Preoperative pelvic floor muscle exercise does not reduce the rate of postprostatectomy incontinence: evidence from a meta-analysis and a systematic review

BACKGROUND: A growing number of researches suggested that preoperative pelvic floor muscle exercise (PFME) was beneficial for urinary incontinence (UI) after a prostatectomy. However, these studies are debatable and inconclusive. Hence, this article aimed to determine whether PFME improves UI after a radical prostatectomy (RP). METHODS: PubMed, Embase, Medline and Cochrane Library were searched for articles published from 2014 to October 2019 based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). This study was evaluated based on the Oxford Evidence-Based Medicine Center. A total of 1,269 subjects (experimental group: 628, control group: 641) in 18 studies met the inclusion criteria. In 18 studies, enough quantitative data on postoperative incontinence were available for meta-analysis. UI was analyzed at 1, 3, 6 and 12 months and all comparative studies were pooled using fixed and random effects models. Contour-enhanced funnel plots were used to assess publication bias. RESULTS: Pooled data revealed a total of 1,269 UI patients that underwent preoperative PFME, including PFME (N=628, 49.48%) and control group (N=641, 50.51%). There was no significant difference in the postoperative incontinence rates at 1 month (RR: 0.85, 95% CI: 0.66–1.09, P=0.031, I(2)=62.4%), 6 weeks (RR: 0.95, 95% CI: 0.85–1.05, P=0.618, I(2)=0.0%), 3 months (RR: 0.92, 95% CI: 0.63–1.34, P=0.000, I(2)=83.2%), 6 months (RR: 0.86, 95% CI: 0.69–1.08, P=0.364, I(2)=8.4%) or 12 months (RR: 0.83, 95% CI: 0.47–1.47, P=0.596, I(2)=0.0%) after operation. CONCLUSIONS: Contrary to previous work, the results presented here indicated that preoperative PFME protocols did not reduce the rate of UI. Further high-quality randomized controlled trials are necessary in the future to verify these findings.