The therapeutic effect of pelvic floor muscle training on stress urinary incontinence following prostatectomy: a systematic review and meta-analysis

Liping Xin; Maomao Li; Minli Pan

doi:10.21037/tau-23-337

The therapeutic effect of pelvic floor muscle training on stress urinary incontinence following prostatectomy: a systematic review and meta-analysis

Transl Androl Urol. 2023 Jul 31;12(7):1155-1166. doi: 10.21037/tau-23-337. Epub 2023 Jul 24.

Authors

Liping Xin^{1

2}, Maomao Li³, Minli Pan⁴

Affiliations

¹ Graduate School, Zhejiang University of Traditional Chinese Medicine, Ningbo, China.
² Departments of Rehabilitation Medicine, Ningbo Yinzhou No. 2 Hospital, Ningbo, China.
³ Departments of Urology, Ningbo Yinzhou No. 2 Hospital, Ningbo, China.
⁴ Dialysis Center, Ningbo Yinzhou No. 2 Hospital, Ningbo, China.

Abstract

Background: Prostatectomy often causes urinary incontinence, especially stress Urinary incontinence, which has a serious impact on the quality of life of patients. Previous studies have proved that pelvic floor muscle training can help restore pelvic floor function and reduce Urinary incontinence, but the quantitative evaluation and systematic analysis of its effect have not yet been clear. This meta-analysis aimed to systematically evaluate the therapeutic effect of pelvic floor muscle training on managing stress urinary incontinence after prostatectomy.

Methods: The literature on pelvic floor muscle training for patients after prostatectomy was searched in PubMed, Web of Science, EMBASE, CNKI, VIP, Wanfang, and China Biology Medical Literature Database (CBM) from database establishment up to January 30th, 2023. Risk bias assessment was conducted using RoB1, a risk assessment tool recommended by Cochrane for evaluating RCTs literature. Publication bias was evaluated through funnel plots. Meta-analysis of effect size was performed using R 4.2.2.

Results: Eleven randomized controlled studies were included. The risk of bias assessment showed that three studies had a moderate risk of bias and eight had a low risk. The meta-analysis results showed that the patient-reported incontinence was improved after one month [odds ratio (OR): 2.71, 95% 95% confidence interval (CI): 1.86-3.94, P<0.01]; improved after three months (OR: 3.42, 95% CI: 1.96-5.98, P<0.01); improved after six months (OR: 3.77, 95% CI: 1.51-9.41, P<0.01); improved after 12 months (OR: 1.21, 95% CI: 1.11-1.31, P<0.01); and the International Consultation on Incontinence Questionnaire-Simple Form (ICIQ-SF) score decreased [mean difference (MD): -2.74, 95% CI: -4.96 to -0.52, P=0.02]. Subgroup analysis showed that the ICIQ-SF score decreased after one month (MD: -0.61, 95% CI: -0.81 to -0.40) and three months (MD: -3.43, 95% CI: -6.85 to -0.02).

Conclusions: Pelvic floor muscle training significantly improves stress urinary incontinence after prostatectomy, which can be improved by 2.77 times at most. However, due to the limited number of studies included, further validation is needed.

Keywords: Pelvic floor muscle training (PFMT); meta-analysis; prostatectomy; stress urinary incontinence.