Long-term effects of pelvic floor muscle training (PFMT) vs extracorporeal magnetic innervation (ExMI) on post-prostatectomy urinary incontinence

Introduction & Objectives: In a previous study we showed that PFMT and ExMI reduce urinary incontinence (UI) after radical retropubic prostatectomy (RRP), and ExMI reduces rehabilitation times by 40% (Terzoni S. UI after RRP. Efficacy of two conservative treatments managed by nurses. PhD thesis in Nursing Sciences. University of Milan; 2011). It is known that patients can achieve some degree of spontaneous recovery in six months after RRP, but few data exist regarding long-time effects of PFMT and ExMI (Hunter KF et al. Conservative management for post-prostatectomy urinary incontinence. Cochrane Database Syst Rev. 2007 (2)). This study compares the effects of PFMT and ExMI on UI, over a follow-up period of 12 months. Material & Methods: We recruited a non-randomized sample of 65 PFMT and 23 ExMI patients (the machine was at our disposal for only 6 weeks) rehabilitated for post-RRP UI in our hospital. The patients quantified leakages with 24-hours pad tests. During rehabilitation, PFMT patients had received 1 session per week and had performed daily exercises; ExMI patients had received three. After rehabilitation, both groups followed a protocol of daily maintenance exercises (Bortolami A. La riabilitazione del pavimento pelvico. Milan: Elsevier; 2011). We assessed all patients at 3, 6, and 12 months after rehabilitation. Results: The median daily leakage in the sample was 180 grams before treatment, and 5 grams after, with comparable initial symptoms (1) and significant leakage reduction (p<0.05) in both groups. The median number of sessions (PFMT=7, ExMI=14) was related to the initial leakage (p=0.02). Many PFMT patients experienced difficulties due to physical conditions and low awareness of pelvic muscles, and required up to 2 months of additional sessions. This fact did not influence their results (ANCOVA: p=0.86). The table summarizes our results. PFMT ExMI Leakage difference Median age 69.50 69.00 Median BMI 26.36 26.39 End of rehabilitation-3 months k=0.48, n=60 k=0.70, n=11 p=0.38 3 months-6 months k=0.61, n=48 k=0.70, n=11 p=0.21 6 months-1 year k=1.00, n=33 k=1.00, n=7 p=0.61 Concordancy in the PFMT group was low at 3 months, due to slight variations among the patients' leakages; however, the strong correlation (rho=0.81, p<0.001) confirmed the persistence of the rehabilitation results. Conclusions: Our patients maintained the results of rehabilitation during the year. Both treatments led to clinically relevant incontinence reduction, with similar leakages in the two groups over time. ExMI should be used for quick muscle strengthening; after that, nurses should teach maintenance exercises to patients. PFMT can be effective in people with physical limitations and low awareness of their pelvic floor, provided that patients comply with rehabilitation programmes. Nurses play a crucial role in improving compliance, thanks to their therapeutic relationship with patients.