Pelvic-floor muscle training following prostate surgery unhelpful for urinary incontinence

January 01, 0001

Pelvic-floor muscle training following prostate surgery unhelpful for urinary incontinence

Urinary incontinence is common immediately after prostate surgery. Men are often advised to do pelvic-floor exercises, but evidence to support this is inconclusive. The aim of the researchers from the UK and Canada was to establish if formal one-to-one pelvic floor muscle training reduces incontinence. they undertook two randomised trials in men in the UK who were incontinent 6 weeks after radical prostatectomy (trial 1) or transurethral resection of the prostate (TURP; trial 2) to compare four sessions with a therapist over 3 months with standard care and lifestyle advice only. Randomisation was by remote computer allocation. The primary endpoints were collected via postal questionnaires.

In the intervention group in trial 1, the rate of urinary incontinence at 12 months (76%) was not significantly different from the control group (77%). In trial 2, the difference in the rate of urinary incontinence at 12 months (65%) from the control group was not significant (62%). Adjusting for minimisation factors or doing treatment-received analyses did not change these results in either trial. No adverse effects were reported. In both trials, the intervention resulted in higher mean costs per patient (£180 and £209 respectively) but the researchers did not identify evidence of an economically important difference in QALYs.

The researchers concluded: "In settings where information about pelvic-floor exercise is widely available, one- to-one conservative physical therapy for men who are incontinent after prostate surgery is unlikely to be effective or cost effective. The high rates of persisting incontinence after 12 months suggest a substantial unrecognised and unmet need for management in these men."

These rates are very high!

For the full abstract, click here.

The Lancet published online 8 July 2011 © 2011 Elsevier Limited
Urinary incontinence in men after formal one-to-one pelvic-floor muscle training following radical prostatectomy or transurethral resection of the prostate (MAPS): two parallel randomised controlled trials. Cathryn Glazener, Charles Boachie, Brian Buckley et al. Correspondence to Cathryn Glazener: [email protected]

Category: U. Urinary System. Keywords: urinary, incontinence, men, pelvic floor, muscle, training, radical prostatectomy, transurethral resection, postal questionnaires, randomised controlled trials, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 19 July 2011

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