Postoperative Pelvic Floor Muscle Training for Urinary Incontinence Following Radical Prostatectomy: A Meta-Analysis With Exploratory Subgroup Analysis by Surgical Approach

OBJECTIVES: This meta-analysis evaluated postoperative pelvic floor muscle training (PFMT) for urinary incontinence after radical prostatectomy (RP) and explored whether effects differed by surgical approach. METHODS: PubMed, Web of Science, Cochrane Library, Scopus, PEDro, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) published from January 1, 2005, to January 1, 2025. Random-effects models were used. Short-term ICIQ-SF scores were summarized as standardized mean differences (SMDs; negative values favor PFMT), and long-term continence as odds ratios (ORs), each with 95% confidence intervals (CIs). Subgroup analyses by surgical approach were exploratory. RESULTS: Seven RCTs involving 666 participants were included. At 3 months, 3 studies (n = 151) favored PFMT (SMD = -1.22, 95% CI [-2.40, -0.04], P = .04; I² = 90%). A sensitivity analysis excluding de Lira et al. included 2 studies (n = 120) and yielded SMD = -1.81 (95% CI [-2.40, -1.21]; I² = 48%). At 12 months, 4 studies (n = 515) favored PFMT (OR = 7.21, 95% CI [3.99, 13.02], P < .00001; I² = 0%). Interaction tests did not show differences by surgical approach at either 3 months (P = .68) or 12 months (P = .53). CONCLUSIONS: Postoperative PFMT may improve short- and long-term continence recovery after RP. Certainty was very low for the heterogeneous short-term evidence and low for the long-term evidence; differences by surgical approach remain inconclusive.