshi Kikuchi; Ryuji Matsumoto; Takahiro Osawa; Takashige Abe; Nobuo Shinohara

doi:10.1111/bju.16369

Physiotherapy for continence and muscle function in prostatectomy: a randomised controlled trial

BJU Int. 2024 Apr 24. doi: 10.1111/bju.16369. Online ahead of print.

Affiliations

¹ Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
² Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
³ Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.

PMID: 38658057
DOI: 10.1111/bju.16369

Abstract

Objective: To assess the effectiveness of pre- and postoperative supervised pelvic floor muscle training (PFMT) on the recovery of continence and pelvic floor muscle (PFM) function after robot-assisted laparoscopic radical prostatectomy (RARP).

Patients and methods: We carried out a single-blind randomised controlled trial involving 54 male patients scheduled to undergo RARP. The intervention group started supervised PFMT 2 months before RARP and continued for 12 months after surgery with a physiotherapist. The control group was given verbal instructions, a brochure about PFMT, and lifestyle advice. The primary outcome was 24-h pad weight (g) at 3 months after RARP. The secondary outcomes were continence status (assessed by pad use), PFM function, and the Expanded Prostate Cancer Index Composite (EPIC) score.

Results: Patients who participated in supervised PFMT showed significantly improved postoperative urinary incontinence (UI) compared with the control group (5.0 [0.0-908.0] g vs 21.0 [0.0-750.0] g; effect size: 0.34, P = 0.022) at 3 months after RARP based on 24-h pad weight. A significant improvement was seen in the intervention compared with the control group (65.2% continence [no pad use] vs 31.6% continence, respectively) at 12 months after surgery (effect size: 0.34, P = 0.030). Peak pressure during a maximum voluntary contraction was higher in the intervention group immediately after catheter removal and at 6 months, and a longer duration of sustained contraction was found in the intervention group compared with the control group. We were unable to demonstrate a difference between groups in EPIC scores.

Conclusion: Supervised PFMT can improve postoperative UI and PFM function after RARP. Further studies are needed to confirm whether intra-anal pressure reflects PFM function and affects continence status in UI in men who have undergone RARP.

Keywords: continence; intra‐anal manometry; pelvic floor muscle function; pelvic floor muscle training; physiotherapy; randomised controlled trial; robot‐assisted laparoscopic radical prostatectomy; urinary incontinence.