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