Pelvic Floor Muscle Training with Preoperative Biofeedback in Patients with Postprostatectomy Incontinence: A Systematic Review and Meta-analysis of Randomised Clinical Trials

Abstract

Background and objective The evidence on pelvic floor muscle training (PFMT) with preoperative biofeedback after radical prostatectomy (RP) is inconclusive. The objective was to analyse the efficacy of PFMT with preoperative biofeedback in reducing postprostatectomy incontinence. Methods A systematic review and meta-analysis (CRD42024506285) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The search was performed until July 2024. We selected randomised clinical trials including adults with prostate cancer who were candidates for RP and underwent PFMT with preoperative biofeedback compared with the control group, usual care, or PFMT with postoperative biofeedback, and we assessed urinary incontinence, quality of life, or other surgery-related adverse events. Quality of evidence and risk of bias were assessed. A meta-analysis was performed. Key findings and limitations Fourteen studies were included in the systematic review and 13 were included in the meta-analysis. Up to 3 mo following RP, the meta-analysis showed significantly lower rates of postprostatectomy incontinence (n = 485; odds ratio [OR] = 0.51; 95% confidence interval [CI] = 0.28, 0.92; p = 0.02; I2 = 21%) in the preoperative biofeedback group than in the control group (ie, no intervention or usual care). Results were maintained at 3–<6 mo (n = 436; OR = 0.40; 95% CI = 0.20, 0.79; p = 0.008; I2 = 49%) and at 6–<12 mo (n = 409; OR = 0.29; 95% CI = 0.10, 0.85; p = 0.02; I2 = 65%) following RP. No significant changes were observed when compared with the postoperative biofeedback. No publication bias was detected. The level of evidence ranged from very low to low. Further high-quality research is required. Conclusions and clinical implications PFMT with preoperative biofeedback reduced postprostatectomy incontinence significantly at different follow-up periods, supporting its use in clinical practice.