Abstract and Introduction
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.
Introduction
Prostate cancer is one of the most common cancers among males worldwide, with its incidence positively correlated with age. In males aged 65 and above, the incidence rate of prostate cancer is close to 60%.[1] Radical prostatectomy (RP), is the gold standard for localized prostate cancer treatment and is associated with a 5-year survival rate greater than 95%.[2,3] Despite excellent disease-specific survival, RP often causes debilitating consequences to continence and erectile function. Urinary incontinence is common after RP, occurring in 2% to 87% of patients.[4,5] While continence improves in most men over time, this recovery time is variable with some patients requiring up to 12 months.[6,7] In addition, a large proportion of men fail to achieve complete continence at any point and suffer from long-term leakage and impact on quality of life.
Pelvic floor muscle training (PFMT) is a well-described treatment for urinary incontinence after RP.[8,9] Accordingly, it is recommended by the European Association of Urology (EAU) and the American Urology Association (AUA) as a first-line treatment for Urinary incontinence after prostatectomy.[8,9]
Despite significant reported studies demonstrating that PFMT can improve post-operative urinary incontinence, there remains controversy as to its efficacy given conflicting results reported in other studies.[10–13] For example, a 2004 study did not recommend it as a first-line rehabilitation after prostatectomy, as incontinence symptoms did not significantly improve over time.[14] Systematic review is limited and also complicated by the wide variety of PFMT regimens that are reported across the literature. Thus, further systematic evaluations are needed to provide evidence-based medical evidence for the application and standardization of PFMT. We present this article in accordance with the PRISMA reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-23-337/rc).
Transl Androl Urol. 2023;12(7):1155-1166. © 2023 AME Publishing Company
