Pelvic floor muscle training in radical prostatectomy: a randomized controlled trial of the impacts on pelvic floor muscle function and urinary incontinence

Abstract

Background: Pelvic floor muscle training (PFM) training for post-prostatectomy incontinence (PPI) is an important rehabilitative approach, but the evidence base is still evolving. We developed a novel PFM training program focussed on activating fast and slow twitch muscle fibres. We hypothesized that this training, which commenced pre-operatively, would improve PFM function and reduce PPI, when compared to a control group.

Methods: This randomized trial allocated 97 men (63 ± 7y, BMI = 25.4, Gleason 7) undergoing radical prostatectomy (RP) to either a control group (n = 47) performing low-volume rehabilitation, or an intervention group (n = 50). Both interventions commenced 5 weeks prior to surgery and continued for 12 weeks post-RP. Participants were assessed pre-operatively and at 2, 6 and 12 weeks post-RP using 24 h pad weights, International Prostate Symptom Score (IPSS), Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) and real time ultrasound (RTUS) measurements of PFM function.

Results: Following RP, participants in the control group demonstrated a slower return to continence and experienced significantly more leakage (p < 0.05), measured by 24 h pad weight, compared to the intervention group, suggesting an impact of the prehabilitation protocol. PFM function measures were enhanced following RP in the intervention group. Secondary measures (IPSS, EPIC-CP and RTUS PFM function tests) demonstrated improvement across all time points, with the intervention group displaying consistently lower "bothersome" scores.

Conclusions: A pelvic floor muscle exercise program commenced prior to prostate surgery enhanced post-surgical measures of pelvic floor muscle function, reduced PPI and improved QoL outcomes related to incontinence.

Trial registration: The trial was registered in the Australia New Zealand Clinical Trials Registry and allocated as ACTRN12617001400358. The trial was registered on 4/10/2017 and this was a retrospective registration.

Keywords: Men’s health; Pelvic floor muscle; Prostatectomy; Quality of life; Urinary incontinence.

Fig. 1

The number of “dry” patients (panel a) and changes in 24-h pad weight (panel b) for patients following radical prostatectomy within the intervention and control groups at baseline, then at 2, 6 and 12 weeks post-surgery. All participants were fully continent at the pre-operative assessment (baseline). * indicates a significant difference (p < 0.05) between groups at the relevant time points

Fig. 2

Changes in the International Prostate Symptom Score (panel a) and the EPIC-CP (panel b) for patients following radical prostatectomy within the intervention and control groups at baseline, then at 2, 6 and 12 weeks post-surgery. The IPSS (maximum score = 12) is as a measure of self-reported urinary symptoms and quality of life, with lower scores indicating better outcomes. The EPIC-CP is a health related quality of life measure for men following treatment for prostate cancer, wherein the urinary continence domain (maximum score = 12) assesses self-reported bother of urinary incontinence symptoms, with lower scores indicating better outcomes. * indicates a significant difference (p < 0.05) between groups at the relevant time points

Fig. 3

Changes in the Rapid Response Test (RRT – panel a) and the Sustained Endurance Test (SET – panel b) for patients following radical prostatectomy within the intervention and control groups at 2, 6 and 12 weeks post-surgery. The RRT tests uses real time ultrasound (RTUS) to measure the speed of pelvic floor muscle contractions, with lower scores representing a better outcome. The SET also uses RTUS to measure the endurance of pelvic floor musculature to sustain a contraction over time (maximum score = 60 s), with higher scores representing a better outcome. * indicates a significant difference (p < 0.05) between groups at the relevant time points