Electrical stimulation for post-prostatectomy urinary incontinence : is it useful when patients cannot learn muscular exercises?

Urinary incontinence is common after radical prostatectomy. Pelvic floor muscle training (PFMT) and functional electrical stimulation (FES) can be used to reduce urine leakage. Some patients have difficulty in performing PFMT, and do not obtain clinically significant results. FES might be helpful to them, but its role is unclear in the literature. To verify if FES can reduce urine leakage in patients who do not benefit from PFMT. To obtain mid-term data regarding the persistence of the results through FES or PFMT, associated with a maintenance programme. Prospective and retrospective study (104 PFMT patients, 34 FES) using 24-h pad-test to quantify leakage. Rehabilitation ended when patients obtained leakage <10 g/day. Rehabilitated patients followed a maintenance PFMT programme and performed a follow-up 24-h pad test after 3 months; 51% (PFMT) and 32% (FES) of patients reached leakage <10 g/day. Overall, 82.3% in the PFMT group and 82.3% in the FES group reduced leakage by at least 50% through rehabilitation. No significant difference existed between the two treatments (p = 0.32). After 3 months, 51 rehabilitated patients out of 56 (PFMT) and 11 out of 11 (FES), respectively, showed persistence of the results. PFMT cannot be replaced by machines, but FES can help those who are unable to execute PFMT to strengthen their sphincter and later learn PFMT. Even those who did not achieve rehabilitation had clinically relevant results in both groups. These methods seem useful for incontinent patients after prostatectomy.