A Cochrane review [Abstract] 1 included 50 studies (45 after radical prostatectomy, 4 after transurethral resection, 1 after either operation), with a total of 4717 subjects. There was considerable variation in the interventions, populations and outcome measures.
There was no evidence from eight trials that pelvic floor muscle training with or without biofeedback was better than control for men who had urinary incontinence up to 12 months after radical prostatectomy; 57% with urinary incontinence in the intervention group versus 62% in the control group, RR for incontinence after 12 months 0.85, 95% CI 0.60 to 1.22. Individual small trials provided data to suggest that electrical stimulation, external magnetic innervation, or combinations of treatments might be beneficial but the evidence was limited. Amongst trials of conservative treatment for all men after radical prostatectomy, aimed at both treatment and prevention, there was moderate evidence of an overall benefit from pelvic floor muscle training versus control management in terms of reduction of urinary incontinence;10% with urinary incontinence after one year in the intervention groups versus 32% in the control groups, RR for urinary incontinence 0.32, 95% CI 0.20 to 0.51. However, this finding was not supported by other data from pad tests.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes), by limitations in study quality and by imprecise results (limited study size for each comparison).
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