Pelvic Floor Rehabilitation for Urinary Incontinence after Radical Prostatectomy: Techniques and Recommendations

Abstract

Introduction: Urinary incontinence is a common complication following radical prostatectomy, significantly impacting patients' quality of life. This systematic review aimed to evaluate the efficacy of various pelvic floor rehabilitation techniques in managing post-prostatectomy urinary incontinence. Methods: A comprehensive literature search was conducted using PubMed and Google Scholar, yielding 34 relevant studies for analysis. Results: The review found that pelvic floor rehabilitation, encompassing techniques such as pelvic floor exercises, biofeedback, electrical stimulation, and behavioral management, offers a non-invasive and cost-effective approach to improving continence outcomes. While the optimal timing and duration of rehabilitation remain debated, evidence supports initiating pelvic floor muscle training preoperatively and continuing postoperatively. Combining multiple rehabilitation techniques, particularly manual therapy with biofeedback or functional electrostimulation, appears to yield the best results in accelerating continence recovery. Preoperative rehabilitation showed mixed outcomes, with some studies reporting improved continence and others finding no additional benefit. Postoperative rehabilitation strategies varied, but generally focused on gradually increasing pelvic floor strength and control. The long-term efficacy of rehabilitation at 12 months post-surgery was comparable to no intervention in some studies. Conclusion: While pelvic floor rehabilitation demonstrates modest effectiveness in managing post-prostatectomy urinary incontinence, particularly in the short term, further research is needed to establish optimal protocols and long-term benefits. These findings underscore the importance of a comprehensive, patient-centered approach to post-prostatectomy care.