Predicting Pelvic Floor Physical Therapy Response After Prostatectomy

By Patrick Daly - Last Updated: November 30, 2022

In a study presented at the 23rd Annual Meeting of the Society of Urologic Oncology, researchers explored predictors of successful response to pelvic floor physical therapy (PFPT) for the 4% to 8% of men who develop long-term stress urinary incontinence after open or robotic-assisted radical prostatectomy. According to the study’s lead author and presenter, Nehizena Aihie, patients who recovered from postprostatectomy incontinence (PPI) started PFPT earlier than patients who did not recover.

However, Aihie noted that no anatomic features or other variables were identified that could successfully predict response to PFPT in patients with PPI. Aihie suggested they were likely unable to identify any predictive factors due to the study’s small sample size.

Earlier PFPT May Accelerate Continence Recovery After Prostatectomy

A total of 76 men were enrolled in the retrospective study (80% White; mean age, 63.2 ± 6.6 years; average prostate volume, 49 ± 32.6cc). Researchers used multivariate analyses to attempt to identify predictors for PFPT success. In addition, a subgroup of patients with preoperative multiparametric magnetic resonance imaging (mpMRI) available were assessed for associations between PFPT success and Lee type classification of prostatic apex, membranous urethra length, or presence of median lobe.

Among the cohort, 25% of patients successfully recovered from PPI after undergoing PFPT, 30% had some improvements, and 25% had no changes. Of note, patients with complete PPI resolution started PFPT at 40.9 days compared with patients who didn’t recover at 47.6 days (P=.02). Moreover, patients with early continence recovery started PFPT the earliest, at 25.5 days.

In the 52 patients with mpMRI, average membranous urethral length was 1.3 ± 0.3 cm, 50.9% had a median lobe present, and type of prostatic apex was close to evenly distributed between B, C, and D (27.3%, 27.3%, and 29.5%, respectively).

Ultimately, Aihie and colleagues suggested that “further research and larger sample size is needed to better define patient characteristics and anatomic features that make PFPT more effective in the treatment of PPI.”