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

Joanne E Milios; Timothy R Ackland; Daniel J Green

doi:10.1186/s12894-019-0546-5

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

BMC Urol. 2019 Nov 15;19(1):116. doi: 10.1186/s12894-019-0546-5.

Authors

Joanne E Milios^{1

2}, Timothy R Ackland³, Daniel J Green³

Affiliations

¹ School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, Western Australia, 6009, Australia. jomilios22@gmail.com.
² Faculty of Science, School of Human Services (Sport Science, Exercise and Health), University of Western Australia, Parkway Rd, Crawley, Western Australia, 6009, Australia. jomilios22@gmail.com.
³ School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, Western Australia, 6009, Australia.

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.

Publication types

Randomized Controlled Trial

MeSH terms

Aged
Exercise Therapy* / methods
Humans
Male
Middle Aged
Pelvic Floor* / physiopathology
Postoperative Complications / rehabilitation*
Prostatectomy* / methods
Recovery of Function
Urinary Incontinence / rehabilitation*