Novel online comprehensive pelvic floor therapy program following prostatectomy

Background: Although pelvic floor muscle training (PFMT) is widely shown to improve post-prostatectomy incontinence (PPI), numerous barriers impede access to formal PFMT and include the limited availability of specialized therapists and financial or scheduling barriers. To address these barriers, we developed a novel online program delivering comprehensive long-term PFMT, pelvic floor education (PFE), and dietary/behavioral modification education. This study is a prospective interim analysis of online PFMT/ PFE (oPFMT/PFE), with focus on feasibility, satisfaction, and continence outcomes.Methods: Patients anticipating robotic-assisted laparoscopic prostatectomy (RALP) were recruited (6/2021-9/2022) for oPFMT/PFE. oPFMT/PFE comprises a 12-month program of 3 phases, including multiple exercises with varied contraction types and duration, and comprehensive dietary and behavioral technique education. Incontinence and quality of life (QOL) outcomes are assessed at 3 weeks, 3, 6, and 12 months following RALP using validated International Consultation on Incontinence Questionnaire Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) and Incontinence Impact Questionnaire (IIQ-7) questionnaires and additional items assessing satisfaction, improvement, and daily pad use. Primary study outcomes included ICIQ-MLUTS stress urinary incontinence (SUI) domain score (SDS) and SUI cure [ICIQ SUI domain score (SDS) =0]. Interim 6-month analysis was performed using mixed effects linear regression and mixed effects Poisson regression.Results: Analysis included 21 men (64 +/- 6 years). At 6-month follow-up, men undergoing oPFMT/ PFE showed significant improvement in SDS compared to the 3-week time point [mean +/- standard error (SE) =1.05 +/- 0.24 vs. 0.45 +/- 0.17, P=0.011], but still experienced higher scores than at baseline (P=0.017). Six-month patient-reported improvement averaged 7.42 +/- 0.74 (10-point Likert scale). All (100%) of 19 respondents (2 missing data) found the program easy to use, educational, and would recommend it to others, with 89% expressing satisfaction with the program. During patient interview at 6-month follow-up, no men reported inability to access the program online or any adverse events. Finally, IIQ-7 score improved significantly from the 3-week timepoint (4.47 +/- 1.10) at both time points (3-month 1.14 +/- 0.44, P<0.001 and 6-month 1.10 +/- 0.37, P<0.001), and neither 3-nor 6-month scores differed from baseline (P=0.80 8 and P=0.444, respectively).Conclusions: Our novel oPFMT/PFE yields significant improvements to validated urinary incontinence (UI) and QOL measures, providing a valuable and accessible treatment option for PPI.

Automated summary

This study presents a prospective interim analysis of an online pelvic floor muscle training (PFMT) and pelvic floor education (PFE) program for post-prostatectomy incontinence (PPI). The results show significant improvements in incontinence and quality of life measures, indicating the effectiveness and satisfaction of the online program.