Background: The societal effects of prostate cancer are profound. Prostate surgeries remain one of the main treatment modalities in the care of prostate cancer, and one of the common complications associated with this procedure is postoperative erectile dysfunction (ED). ED can have a significant negative impact on men’s quality of life. The included articles from the last systematic review on effect of pre-operative pelvic floor muscle training (PPFMT) on ED after radical prostatectomy (RP) showed mixed findings but recommended the need for better exercise regime to witness better outcome. Therefore, this systematic review aims to provide further evidence from 2018 to understand the impact of PPFMT on postoperative ED and provide latest insights for future research. Methods: A systematic search was conducted on Medline, Embase, CINAHL, and Google Scholar from 2018 to June 2025, with the assistance of a subject-expert librarian. The inclusion criteria include articles which examine the effect of PPFMT on ED post prostatectomy from 2018 to June 2025 and have a minimum of two comparative groups (control vs. case). In addition, non-English articles were excluded from the study. The included articles were further assessed by two independent reviewers using Covidence, and disagreements were resolved by another independent reviewer. Results: A total of 344 articles were located and after removing duplicates, 250 articles remained. Following the abstract and title screening, nine articles were assessed for eligibility. Upon full-text review, three studies (two randomized control trials (RCTs) and one non-RCT) were ultimately included. The two RCTs showed no significant impact of PPFMT on post-operative ED. On the other hand, the non-RCT reported a significant difference in the post-operative ED rate in the case (5%) vs. control (48.6%) group. PPFMT was defined as ten pre-operative physiotherapy sessions in ten consecutive working days using anal biofeedback. Conclusions: The current study, since 2018, reveals mixed findings on the effect of PPFMT on postoperative ED. However, upon reviewing the evidence on the positive role of PPFMT in other fields (e.g., gynecology, general surgery), we noticed that the included studies may be lacking some major components like knowledge assessment, subjective and objective assessment, along with characteristics of sessions (number, duration, intensity, interval to surgery, and biofeedback) that play a crucial role in the effectiveness of the PPFMT in strengthening the pelvic floor muscle and improving the outcomes. Further research with robust designs is warranted.
Mehrnoush et al. (Thu,) studied this question.