Effectiveness of physiotherapy interventions for improving erectile function and climacturia in men after prostatectomy: a systematic review and meta-analysis of randomized controlled trials.
Priya Kannan, Stanley J Winser, Lam Choi Ho and 4 others
PMID 30983396WHAT IT FOUND
Pelvic floor muscle training alone did not show improvement in erectile function or climacturia after prostate surgery.
Some results for pelvic floor muscle training plus biofeedback or plus electrical stimulation pointed toward possible improvement, but they came from very few low-quality studies.
Key findings
01Pelvic floor muscle training alone did not significantly improve erectile function or climacturia at 12 months compared with no treatment.
02Adding biofeedback to pelvic floor muscle training did not significantly improve erectile function at three months, but showed a significant 12-month difference compared with no treatment.
03Pelvic floor muscle training plus electrical stimulation did not significantly improve erectile function; one small study reported more men with improved climacturia than no treatment.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only seven studies were included, and the included studies were small and of low to high methodological quality. The GRADE evidence quality ranged from very low to moderate, so the findings are not definitive. The positive biofeedback result came from two studies and was graded as very low quality. The positive climacturia result for electrical stimulation came from one study of 31 participants. Only two studies tracked adherence, only three provided supervised physiotherapist training for three months, and only two advised men to contract pelvic floor muscles during sexual activity. Several included studies did not report who provided the treatment, and four did not report evaluating participants' ability to contract pelvic floor muscles. The review excluded active-comparison trials, so it cannot say which physiotherapy method is better. Safety of electrical stimulation in the presence of cancer remains uncertain.
Declared interests
The authors declared no potential conflicts of interest and received no financial support for the research, authorship, or publication.
The easy way to misread this
Do not present pelvic floor muscle training plus biofeedback as proven for erectile function after prostate surgery. The positive 12-month result came from two studies with very low-grade evidence, and the three-month result was not significant.