A Biofeedback guided program or pelvic floor muscle electric stimulation can improve early recovery of urinary continence after radical prostatectomy: a meta-analysis and systematic review.

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Abstract

PURPOSE: Urinary incontinence (UI) after radical prostatectomy (RP) is an early side effect after catheter removal. This systematic review and meta-analysis was conducted to compare different forms of non-invasive treatments for post-RP UI and to analyze whether the addition of biofeedback (BF) and/or pelvic floor muscle electric stimulation (PFES) to PF muscle exercise (PFME) alone can improve results in terms of continence recovery rate.MATERIALS AND METHODS: A literature search was performed following the PRISMA guidelines. We performed a cumulative meta-analysis to explore the trend in the effect sizes across subgroups during a 12-mo follow-up.RESULTS: 26 articles were selected. At baseline after RP and catheter removal, mean pad weight varied extremely. At 1- and 3-mo intervals, mean difference in pad weight recovery from baseline was significantly higher using guided programs (BF, PFES or both) than using PFME alone (3-mo: PFME 111.09 g (95%CI 77.59-144.59), BF 213.81 g (95%CI -80.51-508-13), PFES 306.88 g (95%CI 158.11-455.66), BF+PFES 266.31 g (95%CI 22.69-302.93); p<0.01), while at 6- and 12-mo differences were similar (p>0.04). At 1- and 3-mo intervals, event rate (ER) of continence recovery was significantly higher using guided programs than using PFME alone (3-mo: PFME 0.40 (95%CI 0.30-0.49), BF 0.49 (95%CI 0.31-0.67), PFES 0.57 (95%CI 0.46-0.69), BF+PFES 0.75 (95%CI 0.60-0.91); p<0.01), while at 6- and 12-mo ERs were similar.CONCLUSIONS: Regarding non-invasive treatment of UI secondary to RP, the addition of guided programs using BF or/and PFES demonstrated to improve continence recovery rate, particularly in the first 3-mo interval, when compared to the use of PFME alone.

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