Introduction: A cancer survivorship clinic (CSC) for men undergoing radical prostatectomy (RP) was started in 2010 at our institution to facilitate return of erectile function and urinary continence. In our previous studies we found that men attending a CSC are offered more options for erectile dysfunction, have more rapid return of erectile function, and are more likely to utilize pelvic floor physical therapy (PFPT). This study sought to assess whether starting PFPT prior to RP vs afterward led to improvements in post-operative continence. We hypothesized that starting PFPT pre-op would improve continence rates as patients would have an easier time learning and mastering the exercises.
Methods: A retrospective cohort study of a RP database was conducted of men undergoing surgery between Sept 2014 and Dec 2018. The primary outcomes of interest were incontinence rates based upon pads per day (PPD) at the 1 and 3 month post-op visit and need for incontinence procedure. Patients who had documented follow-up less than 4 months were excluded. Nerve-sparing status was also investigated.
Results: 333 men were identified for inclusion. Mean follow-up was 37.0 (SD 19.1) months in the pre-op group and 32.8 (SD 16.4) months in the post-op group. Patient age and BMI were comparable between cohorts (p-value 0.12, 0.11, respectively). The rate of nerve-sparing status was not statistically different with a p-value of 0.23. The cohorts were similar in regard to tobacco use, DM, MI, and stroke. At the 1-month mark there was a decreased number of PPD in the pre-op group at 2.35 (SD 0.97) vs 2.91 (SD 2.63), however it was not significant with a p-value of 0.13. At the 3-month mark, there was a statistically significant decrease in PPD at 0.97 (SD 1.46) vs 1.49 (SD 1.60) with a p-value of 0.04. The likelihood of undergoing an incontinence procedure within 60 months of surgery was not different with an odds ratio of 0.37 (CI 0.07-1.91)
Conclusions: Beginning PFPT prior to surgery is associated with decreased PPD at the 3-month post-op mark. This is expected as men that learn exercises prior to surgery will have an easier time mastering them compared to those who learn while still recovering from surgery. Starting therapy before surgery did not have an impact on undergoing an incontinence procedure. This study suggests early improvement in incontinence if therapy is started pre-op, which should be encouraged.