Abstract Introduction Erectile dysfunction (ED) is a common complication following radical prostatectomy (RP), affecting up to 85% of men despite nerve-sparing techniques. Pelvic floor muscle training (PFMT) has been proposed as a non-invasive, low-cost rehabilitation strategy that may facilitate erectile recovery. While PFMT is well-established for urinary continence recovery, its efficacy for erectile function after RP remains uncertain. Objective The objective of this systematic review is to evaluate the effectiveness of PFMT, with or without adjunctive biofeedback or electrical stimulation, in improving erectile function in men who have undergone RP for prostate cancer, by examining randomised controlled trials (RCTs). Methods A systematic search was conducted using the PubMed and Web of Science databases. Only RCTs that examined the effects of PFMT (with or without biofeedback or electrostimulation) on erectile dysfunction following RP and met predefined inclusion and exclusion criteria were included. The protocol of this study (CRD420251162740) was registered on PROSPERO. Results Ultimately, 12 RCTs were included in the final analysis. A detailed analysis of the studies will be made during the presentation. We found conflicting evidence regarding the efficacy of PFMT to improve erectile function after RP. There was marked heterogeneity across the included RCTs in terms of PFMT protocols and patient populations. PFMT interventions varied in timing, intensity (daily home exercises ranging from a few contractions to dozens per day), duration (6–12 weeks in some studies vs up to 6–12 months in others), and supervision. The use of adjunct therapies also differed: some trials employed biofeedback-mediated training, others added electrical stimulation of the pelvic floor and one even combined PFMT with psychosocial counseling for couples. Conclusions PFMT may improve erectile function through enhancing the structural support for erections and the hemodynamic erectile response after RP. PFMT is an attractive penile rehabilitation strategy after RP because it is non-invasive, low-risk, and inexpensive. Men who prefer a holistic approach may benefit from PFMT as part of a multimodal rehabilitation program. Our review underscores the need for further research to clarify the role of PFMT erectile function recovery after RP. Developing a consensus on the optimal regimen -including exercise frequency, duration of each contraction, total program length, and whether to incorporate biofeedback or electrical stimulation- would allow for more uniform trials across institutions. Disclosure No
Akdagcik et al. (Mon,) studied this question.