Structured and supervised pelvic floor muscle training following confirmed contraction in post-prostatectomy urinary incontinence: a systematic review of randomized controlled trials

Ege Nur Atabey Gerlegiz; Demet Öztürk; Ceren Gürşen; Türkan Akbayrak; Serap Özgül

doi:10.1007/s11764-025-01882-6

Structured and supervised pelvic floor muscle training following confirmed contraction in post-prostatectomy urinary incontinence: a systematic review of randomized controlled trials

J Cancer Surviv. 2025 Aug 28. doi: 10.1007/s11764-025-01882-6. Online ahead of print.

Authors

Ege Nur Atabey Gerlegiz¹, Demet Öztürk², Ceren Gürşen², Türkan Akbayrak², Serap Özgül²

Affiliations

¹ Department of Fundamental Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, 06100, Samanpazari, Ankara, Turkey. nur_atabey@hacettepe.edu.tr.
² Department of Fundamental Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, 06100, Samanpazari, Ankara, Turkey.

PMID: 40877548
DOI: 10.1007/s11764-025-01882-6

Abstract

Purpose: Prostate cancer is the second most commonly diagnosed malignancy in men worldwide. Post-prostatectomy urinary incontinence (PP-UI) is a common and distressing complication that significantly reduces quality of life in prostate cancer survivors. This systematic review aimed to evaluate the effectiveness of structured and supervised pelvic floor muscle training (PFMT), initiated after confirmed pelvic floor muscle activation, delivered pre- or postoperatively, with or without biofeedback (BF), on symptom severity and continence-related quality of life.

Methods: A comprehensive search of MEDLINE and Web of Science was conducted in December 2024. Twenty randomized controlled trials (RCTs) involving 2444 participants met inclusion criteria. All studies confirmed correct pelvic floor muscle contraction prior to intervention and implemented structured, supervised PFMT protocols. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and study quality was evaluated using the GRADE framework. Due to heterogeneity in interventions and outcomes, a narrative synthesis was performed.

Results: Thirteen of the twenty RCTs (65%) reported significant improvements in continence recovery and symptom severity with structured and supervised PFMT. Early initiation, higher training intensity, anterior compartment-focused training, and use of BF were associated with greater benefits. However, protocol and outcome variability limited consistency across studies.

Conclusions: Structured and supervised PFMT based on confirmed muscle activation is a key component of effective PP-UI management. Early, intensive training under therapist guidance is likely to accelerate recovery and enhance continence outcomes.

Implications for cancer survivors: Targeted PFMT programs with confirmed muscle activation and professional supervision provide a safe, non-invasive, and potentially effective strategy to improve urinary continence and overall quality of life after prostate cancer treatment.

Trial registration: PROSPERO ID: CRD42023387493.

Keywords: Biofeedback; Pelvic floor muscle training; Prostate cancer survivorship; Rehabilitation; Supervised exercise; Urinary incontinence.

Publication types

Review