Feng Dechao, Liu Shengzhuo, Li Dengxiong, Han Ping, Wei Wuran
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
Transl Androl Urol. 2020 Oct;9(5):2031-2045. doi: 10.21037/tau-20-615.
The underutilization of additional supportive muscles is one of the potential reasons for suboptimal efficacy of conventional pelvic floor muscle training (CPFMT). The present study concentrates on any advantage of advanced pelvic floor muscle training (APFMT) in patients with urinary incontinence (UI) after radical prostatectomy (RP).
Literature search was conducted on PubMed, Embase, Cochrane Library and Web of Science from database inception to February 2020. The data analysis was performed by the Cochrane Collaboration's software RevMan 5.3.
Both APFMT and CPFMT groups indicates superiority over baseline in terms of pad number, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score, pad weight at short-term follow-up, and PFME and PFMS at intermediate-term follow-up. No adverse events were reported in all included studies. Patients receiving APFMT had a similar attrition rate to those receiving CPFMT (18/236 . 22/282, P=0.61). Compared to CPFMT group, APFMT group provided intermediate-term advantages in terms of pad number (MD: -0.75, 95% CI: -1.36 to -0.14; P=0.02), ICIQ-SF score (MD: -3.79, 95% CI: -5.89 to -1.69; P=0.0004), PFME (MD: 1.93, 95% CI: 0.99 to 2.87; P<0.0001) and pad weight (MD: -1.40, 95% CI: -1.70 to -1.00; P<0.00001).
Current evidence indicated that APFMT might facilitate the recovery of UI after RP according to intermediate-term advantages over CPFMT in terms of pad number, ICIQ-SF score, PFME and pad weight. Further standardized, physiotherapist-guided and well-designed clinical trials conducted by large multicenter and experienced multidisciplinary clinicians are still warranted.
传统盆底肌训练（CPFMT）疗效欠佳的潜在原因之一是辅助支撑肌肉利用不足。本研究聚焦于晚期盆底肌训练（APFMT）对根治性前列腺切除术（RP）后尿失禁（UI）患者的任何益处。
从数据库建立至2020年2月，在PubMed、Embase、Cochrane图书馆和科学网进行文献检索。数据分析采用Cochrane协作网的RevMan 5.3软件。
在短期随访时，APFMT组和CPFMT组在护垫使用数量、国际尿失禁咨询委员会简表（ICIQ-SF）评分、护垫重量方面均优于基线水平；在中期随访时，APFMT组和CPFMT组在盆底肌收缩（PFME）和盆底肌放松（PFMS）方面均优于基线水平。所有纳入研究均未报告不良事件。接受APFMT的患者与接受CPFMT的患者失访率相似（18/236. 22/282，P = 0.61）。与CPFMT组相比，APFMT组在中期随访时，在护垫使用数量（MD：-0.75，95%CI：-1.36至-0.14；P = 0.02）、ICIQ-SF评分（MD：-3.79，95%CI：-5.89至-1.69；P = 0.0004）、PFME（MD：1.93，95%CI：0.99至2.87；P < 0.0001）和护垫重量（MD：-1.40，95%CI：-1.70至-1.00；P < 0.00001）方面具有优势。
目前的证据表明，APFMT在护垫使用数量、ICIQ-SF评分、PFME和护垫重量方面比CPFMT具有中期优势，可能有助于RP术后UI的恢复。仍需要由大型多中心且经验丰富的多学科临床医生进行进一步的标准化、物理治疗师指导且设计良好的临床试验。
