Using Preoperative Pelvic Floor Assessment to Predict Early Return of Continence after Robotic Radical Prostatectomy



      To evaluate whether pre-operative pelvic floor physical therapy (PFPT) parameters may predict early return of urinary continence after RP. While long-term urinary continence is eventually achieved in most patients who undergo radical prostatectomy (RP), predicting when patients will become continent is challenging. Prior studies aiming to predict return of post-operative continence have not evaluated patient-specific pelvic floor strength parameters.


      We reviewed a prospectively maintained database of patients undergoing RP who underwent pre-operative PFPT consultation and completed 3-month patient-reported quality of life evaluation. Trained therapists documented pelvic strength parameters. Urinary continence was defined as using 0 or 1 pad per day. We evaluated the association of PFPT parameters with urinary continence at 3 months, adjusting for other factors that could affect continence.


      144 men met inclusion criteria. The majority of patients underwent nerve-sparing procedures and had intermediate- or high-risk prostate cancer. At 3 months, 90 of 144 (62.5%) were continent, while 54 of 144 (37.5%) were not. On multivariable analysis, prostate volume (OR 0.98, 95% CI 0.96-1.00) and pelvic floor endurance (OR 2.71, 95% CI 1.23-6.17) were significantly associated with being continent at 3 months. 56 of 76 (74%) men with good pelvic floor endurance were continent at 3 months, while only 34 of 68 (50%) men with poor endurance were continent (P = .006).


      Pre-operative assessment of pelvic floor endurance is an objective measure that may allow more accurate prediction of early continence after radical prostatectomy. Improved patient counseling could positively impact patient satisfaction and quality of life and reduce decision regret.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sacco E
        • Prayer-Galetti T
        • Pinto F
        • Fracalanza S
        • Betto G
        • Pagano F
        • et al.
        Urinary incontinence after radical prostatectomy: incidence by definition, risk factors and temporal trend in a large series with a long-term follow-up.
        BJU Int. 2006; 97: 1234-1241
        • Sandhu JS
        • Breyer B
        • Comiter C
        • Eastham J
        • Gomez C
        • Kirages D
        • et al.
        Incontinence after Prostate Treatment: AUA/SUFU Guideline.
        J Urol. 2019; 202: 369-378
        • Filocamo MT
        • Li Marzi V
        • Del Popolo G
        • Cecconi F
        • Marzocco M
        • Tosto A
        • et al.
        Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence.
        Eur Urol. 2005; 48: 734-738
        • Manassero F
        • Traversi C
        • Ales V
        • Pistolesi D
        • Panicucci E
        • Valent F
        • et al.
        Contribution of early intensive prolonged pelvic floor exercises on urinary continence recovery after bladder neck-sparing radical prostatectomy: Results of a prospective controlled randomized trial.
        Neurourol Urodyn. 26. Neurourol Urodyn, 2007: 985-989
        • Chang P
        • Szymanski KM
        • Dunn RL
        • Chipman J
        • Litwin M
        • Nguyen P
        • et al.
        Expanded prostate cancer index composite for clinical practice: development and validation of a practical health related quality of life instrument for use in the routine clinical care of patients with prostate cancer.
        J Urol. 2011; 186: 865-872
        • Centemero A
        • Rigatti L
        • Giraudo D
        • Lazzeri M
        • Lughenzzani G
        • Zugna D
        • et al.
        Preoperative pelvic floor muscle exercise for early continence after radical prostatectomy: a randomised controlled study.
        Eur Urol. 2010; 57: 1039-1043
        • Dubbelman Y
        • Groen J
        • Wildhagen M
        • Rikken B
        • Bosch R
        Quantification of changes in detrusor function and pressure-flow parameters after radical prostatectomy: relation to postoperative continence status and the impact of intensity of pelvic floor muscle exercises.
        Neurourol Urodyn. 2012; 31: 637-641
        • Nilssen SR
        • Mørkved S
        • Overgård M
        • Lydersen S
        • Angelsen A
        Does physiotherapist-guided pelvic floor muscle training increase the quality of life in patients after radical prostatectomy? A randomized clinical study.
        Scand J Urol Nephrol. 2012; 46: 397-404
        • Overgård M
        • Angelsen A
        • Lydersen S
        • Mørkved S
        Does physiotherapist-guided pelvic floor muscle training reduce urinary incontinence after radical prostatectomy? A randomised controlled trial.
        Eur Urol. 2008; 54: 438-448
        • Park SW
        • Kim TN
        • Nam JK
        • Ha HK
        • Shin DG
        • Lee W
        • et al.
        Recovery of overall exercise ability, quality of life, and continence after 12-week combined exercise intervention in elderly patients who underwent radical prostatectomy: a randomized controlled study.
        Urology. 2012; 80: 299-305
        • Patel MI
        • Yao J
        • Hirschhorn AD
        • Mungovan SF
        Preoperative pelvic floor physiotherapy improves continence after radical retropubic prostatectomy.
        Int J Urol. 2013; 20: 986-992
        • Anderson CA
        • Omar MI
        • Campbell SE
        • Hunger KF
        • Cody JD
        • Glazener CMA
        Conservative management for postprostatectomy urinary incontinence.
        Cochrane Database Syst Rev. 1. Cochrane Database Syst Rev, 2015CD001843
        • Bø K
        • Sherburn M
        Evaluation of female pelvic-floor muscle function and strength.
        Phys Ther. 2005; 85: 269-282
        • Siegel AL
        Pelvic floor muscle training in males: practical applications.
        Urology. 2014; 84: 1-7
        • Messelink B
        • Benson T
        • Berghmans B
        • Bø K
        • Corcos J
        • Fowler C
        • et al.
        Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society.
        Neurourol Urodyn. 2005; 24: 374-380
        • Slieker-ten Hove MC
        • Pool-Goudzwaard AL
        • Eijkemans MJ
        • Steegers-Theunissen RPM
        • Burger CW
        • Vierhout ME
        Face validity and reliability of the first digital assessment scheme of pelvic floor muscle function conform the new standardized terminology of the International Continence Society.
        Neurourol Urodyn. 2009; 28: 295-300
        • Yang X
        • Zhu L
        • Li W
        • Sun X
        • Huang Q
        • Tong B
        • et al.
        Comparisons of Electromyography and Digital Palpation Measurement of Pelvic Floor Muscle Strength in Postpartum Women with Stress Urinary Incontinence and Asymptomatic Parturients: A Cross-Sectional Study.
        Gynecol Obstet Invest. 2019; 84: 599-605
        • Manley L
        • Gibson L
        • Papa N
        • Beharry BK
        • Johnson L
        • Lawrentschuk N
        • et al.
        Evaluation of pelvic floor muscle strength before and after robotic-assisted radical prostatectomy and early outcomes on urinary continence.
        J Robot Surg. 2016; 10: 331-335
        • Kretschmer A
        • Buchner A
        • Grabbert M
        • Sommer A
        • Herlemann A
        • Stief CG
        • et al.
        Perioperative patient education improves long-term satisfaction rates of low-risk prostate cancer patients after radical prostatectomy.
        World J Urol. 2017; 35: 1205-1212
        • Martinez LS
        • Schwartz JS
        • Freres D
        • Fraze T
        • Hornik RC
        Patient-clinician information engagement increases treatment decision satisfaction among cancer patients through feeling of being informed.
        Patient Educ Couns. 2009; 77: 384-390
        • Flury N
        • Koenig I
        • Radlinger L
        Crosstalk considerations in studies evaluating pelvic floor muscles using surface electromyography in women: a scoping review.
        Arch Gynecol Obstet. 2017; 295: 799-809
        • Sanda MG
        • Dunn RL
        • Michalski J
        • Sandler HM
        • Northouse L
        • Hembroff L
        • et al.
        Quality of Life and Satisfaction with Outcome among Prostate-Cancer Survivors.
        N Engl J Med. 2008; : 358