Impact of preoperative pelvic floor muscle strength and endurance on urinary continence after radical prostatectomy: a sub-analysis of a randomized clinical trial.

INTRODUCTION

To assess the impact of preoperative pelvic floor muscle (PFM) strength on urinary incontinence (UI) after radical prostatectomy (RP).

MATERIAL AND

METHODS

A total of 127 men who underwent surgical treatment for clinically localized prostate cancer in a tertiary university hospital were included in a sub-analysis. PFM strength (cmH2O) and endurance (s) were measured using a perineometer on the day before and at 1, 3, and 6 months after surgery. UI volume was measured using an 8-hour pad test. The primary outcome was continence, defined as 0-5 grams of urine during the 8-hour pad test at 6 months post-RP. The association between baseline PFM strength and continence was analyzed using Spearman's correlation coefficient, receiver-operating characteristic analysis, and logistic regression analysis.

RESULTS

At 6 months post-RP, 45 of 127 (35.4%) men were continent. UI showed a strong negative (r = -0.7; p <0.001) association with preoperative PFM strength and a medium negative (r = -0.55; p <0.001) association with PFM endurance. PFM strength (odds ratio [OR] = 1.16, p <0.0001), PFM endurance (OR 1.6, p <0.0001), and preoperative prostate-specific antigen (OR = 0.87, p = 0.03) were the most significant predictors of continence in the univariate regression analysis. In the multivariate analysis, only PFM strength remained a significant predictor (OR = 1.13, p <0.001) of UI. The thresholds for PFM endurance and strength were 9.6 seconds and 98.9 cmH2O, respectively.

CONCLUSIONS

Preoperative PFM strength and endurance demonstrated significant associations with postoperative UI. Objectively measured preoperative PFM conditions could help identify patients at increased risk of UI after RP.