Pelvic floor muscle training alone and in combination with biofeedback and/or electrical stimulation for urinary incontinence following prostatectomy: a meta-analysis

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Abstract

The prevalence rates of urinary incontinence
(UI) following prostatectomy ranges from 2-60%. Efficacy
of pelvic floor muscle training (PFMT) alone and in combination with biofeedback (BFB) and/or electrical stimulation
(ES) for UI in men following prostatectomy is inconclusive.
The objective was to determine whether PFMT works well
alone or in combination with BFB and/or ES compared to
control.
Methods: Databases Ovid Medline, EMBASE, CENTRAL, Scopus, Web of Science, and the specialized register
of the Cochrane incontinence review group and abstract
proceedings from various urological meetings were searched
from inception-August 2017. Cluster, randomised, and cross
over trials utilizing PFMT alone and PFMT plus BFB and/or
ES against control for UI following prostatectomy were
included for the review. The grading of recommendations,
assessment, development, and evaluation (GRADE) tool
was used for quality appraisal. Two independent reviewers
screened the titles and abstracts, reviewed full-text articles,
and performed data extraction.
Results: In total, 68 full-text articles were assessed
for eligibility. Sixteen studies were included for the metaanalysis. Meta-analysis of low-moderate GRADE quality
studies showed that PFMT alone compared to control can
significantly increase continence rates immediately following intervention (RR 2.21, 95% CI 1.32,3.71; p = 0.003;
n = 469) and at follow-up (RR 1.17, 95% CI 1.00,1.37;
p = 0.05; n = 1255). Pooled-analysis of moderate GRADE
quality studies revealed that PFMT alone plus ES compared to no treatment control can significantly reduce
grams of urine lost on the 24-hr pad test (−13.01 95%
CI −21.63, −4.38); p = 0.003; n = 129). PFMT alone plus
BFB did not improve continence either immediately following intervention (RR 1.70 [95% CI 0.95 to 3.04]; p = 0.07)
or follow-up (RR 1.17 [95% CI 0.93 to 1.48]; p = 0.18);
the GRADE quality for this comparison ranged from
low-moderate.
Conclusion(s): This review found low-moderate GRADE
quality of evidence to suggest that PFMT alone could improve
recovery of continence in men following prostatectomy.
Meta-analysis showed positive treatment effects for PFMT
plus ES for post-prostatectomy incontinence, however, its
safety issues limit the clinical use of ES on men with prostate
cancer due to the risk of dissemination of residual cancer cells. In the absence of literature relating to the safety
of ES in the presence of malignancy, phase 4 studies (for
detecting uncommon adverse effects) with suitable models
are required to test the safety of ES in malignancy. The
specific effects of PFMT combined with BFB is uncertain.
Although meta-analysis found insignificant results for PFMT
plus BFB, greater number of men were continent in the intervention group showing positive effects for this intervention.
Future high-quality studies with adequate blinding (participants, therapist, and assessors) and active, sham or placebo
have the potential to alter the effects obtained for PFMT alone
combined with BFB in this review.
Original languageEnglish
Title of host publicationPhysiotherapy
Pagese26-27
Number of pages2
Volume105
DOIs
Publication statusPublished - 1 Jan 2019

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