The therapeutic effect of pelvic floor muscle exercise on urinary incontinence after radical prostatectomy: a meta-analysis

Abstract

Pelvic floor muscle exercise (PFME) is the most common conservative management for urinary incontinence (UI) after radical prostatectomy (RP). However, whether the PFME guided by a therapist (G-PFME) can contribute to the recovery of urinary continence for patients after RP is still controversial. We performed this meta-analysis to investigate the effectiveness of G-PFME on UI after RP and to explore whether the additional preoperative G-PFME is superior to postoperative G-PFME alone. Literature search was conducted on Cochrane Library, Embase, Web of Science, and PubMed, to obtain all relevant randomized controlled trials published before March 1, 2018. Outcome data were pooled and analyzed with Review Manager 5.3 to compare the continence rates of G-PFME with control and to compare additional preoperative G-PFME with postoperative G-PFME. Twenty-two articles with 2647 patients were included. The continence rates of G-PFME were all superior to control at different follow-up time points, with the odds ratio (OR) (95% confidence interval [CI]) of 2.79 (1.53-5.07), 2.80 (1.87-4.19), 2.93 (1.19-7.22), 4.11 (2.24-7.55), and 2.41 (1.33-4.36) at 1 month, 3 months, 4 months, 6 months, and 12 months after surgery, respectively. However, there was no difference between additional preoperative G-PFME and postoperative G-PFME, with the OR (95% CI) of 1.70 (0.56-5.11) and 1.35 (0.41-4.40) at 1 month and 3 months after RP, respectively. G-PFME could improve the recovery of urinary continence at both early and long-term stages. Starting the PFME preoperatively might not produce extra benefits for patients at early stage, compared with postoperative PFME.

Keywords: continence rate; pelvic floor muscle exercise; radical prostatectomy; urinary incontinence.

Figure 1

Flow diagram of trial selection process.

Figure 2

Risk of bias of included studies.

Figure 3

Forest plot comparing G-PFME with control at 1 month, 3 months, and 4 months after surgery. (a) Forest plot comparing G-PFME with control at 1 month after surgery. (b) Forest plot comparing G-PFME with control at 3 months after surgery. (c) Forest plot comparing G-PFME with control at 6 months after surgery. A or B: if a study has two treatment groups, then one treatment group is named as A and the other treatment group is named as B. G-PFME: pelvic floor muscle exercise guided by a therapist; CI: confidence interval; df: degrees of freedom; M–H: Mantel–Haenszel.

Figure 4

Forest plot comparing G-PFME with control at 6 months and 12 months after surgery. (a) Forest plot comparing G-PFME with control at 6 months after surgery. (b) Forest plot comparing G-PFME with control at 12 months after surgery. A or B: if a study has two treatment groups, then one treatment group is named as A and the other treatment group is named as B. G-PFME: pelvic floor muscle exercise guided by a therapist; CI: confidence interval; df: degrees of freedom; M–H: Mantel–Haenszel.

Figure 5

Forest plot comparing preoperative G-PFME with postoperative G-PFME at 1 month and 3 months after surgery. (a) Forest plot comparing preoperative G-PFME with postoperative G-PFME at 1 month after surgery. (b) Forest plot comparing preoperative G-PFME with postoperative G-PFME at 3 months after surgery. G-PFME: pelvic floor muscle exercise guided by a therapist; CI: confidence interval; df: degrees of freedom; M–H: Mantel–Haenszel.