Postoperative Pelvic Floor Muscle Training for Urinary Incontinence Following Radical Prostatectomy: A Meta-Analysis With Exploratory Subgroup Analysis by Surgical Approach.

OBJECTIVES

This meta-analysis evaluated postoperative pelvic floor muscle training (PFMT) for urinary incontinence after radical prostatectomy (RP) and explored whether effects differed by surgical approach.

METHODS

PubMed, Web of Science, Cochrane Library, Scopus, PEDro, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) published from January 1, 2005, to January 1, 2025. Random-effects models were used. Short-term ICIQ-SF scores were summarized as standardized mean differences (SMDs; negative values favor PFMT), and long-term continence as odds ratios (ORs), each with 95% confidence intervals (CIs). Subgroup analyses by surgical approach were exploratory.

RESULTS

Seven RCTs involving 666 participants were included. At 3 months, 3 studies (n = 151) favored PFMT (SMD = -1.22, 95% CI [-2.40, -0.04], P = .04; I² = 90%). A sensitivity analysis excluding de Lira et al. included 2 studies (n = 120) and yielded SMD = -1.81 (95% CI [-2.40, -1.21]; I² = 48%). At 12 months, 4 studies (n = 515) favored PFMT (OR = 7.21, 95% CI [3.99, 13.02], P < .00001; I² = 0%). Interaction tests did not show differences by surgical approach at either 3 months (P = .68) or 12 months (P = .53).

CONCLUSIONS

Postoperative PFMT may improve short- and long-term continence recovery after RP. Certainty was very low for the heterogeneous short-term evidence and low for the long-term evidence; differences by surgical approach remain inconclusive.