Preoperative pelvic floor muscle exercise and postprostatectomy incontinence: a systematic review and meta-analysis

Context: Preoperative pelvic floor muscle exercise (PFME) is often prescribed to reduce the severity of postprostatectomy incontinence. Objective: Systematic review and meta-analysis of evidence regarding the effect of preoperative PFME on postoperative urinary incontinence following radical prostatectomy. Evidence acquisition: A systematic search was performed of the Cochrane Library, Medline, Embase, and all potential articles from references in relevant articles on 4 October 2014. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Identified reports were critically appraised for quality and relevance. Only studies of preoperative PFME compared with no preoperative PFME were included. Evidence synthesis: Eleven studies were included based on the selection criteria. The total number of patients included in the final analysis was 739. In seven studies, sufficient quantitative data on postoperative incontinence were available for meta-analysis. At 1 mo, there was no difference in continence rates between the groups (odds ratio [OR]: 0.68; 95% confidence interval [CI], 0.45-1.03). At 3 mo, there was 36% improvement in the preoperative PFME group (OR: 0.64; 95% CI, 0.47-0.88). At 6 mo, there was no difference between groups (OR: 0.60; 95% CI, 0.32-1.15). When examining quality of life measures, four of seven studies demonstrated significant improvement in the preoperative PFME group at 3 mo, and two of these studies demonstrated significant differences at 6 mo. Conclusions: Preoperative PFME improves postoperative urinary incontinence after radical prostatectomy at 3 mo but not at 6 mo, suggesting it improves early continence but not long-term continence rates. Patient summary: We reviewed all evidence for preoperative pelvic floor muscle exercise (PFME) in treating urinary incontinence following radical prostatectomy. We found evidence to suggest that preoperative PFME improves early continence rates but not long-term continence rates.