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. 2023 Apr 18;4(4):CD014799.
doi: 10.1002/14651858.CD014799.pub2.

Conservative interventions for managing urinary incontinence after prostate surgery

Eugenie E Johnson  1   2 , Charalampos Mamoulakis  3 , Akvile Stoniute  1   2 , Muhammad Imran Omar  4   5 , Sanjay Sinha  6
Affiliations

Conservative interventions for managing urinary incontinence after prostate surgery

Eugenie E Johnson et al. Cochrane Database Syst Rev. .

Abstract

Background: Men may need to undergo prostate surgery to treat prostate cancer or benign prostatic hyperplasia. After these surgeries, men may experience urinary incontinence (UI). Conservative treatments such as pelvic floor muscle training (PFMT), electrical stimulation and lifestyle changes can be undertaken to help manage the symptoms of UI.

Objectives: To assess the effects of conservative interventions for managing urinary incontinence after prostate surgery.

Search methods: We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP and handsearched journals and conference proceedings (searched 22 April 2022). We also searched the reference lists of relevant articles.

Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs of adult men (aged 18 or over) with UI following prostate surgery for treating prostate cancer or LUTS/BPO. We excluded cross-over and cluster-RCTs. We investigated the following key comparisons: PFMT plus biofeedback versus no treatment; sham treatment or verbal/written instructions; combinations of conservative treatments versus no treatment, sham treatment or verbal/written instructions; and electrical or magnetic stimulation versus no treatment, sham treatment or verbal/written instructions.

Data collection and analysis: We extracted data using a pre-piloted form and assessed risk of bias using the Cochrane risk of bias tool. We used the GRADE approach to assess the certainty of outcomes and comparisons included in the summary of findings tables. We used an adapted version of GRADE to assess certainty in results where there was no single effect measurement available.

Main results: We identified 25 studies including a total of 3079 participants. Twenty-three studies assessed men who had previously undergone radical prostatectomy or radical retropubic prostatectomy, while only one study assessed men who had undergone transurethral resection of the prostate. One study did not report on previous surgery. Most studies were at high risk of bias for at least one domain. The certainty of evidence assessed using GRADE was mixed. PFMT plus biofeedback versus no treatment, sham treatment or verbal/written instructions Four studies reported on this comparison. PFMT plus biofeedback may result in greater subjective cure of incontinence from 6 to 12 months (1 study; n = 102; low-certainty evidence). However, men undertaking PFMT and biofeedback may be less likely to be objectively cured at from 6 to 12 months (2 studies; n = 269; low-certainty evidence). It is uncertain whether undertaking PFMT and biofeedback has an effect on surface or skin-related adverse events (1 study; n = 205; very low-certainty evidence) or muscle-related adverse events (1 study; n = 205; very low-certainty evidence). Condition-specific quality of life, participant adherence to the intervention and general quality of life were not reported by any study for this comparison. Combinations of conservative treatments versus no treatment, sham treatment or verbal/written instructions Eleven studies assessed this comparison. Combinations of conservative treatments may lead to little difference in the number of men being subjectively cured or improved of incontinence between 6 and 12 months (RR 0.97, 95% CI 0.79 to 1.19; 2 studies; n = 788; low-certainty evidence; in absolute terms: no treatment or sham arm: 307 per 1000 and intervention arm: 297 per 1000). Combinations of conservative treatments probably lead to little difference in condition-specific quality of life (MD -0.28, 95% CI -0.86 to 0.29; 2 studies; n = 788; moderate-certainty evidence) and probably little difference in general quality of life between 6 and 12 months (MD -0.01, 95% CI -0.04 to 0.02; 2 studies; n = 742; moderate-certainty evidence). There is little difference between combinations of conservative treatments and control in terms of objective cure or improvement of incontinence between 6 and 12 months (MD 0.18, 95% CI -0.24 to 0.60; 2 studies; n = 565; high-certainty evidence). However, it is uncertain whether participant adherence to the intervention between 6 and 12 months is increased for those undertaking combinations of conservative treatments (RR 2.08, 95% CI 0.78 to 5.56; 2 studies; n = 763; very low-certainty evidence; in absolute terms: no intervention or sham arm: 172 per 1000 and intervention arm: 358 per 1000). There is probably no difference between combinations and control in terms of the number of men experiencing surface or skin-related adverse events (2 studies; n = 853; moderate-certainty evidence), but it is uncertain whether combinations of treatments lead to more men experiencing muscle-related adverse events (RR 2.92, 95% CI 0.31 to 27.41; 2 studies; n = 136; very low-certainty evidence; in absolute terms: 0 per 1000 for both arms). Electrical or magnetic stimulation versus no treatment, sham treatment or verbal/written instructions We did not identify any studies for this comparison that reported on our key outcomes of interest.

Authors' conclusions: Despite a total of 25 trials, the value of conservative interventions for urinary incontinence following prostate surgery alone, or in combination, remains uncertain. Existing trials are typically small with methodological flaws. These issues are compounded by a lack of standardisation of the PFMT technique and marked variations in protocol concerning combinations of conservative treatments. Adverse events following conservative treatment are often poorly documented and incompletely described. Hence, there is a need for large, high-quality, adequately powered, randomised control trials with robust methodology to address this subject.

Trial registration: ClinicalTrials.gov NCT00632138 NCT02645136 NCT00212264 NCT02226237 NCT02086266 NCT02073721.

PubMed Disclaimer

Conflict of interest statement

In accordance with Cochrane's Commercial Sponsorship Policy, the following declarations are relevant from 36 months before the title was registered.

EEJ: Is currently Assistant Managing Editor for Cochrane Incontinence. However, she did not take part in any aspect of the editorial process for this review. CM: none. AS: none. MIO: is an Editor for Cochrane Urology. However, he did not take part in any aspect of the editorial process for this review. SS: none.

Figures

1
1
PRISMA study flow diagram
2
2
Risk of bias graph: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.4
1.4. Analysis
Comparison 1: PFMT versus no treatment, sham treatment or verbal/ written instructions, Outcome 4: Objective cure or improvement in UI: > 3 to 6 months (dichotomous meta‐analysis)
1.6
1.6. Analysis
Comparison 1: PFMT versus no treatment, sham treatment or verbal/ written instructions, Outcome 6: Objective cure or improvement in UI: > 6 to 12 months (dichotmous meta‐analysis)
4.1
4.1. Analysis
Comparison 4: Lifestyle interventions versus no treatment, sham treatment or verbal/ written instructions, Outcome 1: Condition‐specific quality of life: > 3 to 6 months (continuous meta‐analysis)
4.3
4.3. Analysis
Comparison 4: Lifestyle interventions versus no treatment, sham treatment or verbal/ written instructions, Outcome 3: Objective cure or improvement of UI: > 3 to 6 months (dichotomous meta‐analysis)
4.4
4.4. Analysis
Comparison 4: Lifestyle interventions versus no treatment, sham treatment or verbal/ written instructions, Outcome 4: Objective cure or improvement in UI: > 3 to 6 months (continuous meta‐analysis)
5.1
5.1. Analysis
Comparison 5: Combinations of conservative treatments versus no treatment, sham treatment or verbal/ written instructions, Outcome 1: Subective cure or improvement in UI: > 3 to 6 months (dichotomous meta‐analysis)
5.3
5.3. Analysis
Comparison 5: Combinations of conservative treatments versus no treatment, sham treatment or verbal/ written instructions, Outcome 3: Subective cure or improvement in UI: > 6 to 12 months (dichotomous meta‐analysis)
5.4
5.4. Analysis
Comparison 5: Combinations of conservative treatments versus no treatment, sham treatment or verbal/ written instructions, Outcome 4: Condition‐specific quality of life: > 3 to 6 months (dichotomous meta‐analysis)
5.5
5.5. Analysis
Comparison 5: Combinations of conservative treatments versus no treatment, sham treatment or verbal/ written instructions, Outcome 5: Condition‐specific quality of life: > 3 to 6 months (continuous meta‐analysis)
5.7
5.7. Analysis
Comparison 5: Combinations of conservative treatments versus no treatment, sham treatment or verbal/ written instructions, Outcome 7: Condition‐specific quality of life: > 6 to 12 months (continuous meta‐analysis)
5.8
5.8. Analysis
Comparison 5: Combinations of conservative treatments versus no treatment, sham treatment or verbal/ written instructions, Outcome 8: Objective cure or improvement in UI: > 3 to 6 months (dichotomous meta‐analysis)
5.9
5.9. Analysis
Comparison 5: Combinations of conservative treatments versus no treatment, sham treatment or verbal/ written instructions, Outcome 9: Objective cure or improvement in UI: > 3 to 6 months (continuous meta‐analysis)
5.11
5.11. Analysis
Comparison 5: Combinations of conservative treatments versus no treatment, sham treatment or verbal/ written instructions, Outcome 11: Objective cure or improvement in UI: > 6 to 12 months (continuous meta‐analysis)
5.12
5.12. Analysis
Comparison 5: Combinations of conservative treatments versus no treatment, sham treatment or verbal/ written instructions, Outcome 12: Adherence to treatment: > 3 to 6 months (dichotomous meta‐analysis)
5.13
5.13. Analysis
Comparison 5: Combinations of conservative treatments versus no treatment, sham treatment or verbal/ written instructions, Outcome 13: Adherence to treatment: > 3 to 6 months (continuous meta‐analysis)
5.14
5.14. Analysis
Comparison 5: Combinations of conservative treatments versus no treatment, sham treatment or verbal/ written instructions, Outcome 14: Adherence to treatment: > 6 to 12 months (dichotomous meta‐analysis)
5.15
5.15. Analysis
Comparison 5: Combinations of conservative treatments versus no treatment, sham treatment or verbal/ written instructions, Outcome 15: Adherence to treatment: > 6 to 12 months (continuous meta‐analysis)
5.16
5.16. Analysis
Comparison 5: Combinations of conservative treatments versus no treatment, sham treatment or verbal/ written instructions, Outcome 16: General quality of life: > 3 to 6 months (continuous meta‐analysis)
5.17
5.17. Analysis
Comparison 5: Combinations of conservative treatments versus no treatment, sham treatment or verbal/ written instructions, Outcome 17: General quality of life: > 6 to 12 months (continuous meta‐analysis)
5.19
5.19. Analysis
Comparison 5: Combinations of conservative treatments versus no treatment, sham treatment or verbal/ written instructions, Outcome 19: General muscle‐related adverse events (dichotomous meta‐analysis)
6.1
6.1. Analysis
Comparison 6: PFMT plus electrical stimulation versus PFMT alone, Outcome 1: Subective cure or improvement in UI: > 3 to 6 months (dichotomous meta‐analysis)
6.3
6.3. Analysis
Comparison 6: PFMT plus electrical stimulation versus PFMT alone, Outcome 3: Subjective cure or improvement in UI: > 6 to 12 months (continuous meta‐analysis)
6.6
6.6. Analysis
Comparison 6: PFMT plus electrical stimulation versus PFMT alone, Outcome 6: Condition‐specific quality of life: > 6 to 12 months (continuous meta‐analysis)
6.8
6.8. Analysis
Comparison 6: PFMT plus electrical stimulation versus PFMT alone, Outcome 8: Objective cure or improvement in UI: > 3 to 6 months (continuous meta‐analysis)
6.10
6.10. Analysis
Comparison 6: PFMT plus electrical stimulation versus PFMT alone, Outcome 10: Objective cure or improvement in UI: > 6 to 12 months (continuous meta‐analysis)
6.14
6.14. Analysis
Comparison 6: PFMT plus electrical stimulation versus PFMT alone, Outcome 14: Adverse events relating to the viscera or anorectum (dichotomous meta‐analysis)
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References

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References to studies excluded from this review

Abbinante 2012 {published data only}
    1. Abbinante M, Crivellaro S, Palazzetti A, Tosco L, Frea B. Efficacy of ultrasound-guided pelvic muscle training (Abstract 45). Neurourology and Urodynamics 2012;31(S1):S35.
    1. Crivellaro S, Abbinante M, Palazzetti A, Tosco L, Frea B. Efficacy of ultrasound-guided pelvic muscle training (Abstract 285). European Urology Supplements 2012;11(1):e285-a.
Abel 1996 {published data only}
    1. Abel I, Ottesen B, Fischer-Rasmussen W, Lose G. Maximal electrical stimulation of the pelvic floor in the treatment of urge incontinence: a placebo controlled study (Abstract 16). Neurourology and Urodynamics 1996;15(4):283-4.
Allameh 2021 {published data only}
    1. Allameh F, Rayegani SM, Razzaghi M, Abedi AR, Rahavian A, Javadi A, et al. Comparison of the effect of the pelvic floor muscle biofeedback prior or postradical prostatectomy on urinary incontinence: a randomized controlled trial. Turkish Journal of Urology 2021;47(5):434-41. [DOI: 10.5152/tud.2021.21096] - DOI - PMC - PubMed
Amend 2018 {published data only}
    1. Amend B, DRKS00014311. Pilot study to assess videocontrolled biofeedback in physiotherapeutic rehabiliation of stress urinary incontinence after radical prostatectomy in prostate cancer patients. www.drks.de/DRKS00014311 (first received 12 April 2018).
Arruda 2007 {published data only}
    1. Arruda RM, Sousa GO, Castro RA, Sartori MG, Baracat, EC, Girão MJ. Detrusor overactivity: comparative study among oxybutynin, functional electrostimulation and pelvic floor muscle training. A randomized clinical trial [Hiperatividade do detrusor: comparação entre oxibutinina, eletroestimulação funcional do assoalho pélvico e exercícios perineais. Estudo randomizado]. Revista Brasileira de Ginecologia e Obstetricia 2007;29(9):452-8.
Au 2020 {published data only}
    1. Au D, Matthew AG, Alibhai SM, Jones JM, Fleshner NE, Finelli A, et al. Pfilates and hypopressives for the treatment of urinary incontinence after radical prostatectomy: results of a feasibility randomized controlled trial. PM&R: Journal of Injury, Function, and Rehabilitation 2020;12(1):55-63. - PubMed
Aydın Sayilan 2018 {published data only}
    1. Aydın Sayılan A, Özbaş A. The effect of pelvic floor muscle training on incontinence problems after radical prostatectomy. American Journal of Men’s Health 2018;12(4):1007-15. - PMC - PubMed
Azevedo 2020 {published data only}
    1. Azevedo C, RBR-3jm5y2. Control of urinary loss in men undergoing prostate surgery [Controle da perda urinária em homens submetidos à cirurgia de próstata] [Effectiveness of integrative and complementary practices associated with pelvic muscle training to control urinary incontinence after radical prostatectomy: randomized clinical trial [Efetividade das práticas integrativas e complementares associadas ao treinamento muscular pélvico para o controle da incontinência urinária após prostatectomia radical: ensaio clínico randomizado]]. ensaiosclinicos.gov.br/rg/RBR-3jm5y2 (first received 24 July 2020).
Baroni 2013 {published data only}
    1. Baroni M, Lorenzetti R, Renzi C, Brizzi A, Branchini W, Altavilla MG, et al. Approach HTA (health technology assessment) to treat urinary incontinence after radical prostatectomy (Abstract 23). Neurourology and Urodynamics 2013;32(S1):S20.
Bernier 2008 {published data only}
    1. Bernier F. Pelvic Floor Muscle Retraining: Quantitative, Experimental, Randomized Pilot Study [PhD thesis]. Charlottesville, VA (USA): University of Virginia, 2008.
    1. Bernier F. Pelvic floor muscle retraining: quantitative, experimental, randomized pilot study. In: 39th Annual Conference of the Society of Urologic Nurses and Associates (SUNA); 2008 Oct 3-6; Philadelphia (PA). 2008.
Bourcier 1994 {published data only}
    1. Bourcier A, Juras J. Randomised study comparing physiotherapy and pelvic floor rehabilitation. In: 24th Annual Meeting of the International Continence Society (ICS); 1994 Aug 30 - Sep 02; Prague, Czech Republic. 1994.
Bryant 2001 {published data only}
    1. Bryant CM, Dowell CJ, Fairbrother G. Final results of a randomised trial of a caffeine reduction intervention and descriptive analysis of caffeine behaviours (Abstract 303). In: 31st Annual Meeting of the International Continence Society (ICS); 2001 Sept 18-21; Seoul, Korea. 2001.
Burnett 2012 {published data only}
    1. Burnett AL, NCT01718704. Viberect penile vibratory stimulation to enhance recovery of erectile function and urinary continence post-prostatectomy [Study of non-invasive Viberect ® penile vibratory stimulation regimen to enhance recovery of erectile function/rigidity and urinary control/continence after nerve sparing radical prostatectomy (RP) for clinically localized prostate cancer]. clinicaltrials.gov/show/NCT01718704 (first received 31 October 2012).
Ceresoli 1995 {published data only}
    1. Ceresoli A, Zanetti G, Trinchieri A, Seveso M, Del Nero A, Meligrana C, et al. Stress urinary incontinence after radical perineal prostatectomy [Incontinenza urinaria da stress dopo prostatectomy radicale perineale]. Archivio Italiano di Urologia e Andrologia 1995;67(3):207-10. - PubMed
Feng 2000 {published data only}
    1. Feng MI, Parekh A, Bremner H, Kirages D, Yang R, Kaswick J, et al. The role of pelvic floor exercise on post-prostatectomy incontinence (Poster P15-3). Journal of Endourology 2000;14(Suppl 1):A77. - PubMed
Feng 2022 {published data only}
    1. Feng X, Lv J, Li M, Lv T, Wang S. Short-term efficacy and mechanism of electrical pudendal nerve stimulation versus pelvic floor muscle training plus transanal electrical stimulation in treating post-radical prostatectomy urinary incontinence. Urology 2022;160:168-75. [DOI: 10.1016/j.urology.2021.04.069] - DOI - PubMed
    1. NCT02599831. Efficacy of electrical pudendal nerve stimulation for patients with post prostatectomy urinary incontinence. clinicaltrials.gov/ct2/show/NCT02599831 (first received 09 November 2015).
Floratos 2002 {published data only}
    1. Floratos DL, Sonke GS, Rapidou CA, Alivizatos GJ, Deliveliotis C, Constantinides CA, et al. Biofeedback vs verbal feedback as learning tools for pelvic muscle exercises in the early management of urinary incontinence after radical prostatectomy. BJU International 2002;89(7):714-9. - PubMed
Fode 2015 {published data only}
    1. Fode M, Sønksen J. Penile vibratory stimulation in the treatment of post-prostatectomy incontinence: a randomized pilot study. Neurourology and Urodynamics 2015;34(2):117-22. - PubMed
Franke 1998 {published data only}
    1. Franke JJ, Grier J, Kock MO, Smith JA. Biofeedback-enhanced pelvic floor exercises in the early post-prostatectomy period. Journal of Urology 1998;159(5):37.
Griebling 1999 {published data only}
    1. Griebling TL, Kreder KJ, Sueppel CA, See WA. Timing of biofeedback and pelvic floor muscle exercise training for men undergoing radical prostatectomy (Abstract 322). In: 29th Annual General Meeting of the International Continence Society (ICS); 1999 Aug 22-26; Denver (CO). 1999.
    1. Griebling TL, Kreder KJ, Sueppel CA, See WA. Timing of pelvic floor muscle strenghthening exercises and return of continence in post prostatectomy patients (Abstract 322). In: 29th Annual General Meeting of the International Continence Society (ICS); 1999 Aug 22-26; Denver (CO). 1999.
Heerey 2016 {published data only}
    1. Heerey R, Richardson T, Costello A. The impact of a combined exercise intervention on persistent urinary incontinence after radical prostatectomy: a pilot randomised controlled trial (Abstract 088). BJU International 2016;118(S1):39.
Heydenreich 2016 {published and unpublished data}
    1. Heydenreich M, Puta C, Gabriel H, Zermann DH. Oscillating pole treatment-a new effective treatment option for postprostatectomy urinary incontinence (Abstract ID 0546). Oncology Research and Treatment 2016;39(Suppl 1):37. [DOI: 10.1159/000444354] - DOI
    1. Heydenreich M, Zermann DH. Oscillating pole therapy - the best option to treat urinary incontinence after radical prostatectomy? - Follow-up-data (Abstract V49). Oncology Research and Treatment 2016;39(Suppl 3):10. [DOI: 10.1159/000449050] - DOI
    1. Heydenreich M. AW: study query: does trunk muscle training with an oscillating rod improve urinary incontinence after radical prostatectomy? A prospective randomized controlled trial [personal communication]. Email to: E Johnson 24 March 2022. - PMC - PubMed
Heydenreich 2020 {published and unpublished data}
    1. Heydenreich M, Puta C, Gabriel H, Zermann DH. Einfluss „aktiver schwingungen" auf die funktion des kontinenzapparats - ein neuer ansatz zur behandlung der harninkontinenz nach radikaler prostatektomie (Abstract V27.1) [Influence of "active vibrations" on the function of the continence apparatus - a new approach to the treatment of urinary incontinence after radical prostatectomy. [For information only, English title translated via Google Translate™]]. Der Urologe 2015;54(Suppl 1):83-4.
    1. Heydenreich M, Puta C, Gabriel HH, Dietze A, Wright P, Zermann DH. Does trunk muscle training with an oscillating rod improve urinary incontinence after radical prostatectomy? A prospective randomized controlled trial. Clinical Rehabilitation 2020;34(3):320-33. - PMC - PubMed
    1. Heydenreich M, Walke GR, Zermann DH. Oscillation rod therapy - the better way to treat urinary incontinence after prostatectomy. Update 2017 (Abstract 265). Oncology Research and Treatment 2018;41(Suppl 1):153.
    1. Heydenreich M. AW: study query: does trunk muscle training with an oscillating rod improve urinary incontinence after radical prostatectomy? A prospective randomized controlled trial [personal communication]. Email to: E Johnson 24 March 2022. - PMC - PubMed
    1. Heydenreich M, DRKS00011028. Oscillating rod treatment - an improved approach for post-prostatectomy urinary incontinence. A prospective randomised controlled trial. drks.de/DRKS00011028 (first received 06 September 2016).
Hsu 2016 {published data only}
    1. Hsu LF, Liao YM, Lai FC, Tsai PS. Beneficial effects of biofeedback-assisted pelvic floor muscle training in patients with urinary incontinence after radical prostatectomy: a systematic review and metaanalysis. International Journal of Nursing Studies 2016;60:99-111. - PubMed
Jackson 1996 {published data only}
    1. Jackson J, Emerson L, Johnston B, Wilson J, Morales A. Biofeedback: a noninvasive treatment for incontinence after radical prostatectomy. Urologic Nursing 1996;16(2):50-4. - PubMed
Jalalinia 2020 {published data only}
    1. Jalalinia SF, Raei M, Naseri-Salahshour V, Varaei S. The effect of pelvic floor muscle strengthening exercise on urinary incontinence and quality of life in patients after prostatectomy: a randomized clinical trial. Journal of Caring Sciences 2020;9(1):33-8. - PMC - PubMed
    1. Rai M, Varaei S, IRCT2014090519049N1. The effect of pelvic-floor muscles exercises and in-ward routine trainings on urinary incontinence and quality of life among post-prostatectomy patients [Exploring the effect of performing pelvic floor muscles strengthening exercises on post-prostatectomy patients’ urinary incontinence and quality of life]. en.irct.ir/trial/17138 (first received 14 November 2014).
Joseph 2000 {published data only}
    1. Joseph AC, Chang MK. Comparison of behavior therapy methods for urinary incontinence following prostate surgery: a pilot study. Urologic Nursing 2000;20(3):203-4. - PubMed
Karlsen 2021 {published data only}
    1. Karlsen RV, Bidstrup PE, Giraldi A, Hvarness H, Bagi P, Lauridsen SV, et al. Couple counseling and pelvic floor muscle training for men operated for prostate cancer and for their female partners: results from the randomized ProCan trial. Sexual Medicine 2021;9(3):100350. - PMC - PubMed
    1. Karlsen RV, Johansen C, NCT02103088. Sexual and urological rehabilitation to men operated for prostate cancer and their partners (PROCAN) [PROCAN: sexual and urological rehabilitation to men operated for prostate cancer and their partners: a randomized controlled intervention study]. clinicaltrials.gov/show/NCT02103088 (first received 03 April 2014).
Kaya 2021 {published data only}
    1. Kaya S, NCT04804839. Comparison of the effectiveness of different conservative treatment protocols in postprostatectomy urinary incontinence [Comparison of the effectiveness of different conservative treatment protocols in individuals with symptom of postprostatectomy urinary incontinence: a randomized controlled trial]. clinicaltrials.gov/show/NCT04804839 (first received 18 March 2021).
Kim 2009 {published data only}
    1. Kim YH, Hwang EG, Shin JH, Kim YW, Lim JS, Na YG, et al. Effect of extracorporeal magnetic innervation pelvic floor therapy (EXMI) on urinary incontinence after radical prostatectomy (Abstract UP-1.180). Urology 2009;74(4 Suppl):S227.
    1. Koo D, So SM, Lim JS. Effect of extracorporeal magnetic innervation (ExMI) pelvic floor therapy on urinary incontinence after radical prostatectomy [근치적 전립선적출술 후 요실금에 대한 체외자기장치료의 효]. Korean Journal of Urology 2009;50(1):23-7.
Liu 2008 {published data only}
    1. Liu F, Yao LP, Mai HX, Liu HL, Yuan JL, Wang FL, et al. Extracorporeal magnetic innervation in the treatment of urinary incontinence after radical prostatectomy. Journal of Clinical Rehabilitative Tissue Engineering Research 2008;12(17):3289-92.
Marchiori 2010 {published data only}
    1. Marchiori D, Bertaccini A, Manferrari F, Ferri C, Martorana G. Pelvic floor rehabilitation for continence recovery after radical prostatectomy: role of a personal training re-educational program. Anticancer Research 2010;30(2):553-6. - PubMed
Mariotti 2009 {published data only}
    1. Mariotti G, Sciarra A, Gentilucci A, Salciccia S, Alfarone A, Pierro GD, et al. Early recovery of urinary continence after radical prostatectomy using early pelvic floor electrical stimulation and biofeedback associated treatment. Journal of Urology 2009;181(4):1788-93. - PubMed
    1. Sciarra A, Salciccia S, Gentilucci A, Alfarone A, Di Pierro GB, Mariotti G, et al. Early recovery of urinary continence after radical prostatectomy using early pelvic floor electric stimulation and biofeedback associated treatment (Abstract 1883). Journal of Urology 2009;181(4S):680. - PubMed
    1. Sciarra A, Salciccia S, Gentilucci A, Alfarone A, Mariotti G, Cattarion S, et al. Early recovery of urinary continence after radical prostatectomy using early pelvic floor electric stimulation and biofeedback associated treatment (Abstract 412). European Urology Supplements 2009;8(4):223.
Mathewson‐Chapman 1997 {published data only}
    1. Mathewson-Chapman M. Pelvic muscle exercise/biofeedback for urinary incontinence after prostatectomy: an education program. Journal of Cancer Education 1997;12(4):218-23. - PubMed
Meng 2012 {published data only}
    1. Meng X, Meng XM, Yang XH. The effect of early rehabilitation traning on urinary in continence after prostatectomy with laparospic in high-risk elder patients [早期康复训练对老年高危患者腹腔镜下前列腺癌根治术后尿失禁的影响]. Nursing Practice and Research 2012;9(5):24-6.
Montazeri 2020 {published data only}
    1. Montazeri S, IRCT20200429047243N1. Comparison the effect of pelvic floor muscle biofeedback prior or post radical prostatectomy on urinary incontinence [Comparison the effect of pelvic floor muscle biofeedback prior or post radical prostatectomy on urinary incontinence: a randomized clinical trial]. irct.ir/trial/47616 (first received 05 May 2020).
Moore 1999b {published data only}
    1. Moore KN, Dorey GF. Conservative treatment of urinary incontinence in men: a review of the literature. Physiotherapy 1999;85(2):77-87.
Nehra 2001 {published data only}
    1. Nehra A, Rovner E, Wein A, Lange P, Ellis W, Keane T, et al. Interim analysis of a multi-center study of extracorporeal magnetic innervation (ExMI ) for the treatment of urinary incontinence following radical prostatectomy (Abstract 37). Neurourology and Urodynamics 2001;20(4):430-1.
Novick 2014 {published data only}
    1. Novick BJ, Angie M, Walker E, Kitay R, Monday K, Albert NM. The effect of intensive education on urinary incontinence following radical prostatectomy: a randomized control trial. Urologic Nursing 2014;34(5):246-51. - PubMed
Nowak 2007 {published data only}
    1. Nowak M, Jordan M, Haberl S, Herwig R, Kuehhas F, Brausi M, et al. Prospective study of extracorporeal magnetic innervation pelvic floor therapy (EXMI) versus standard pelvic floor training following radical prostatectomy: impact on timing and magnitude of recovery of continence (Abstract 482). European Urology Supplements 2007;6(2):143.
Oh 2020 {published data only}
    1. Byun SS, Kang M, Lee DO, NCT02485665. Efficacy of extracorporeal biofeedback device for post-prostatectomy incontinence [Efficacy of personalized extracorporeal biofeedback device for pelvic floor muscle training on post-prostatectomy incontinence]. clinicaltrials.gov/show/NCT02485665 (first received 30 June 2015).
    1. Kim JK, Oh JJ, Lee H, Lee S, Hong SK, Lee SE, et al. Effect of personalized extracorporeal biofeedback device for pelvic floor muscle training on urinary incontinence after robot-assisted radical prostatectomy: a randomized controlled trial (Abstract PD40-03). Journal of Urology 2019;201(Suppl 4):e738-9. - PubMed
    1. Oh JJ, Kim JK, Lee H, Lee S, Jin Jeong S, Kyu Hong S, et al. Effect of personalized extracorporeal biofeedback device for pelvic floor muscle training on urinary incontinence after robot-assisted radical prostatectomy: a randomized controlled trial. Neurourology and Urodynamics 2020;39(2):674-81. - PubMed
Oldham 2001 {published data only}
    1. Oldham JA, ISRCTN56654882. An evaluation of pelvic floor muscle exercises and electrical muscle stimulation in patients with stress incontinence [An evaluation of pelvic floor muscle exercises and electrical muscle stimulation in patients with stress incontinence: a randomised, double-blind, controlled trial]. isrctn.com/ISRCTN56654882 (first received 01 March 2001).
Opsomer 1994 {published data only}
    1. Opsomer RJ, Castille Y, Abi-Aad A, Van Cangh PJ. Urinary incontinence after radical prostatectomy: is professional pelvic floor training necessary? (Abstract 26). Neurourology and Urodynamics 1994;13(4):382-4.
Overgård 2008 {published data only}
    1. Angelsen A, Milssen S, Overgård M, Lydersen S, Mørkved S. Does physiotherapist-guided pelvic floor muscle training increase the quality of life in patients after radical prostatectomy? A randomized clinical study (Abstract 733). In: 42nd Annual Meeting of the International Continence Society (ICS); 2012 Oct 15-19; Beijing, China. 2012. - PubMed
    1. Mørkved S, Overgård M, Lydersen S, Angelsen A. Does pelvic floor muscle training with follow up instructions by a physiotherapist reduce urinary incontinence after radical prostatectomy? A randomised controlled trial (Abstract 15). Neurourology and Urodynamics 2008;27(7):587-8.
    1. Mørkved S, NCT00239824. Pelvic floor muscle training to treat urinary incontinence after radical prostatectomy [Urinary incontinence after radical prostatectomy. - Effect of pelvic floor muscle training. A randomised controlled trial]. clinicaltrials.gov/show/NCT00239824 (first received 17 October 2005).
    1. Nilssen SR, Mørkved S, Overgård M, Lydersen S, Angelsen A. Does physiotherapist-guided pelvic floor muscle training increase the quality of life in patients after radical prostatectomy? A randomized clinical study. Scandinavian Journal of Urology and Nephrology 2012;46(6):397-404. - PubMed
    1. Overgård M, Angelsen A, Lydersen S, Mørkved S. Does physiotherapist-guided pelvic floor muscle training reduce urinary incontinence after radical prostatectomy?: A randomised controlled trial. European Urology 2008;54(2):438-48. - PubMed
Pané‐Alemany 2021 {published data only}
    1. Pané-Alemany R, Ramírez I, NCT03587402. Effects of transcutaneous perineal stimulation versus anal stimulation [Effects of transcutaneous perineal stimulation versus anal stimulation on urinary incontinence after radical prostatectomy]. clinicaltrials.gov/show/NCT03587402 (first received 16 July 2018).
    1. Pané-Alemany R, Ramírez-García I, Carralero-Martínez A, Blanco-Ratto L, Kauffmann S, Sánchez E. Efficacy of transcutaneous perineal electrostimulation versus intracavitary anal electrostimulation in the treatment of urinary incontinence after a radical prostatectomy: randomized controlled trial study protocol. BMC Urology 2021;21(1):1-6. - PMC - PubMed
    1. Pané‐Alemany R, Ramírez‐García I, Kauffmann S, Blanco‐Ratto L, Carralero‐Martínez A, Sánchez Ruiz E. Efficacy of transcutaneous perineal electrostimulation versus intracavitary anal electrostimulation in the treatment of urinary incontinence after a radical prostatectomy: randomized controlled trial. Neurourology and Urodynamics 2021;40(7):1761-9. - PubMed
Park 2012 {published data only}
    1. Park SW, Kim TN, Nam JK, Ha HK, Shin DG, Lee W, et al. Recovery of overall exercise ability, quality of life, and continence after 12-week combined exercise intervention in elderly patients who underwent radical prostatectomy: a randomized controlled study. Urology 2012;80(2):299-306. - PubMed
    1. Park SW, Park CS, Kim TN, Lee W, Nam JK, Lee SD, et al. The effects of a 12-week's combined exercise intervention on physical function and mental health after radical prostatectomy in elderly patients with prostate cancer: a prospective, randomised controlled study (Abstract 1309). Journal of Urology 2011;185(4S):e524.
Parsons 2004 {published data only}
    1. Parsons M, Mantle J, Cardozo L, Hextall A, Boos K, Bidmead J. A single blind, randomised, controlled trial of pelvic floor muscle training with home electrical stimulation in the treatment of urodynamic stress incontinence (Abstract 296). In: 34th Annual Meeting of the International Continence Society (ICS) and the International UroGynecological Association (IUGA); 2004 Aug 23-27; Paris, France. 2004.
Perissinotto 2008 {published data only}
    1. Perissinotto MC, D'Ancona CA, Campos RM, Corria Lucio A, Silva W. Physiotherapeutic for treatment of post radical prostatectomy urinary incontinence (Abstract 265). In: 38th Annual Meeting of the International Continence Society (ICS); 2008 Oct 20-24; Cairo, Egypt. 2008.
Radzimińska 2019 {published data only}
    1. Radzimińska A, Strojek K, NCT04172519. Pelvic floor muscles training after radical prostatectomy [Evaluation of the effectiveness of pelvic floor muscles training for urinary incontinence after radical prostatectomy. Pilot study]. clinicaltrials.gov/show/NCT04172519 (first received 21 November 2019).
Robinson 2008 {published and unpublished data}
    1. Robinson J. Re: study query: systematic pelvic floor training for lower urinary tract symptoms post-prostatectomy: a randomized clinical trial [personal communication]. Email to: E Johnson 9 December 2021.
    1. Robinson JP, Bradway CW, Nuamah I, Pickett M, McCorkle R. Systematic pelvic floor training for lower urinary tract symptoms post-prostatectomy: a randomized clinical trial. Internatonal Journal of Urological Nursing 2008;2(1):3-13.
Sacco 2011 {published data only}
    1. Sacco E, Tienforti D, D'Addessi A, Racioppi M, Gulino G, Pinto F, et al. Efficacy of a supervised, affordable program of perioperative pelvic floor muscle training in improving the recovery of continence after radical prostatectomy: a randomized controlled trial (Abstract 138). Neurourology and Urodynamics 2011;30(6):995-7.
Salinas Casado 1996 {published data only}
    1. Casado JS, Chamorro MV, Mohamed SS, Bravo de Rueda C, Aristizabal JM, Resel Estevez L. Results of electric stimulation in the treatment of post-prostatectomy urinary incontinence [Resultados de la electroestimulacion en el tratamiento de la incontinencia urinaria post-prostatectomia]. Actas Urologicas Espanolas 1996;20(6):544-50. - PubMed
Santos 2017 {published data only}
    1. Santos NA, Saintrain MV, Regadas RP, da Silveira RA, Menezes FJ. Assessment of physical therapy strategies for recovery of urinary continence after prostatectomy. Asian Pacific Journal of Cancer Prevention 2017;18(1):81-6. - PMC - PubMed
Seleme 2008 {published data only}
    1. Seleme M, Ribeiro V, Moreno A, Berghmans B, Bendhack M. Efficacy of physiotherapy after radical prostatectomy (Abstract 256). In: 38th Annual Meeting of the International Continence Society (ICS); 2008 Oct 20-24; Cairo, Egypt. 2008.
Simeit 2010 {published data only}
    1. Simeit R, Deck R, Drechsler T, Fiedrich M, Schönrock-Nabulsi P. Quality of life and impact of incontinence in male patients with prostate carcinoma after radical retropubic prostatectomy [Die lebensqualität und die bedeutung der inkontinenz bei männern mit prostatakarzinom nach radikaler retropubischer prostatektomie]. Rehabilitation (Stuttg) 2010;49(3):180-9. - PubMed
Soto González 2020 {published data only}
    1. Soto González M, Da Cuña Carrera I, Gutierrez Nieto M, Lopez Garcia S, Ojea Calvo A, Lantaron Caeiro EM. Early 3-month treatment with comprehensive physical therapy program restores continence in urinary incontinence patients after radical prostatectomy: a randomized controlled trial. Neurourology and Urodynamics 2020;39(5):1529-37. - PubMed
    1. Soto-González M, ISRCTN48761809. Efficacy of physiotherapy in post-prostatectomy urinary incontinence [Effectiveness of a physiotherapy program in the treatment of urinary incontinence post-prostatectomy: a randomized controlled trial]. isrctn.com/ISRCTN48761809 (first received 13 January 2017).
Steenstrup 2017 {published data only}
    1. Steenstrup B, NCT03027986. Evaluation of a postural rehabilitation program based on sensory-motor control in men with urinary incontinence after prostatectomy (PROTOMEN) [Evaluation of a postural rehabilitation program based on sensory-motor control in men with urinary incontinence after prostatectomy]. clinicaltrials.gov/show/NCT03027986 (first received 23 January 2017).
Tantawy 2019 {published data only}
    1. Tantawy SA, Elgohary HM, Abdelbasset WK, Kamel DM. Effect of 4 weeks of whole-body vibration training in treating stress urinary incontinence after prostate cancer surgery: a randomised controlled trial. Physiotherapy 2019;105(3):338-45. - PubMed
    1. Tantawy SA, NCT03325660. Whole body vibration and pelvic floor exercises on urinary incontinence ([PTREC]) [The role of whole body vibration and pelvic floor muscle exercises in treating urinary incontinence following prostate cancer surgery: a comparative randomized controlled trial]. clinicaltrials.gov/show/NCT03325660 (first received 30 October 2017).
Wang 2018a {published data only}
    1. Wang S, Lv J, Li M, Lv T. Efficacy and mechanism of electrical pudendal nerve stimulation in treating post-radical prostatectomy urinary incontinence (Abstract 473). Neurourology and Urodynamics 2018;37(S5):S325-7.
    1. Wang S, NCT02599831. Efficacy of electrical pudendal nerve stimulation for patients with post prostatectomy urinary incontinence. clinicaltrials.gov/show/NCT02599831 (first received 09 November 2015).
Wille 2003 {published data only}
    1. Wille S, Sobottka A, Heidenreich A, Hofman R. Pelvic floor exercises, electrical stimulation and biofeedback after radical prostatectomy: results of a prospective randomized trial. Journal of Urology 2003;170(2):490-3. - PubMed
    1. Wille S, Sobottka A, Olbert P, Heidenreich A, Hofman R. 167: Impact of electrical stimulation or biofeedback on quality of life after radical prostatectomy: results of a prospective randomized trial. Journal of Urology 2004;171(4S):44-5. - PubMed
Yamanishi 1996 {published data only}
    1. Yamanishi T, Yasuda K, Hattori T, Suda S, Hosoka H. Pelvic floor electrical stimulation in the treatment of stress incontinence: a placebo-controlled double-blind trial (Abstract 93). Neurourology and Urodynamics 1996;15(4):397-8.
Yang 2022 {published data only}
    1. Yang XH, Wu LF, Yan XY, Zhou Y, Liu X. Peplau's interpersonal relationship theory combined with bladder function training on patients with prostate cancer. World Journal of Clinical Cases 2022;10(9):2792-800. [DOI: 10.12998/wjcc.v10.i9.2792] - DOI - PMC - PubMed
Yokoyama 2004 {published data only}
    1. Yokoyama T, Nishiguchi J, Watanabe T, Nose N, Nozaki K, Fukita O, et al. Comparative study of effects of extracorporeal magnetic innervation versus electrical stimulation for urinary incontinence after radical prostatectomy. Urology 2004;63(2):264-7. - PubMed
Zachovajevienė 2019 {published data only}
    1. Milonas D, Šiupšinskas L, Zachovajevas P, Zachovajevienė B. Effectiveness of different postoperative training programs on pelvic floor muscles strengthening and reducing of urinary incontinence in men after radical prostatectomy: results of randomized controlled clinical trial (Abstract 22). European Urology Supplements 2018;17(5):e2199.
    1. Milonas D, NCT03858452. Relations between pelvic floor, diaphragm and trunk muscles [Evaluation of functional relations and their changes between pelvic floor, diaphragm and trunk muscles in men after radical prostatectomy]. clinicaltrials.gov/show/NCT03858452 (first received 28 February 2019).
    1. Zachovajevienė B, Šiupšinskas L, Zachovajevas P, Venclovas Z, Milonas D. Effect of diaphragm and abdominal muscle training on pelvic floor strength and endurance: results of a prospective randomized trial. Scientific Reports 2019;9:19192. - PMC - PubMed
Zhang 2007 {published data only}
    1. Zhang AY, Strauss GJ, Siminoff LA. Effects of combined pelvic floor muscle exercise and a support group on urinary incontinence and quality of life of postprostatectomy patients. Oncology Nursing Forum 2007;34(1):47-53. - PubMed
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Zhang 2015 {published and unpublished data}
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References to other published versions of this review

Johnson 2021
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Publication types

Associated data