Urinary incontinence is common immediately after prostate surgery. Researchers show that in men who have undergone prostate surgery, one-to-one therapy sessions to teach pelvic floor exercises are no more effective than the standard care of receiving brief verbal advice and a leaflet with instructions for self-teaching. TheArticle is by Professor Cathryn Glazener, University of Aberdeen, UK, and colleagues.

The researchers undertook two randomised trials in men in the UK who were incontinent 6 weeks after radical prostatectomy for prostate cancer (trial 1) or transurethral resection of the prostate for benign prostate enlargement (TURP; trial 2) to compare four sessions with a therapist over 3 months with standard care and lifestyle advice only.

In the intervention group in trial 1, the rate of urinary incontinence at 12 months (76%) was not significantly different from the control group (77%); in trial 2, the difference in the rate of urinary incontinence at 12 months (65%) from the control group was not significant (62%).

In both trials, the intervention resulted in higher mean costs per patient (£180 and £209 respectively) but the researchers did not identify evidence of an economically important difference in quality of life (as measured by quality adjusted life years).

The authors conclude: "In settings where information about pelvic-floor exercises is widely available, the provision of one-to-one conservative therapy for men with urinary incontinence after radical prostatectomy or TURP is unlikely to be effective or cost effective. Resources allocated to providing such a service might be better used elsewhere.

Research is needed to identify the best management for the large numbers of men who are left with persistent severe incontinence after radical prostatectomy, and particularly the place of continence surgery for men. Similarly, research is needed to identify the best management for men with persistent incontinence after TURP."

Source: The Lancet