Preoperative pelvic floor physiotherapy improves continence after radical retropubic prostatectomy.
OBJECTIVES
Urinary incontinence is a predictable sequela of radical retropubic prostatectomy, and is most severe in the early postoperative phase. The present study aimed to evaluate the effect of a physiotherapist-guided pelvic floor muscle training program, commenced preoperatively, on the severity and duration of urinary continence after radical retropubic prostatectomy.


METHODS
A retrospective analysis of men undergoing radical retropubic prostatectomy by one high-volume surgeon (n = 284) was carried out. The intervention group received physiotherapist-guided pelvic floor muscle training from 4 weeks preoperatively (n = 152), whereas the control group was provided with verbal instruction on pelvic floor muscle exercise by the surgeon alone (n = 132). Postoperatively, all patients received physiotherapist-guided pelvic floor muscle training. The primary outcome measure was 24-h pad weight at 6 weeks and 3 months postoperatively. Secondary outcome measures were the percentage of patients experiencing severe urinary incontinence, and patient-reported time to one and zero pad usage daily.


RESULTS
At 6 weeks postoperatively, the 24-h pad weight was significantly lower (9 g vs 17 g, P < 0.001) for the intervention group, which also showed less severe urinary incontinence (24-h pad weight >50 g; 8/152 patients vs 33/132 patients, P < 0.01). There was no significant difference between groups in the 24-h pad weight at 3 months (P = 0.18). Patient-reported time to one and zero pad usage was significantly less for the intervention group (P < 0.05). Multivariate Cox regression showed that preoperative physiotherapist-guided pelvic floor muscle training reduced time to continence (1 pad usage daily) by 28% (P < 0.05).


CONCLUSIONS
A physiotherapist-guided pelvic floor muscle training program, commenced 4 weeks preoperatively, significantly reduces the duration and severity of early urinary incontinence after radical retropubic prostatectomy.
['Patel|Manish I|MI|', 'Yao|Jinna|J|', 'Hirschhorn|Andrew D|AD|', 'Mungovan|Sean F|SF|']
D000328:Adult D000368:Aged D006801:Humans D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D017773:Pelvic Floor D026741:Physical Therapy Modalities D011300:Preoperative Care D016016:Proportional Hazards Models D011468:Prostatectomy D012189:Retrospective Studies D016896:Treatment Outcome D014549:Urinary Incontinence
preoperative pelvic floor physiotherapy incontinence radical prostatectomy