A Systematic Review of Pelvic Floor Muscle Training for Erectile Dysfunction After Prostatectomy and Recommendations to Guide Further Research

Abstract

Background: Erectile dysfunction is one potential complication after radical prostatectomy; often pelvic floor muscle training is offered as an intervention to improve quality of life and erectile function post-operatively.

Aim: To provide a summary of current evidence regarding the effectiveness of pelvic floor muscle training in the management of erectile dysfunction after radical prostatectomy and provide recommendations for future research.

Methods: An electronic search was conducted for relevant research studies using PubMed, EMBASE, CINAHL, Medline, and PEDro. Quality of selected trials was assessed by 2 independent reviewers using the Modified Downs and Black Checklist; disagreements were resolved by consensus.

Main outcome measure: The main outcome measure is the International Index of Erectile function (IIEF-5).

Results: 9 studies of various study design were included in this review. Most studies demonstrated improvements in erectile dysfunction with pelvic floor muscle training; however, lack of methodological rigor for several studies and variability among training protocols limited interpretation of results.

Clinical implications: Further well powered and rigorously designed randomized controlled trials are needed to investigate the effect of pelvic floor muscle training on erectile dysfunction after radical prostatectomy.

Strengths & limitations: This review employed a systematic method of appraising the available evidence for pelvic floor muscle training for erectile dysfunction after radical prostatectomy. Limited high-quality articles were identified and few conclusions could be drawn from the existing evidence.

Conclusion: Future high-quality randomized controlled trials should include strategies to improve adherence to exercise, clearly describe exercise protocols, and integrate new evidence for verbal cues and biofeedback for muscles involved in erection. Wong C, Louie DR, Beach C. A Systematic Review of Pelvic Floor Muscle Training for Erectile Dysfunction After Prostatectomy and Recommendations to Guide Further Research. J Sex Med 2020;17:737-748.

Keywords: Erectile Dysfunction; Pelvic Floor; Physiotherapy; Prostatectomy; Rehabilitation; Sexual Dysfunction.