Pelvic Floor Muscle Training for Post-Prostatectomy Incontinence: Dose-Response Meta-Analysis

Abstract

Introduction: Pelvic floor muscle training (PFMT) is first-line therapy for post-prostatectomy incontinence (PPI). However, optimal intensity and duration remain unknown. This meta-analysis examines the dose-response relationship between PFMT parameters and continence recovery.

Methods: We searched PEDro, MEDLINE, and CENTRAL (2000–2024) for RCTs of PFMT after radical prostatectomy. Inclusion: men with PPI ≥3 months post-surgery, PFMT intervention with defined weekly minutes and duration. Primary outcome: continence rate (0–1 pad/day) at 6 months. Dose-response was analyzed by meta-regression.

Results: Fifteen RCTs (n=1,843) contributed data. Mean PFMT dose ranged from 90 to 420 minutes/week. Higher weekly minutes were associated with greater continence recovery: each additional 60 minutes/week increased odds by 12% (OR 1.12, 95%CI 1.04–1.21). Programs ≥12 weeks showed no advantage over 8-week programs. Supervised sessions were more effective than home-based alone (OR 1.9, p<0.01).

Discussion: A minimum of 150 minutes weekly of supervised PFMT appears optimal. Longer duration beyond 8 weeks does not improve outcomes, suggesting early intensive rehabilitation is key. Heterogeneity in incontinence definitions and baseline severity limited precision.

Conclusions: Intensive (≥150 min/week) supervised PFMT for 8 weeks maximizes PPI recovery. Clinicians should prescribe dose explicitly, not simply recommend PFMT.