Preoperative pelvic floor muscle training (PFMT) has benefits for patients undergoing radical prostatectomy (RP). PFMT can help reduce worries and anxiety by allowing patients to start exercises before surgery. Evidence shows that PFMT decreases the severity and duration of stress urinary incontinence (SUI) following RP compared to no exercises or just written and oral instructions. Preoperative PFMT is recommended as patients can practice exercises pain-free before surgery with their anatomy still intact.

1. Anaïs Bassas Parga
PHYSIOTHERAPY
BEFORE
RADICAL PROSTATECTOMY

2. Do you recommend PFMT before RP?
Benefits:
- Less worries
- Less anxiety
- Starting exercises quickly
- Hypertrophy and increase local blood
supply
Why not??

3. Patient information. Basic issues
1. Information about pelvic floor:
a. Where PF is
b. PF function
c. Why patient must do PFMT
2. Oral & written information / instructions about exercises
3. To teach awareness of their muscle and how it works
To locate and Feel the PF

4. Patient information. Basic issues
4. The “Knack” technique
5. Practise of PFM contractions with or without BFB
6. Urethrocavernosus reflex or Post void milking mechanism.
Routine at home

5. Not all the patients are referred to
physiotherapy...
Connection
Doctor Patient Physiotherapist
Knowledge

6. Communication
Urology visit: prostate CANCER diagnosis.
Patients feel shocked & disoriented.
They forgot oral information.
Urge to be treated
+ visit physiotherapist: written information,
and images...

7. Accessing physiotherapy
Barriers:
- where?
- How much?
- Perception “they might be lucky”
- Embarrassment/Shame
- No info about PFM
- Focus on cancer
Hirschhorn et al. BJU Int 2014
Hirschhorn et al. BMC 2013

8. Sounds reasonable, but….
Evidence?

9. Hirschhorn et al. BJU Int 2014
Public hospital (n=32) & Private hospital (n=107) providers of PFMT
ICIQ-UI done to assess UI at 3 months after RP
Conclusion
Private hospital provides preoperative PFMT more than public hospital.
Patients receiving preop PFMT had significantly better self-report UI at 3
months after RP that those who didn’t received it.
(Mean ICIQ-UI 6.2 vs 9.2).
Additional strategies are needed to improve PFMT treatment among
patients undergoing RP in the public system.

10. Geraerts et al. Eur Urol 2013

11. Collado et al. Abstract 28th EAU meeting 2013.
Methods 179 males
- Treatment group (n=87):
3 weeks before RP: weekly assisted BFB session and hypopressive + daily
home PFMT & written instructions
- Control group (n=92):
Oral instructions on Kegel exercises after RP
Structured programme starts after 3 weeks after RP.
Degree of incontinence assessed with:
24 hours pad-test / ICIQ-UI SF

12. Conclusions
Intensive preoperatory PFMT considerably REDUCES DURATION AND
SEVERITY of SUI after RP.
Collado et al. Abstract 28th EAU meeting 2013, contd.

13. Patel et al. Int J Urol 2013
24h pad-test incontinence severity
(>50g)
6w 3 months 6w 3 months
Treatment g 9g no sign diff 8/152 no sign diff
Control g 17g no sign diff 33/132 no sign diff
RESULTS
Preop physiotherapist-
guided PFMT reduces
time to continence by
28%
(it reduces the duration
and severity of early
incontinence after
RRP)

14. SUMMARY
- Preop PFMT is better than:
- Nothing.
- Oral & written instructions
- Preop PFMT cannot ensure complete continence after surgery
- Preop PFMT reduces duration and severity of early SUI.

15. SUMMARY
We recommend to teach PFM exercises before surgery because:
- patient is pain-free and with a normal sensation (anatomicly intact)
- have time to practise PFM exercises and become confident with the
exercises
- Evidence: reduces severity and duration of SUI
- Better quality of life and better satisfaction with the treatment

16. SUMMARY
We encourage all physiotherapists to:
- Promote their services to healthcare professionals and general public.
- Do more studies. We need more evidence!
Bernad et al J Cancer Surviv 2015 (systematic review)
There is some evidence that RT has detrimental impacts on both PFMs’
structure and function.
But we also need more studies in
radiotherapy

17. Thank you very much