Introduction: While long-term urinary continence is eventually achieved in most patients who undergo radical prostatectomy, predicting when patients will become continent can be challenging. Prior trials evaluating the effect of pelvic floor physical therapy (PFPT) with biofeedback on continence have showed conflicting results. However, these studies have primarily evaluated patients who received post-operative PFPT and have not reported on whether detailed patient-specific parameters gathered by the pelvic floor physical therapist may influence continence. We evaluated the association of pre-operative PFPT parameters with early return of urinary continence after radical prostatectomy.
Methods: We reviewed a prospectively maintained database of all patients undergoing robotic radical prostatectomy at our institution for those who had pre-operative PFPT consultation and 3-month patient-reported quality of life evaluation using EPIC-CP. All patients were evaluated by one of two therapists specializing in PFPT with biofeedback, who documented pelvic floor resting tone, pelvic floor working tone, pelvic floor endurance (defined as the ability to hold a 10-second pelvic floor muscle contraction), and dominant hand grip strength. We used multivariable logistic regression to evaluate the association of PFPT parameters with urinary continence at 3 months, defined as using 0 or 1 urinary pads. We adjusted for other factors that could affect continence, including age, BMI, D’Amico risk classification, nerve sparing, and prostate volume.
Results: 144 men underwent robotic radical prostatectomy with pre-operative PFPT evaluation and completed a 3-month EPIC-CP questionnaire. 92.4% of men received some nerve-sparing. 89% of men had either intermediate- or high-risk prostate cancer. At 3 months, 90/144 (62.5%) were continent (using 0-1 pads), while 54/144 (37.5%) were using 2 or more pads. On multivariable analysis, prostate volume (OR 0.98, 95% CI 0.96-1.00) and pelvic floor endurance (OR 2.70, 95% CI 1.23-6.25) were significantly associated with being continent at 3 months. Neither pelvic floor resting tone, working tone, nor dominant hand grip strength were associated with continence. 56/76 (74%) men with good pelvic floor endurance were continent at 3 months, while only 34/68 (50%) men with poor endurance were continent (p = 0.006).
Conclusions: Beyond the potential benefits of PFPT itself, pre-operative assessment of pelvic floor endurance may allow more accurate prediction of early continence return after radical prostatectomy. Source of