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.