Kegel exercises, incontinence, training, and recovery of continence after RP


A new study just published in The Lancet has reported that  — among men who have urinary incontinence 6 weeks after a radical prostatectomy (RP) — formal one-on-one training of patients by expert therapists does not in fact reduce the rate of continence at 12 months compared to patients in a control group.

This paper by Glazener et al. reports data from two (concurrent) randomized clinical trials (carried out in the United Kingdom) in men who were incontinent 6 weeks after either a radical prostatectomy (Trial 1) or a transurethral resection of the prostate (a TURP; Trial 2). In each of the two trials, patients were randomized to either four one-on-one formal Kegel training sessions with a qualified therapist over 3 months with standard care or to lifestyle advice only. The primary study endpoints, collected through the use of questionnaires mailed to the individual trial participants, were the patients’ reports of urinary incontinence and incremental cost per quality-adjusted life year (QALY) after 12 months.

For Trial 1 (in the men who were incontinent 6 weeks after an RP):

  • The trial enrolled 371 men.
    • 176 were randomized to one-on-one training sessions, and 148/176 of these men (76 percent) responded to the questionnaires.
    • 195 were randomized to the lifestyle advice only (control) group, and 151/195 of these men (77 percent) responded to the questionnaires.
  • The rate of urinary incontinence at 12 months among men given one-on-one training was not significantly different from the rate among men in the control group (absolute risk difference [RD] =1·9 percent).

For Trial 2 (in the men who were incontinent 6 weeks after a TURP)

  • The trial enrolled 397 men.
    • 194 were randomized to one-on-one training sessions, and 126/194 of these men (65 percent) responded to the questionnaires.
    • 203 were randomized to the lifestyle advice only (control) group, and 126/194 of these men (62 percent) responded to the questionnaires.
  • The rate of urinary incontinence at 12 months among men given one-on-one training was not significantly different from the rate among men in the control group (absolute RD =3.4 percent).

The authors further report that

  • Neither adjusting for minimization factors nor analyses based on the treatment method used (for the RP or the TURP) made any significant change in these results in either trial.
  • No adverse effects were reported in either trial.
  • The intervention resulted in higher mean costs per patient (£180 = US$293 in Trial 1 and £209 = US$341 in Trial 2) from the use of one-on-one training, but there was no evidence of an economically important difference in quality-adjusted life-years (QALYs).

Given the relative high risk for persistent, post-surgical incontinence after RPs and TURPs, the authors state very simply that there appears to be “a substantial unrecognized and unmet need for management in these men.”

The cynic could easily conclude that this study will be used to justify the elimination of access to post-surgical support for men needing to know how to carry out Kegel exercises properly. The optimist could just as easily conclude that this study validates the need for research into ways to better avoid the problem in the first place and to manage the problem when it occurs.

4 Responses

  1. The report fails to describe the manner in which Kegel exercises were explained to the participants and certainly leaves open whether or not the respondents did actually carry out the correct Kegel exercises on a regular and progressive basis. This study report leaves much to be desired.

  2. This report is based solely on the abstract of the paper. We do not have access to the complete text, which undoubtedly gives greater detail.

    It seems highly unlikely to me that a study of this type would be carried out without making sure that the patients who were receiving on-on-one training had, in fact, learned to do the Kegel exercises correctly.

  3. This study deals with receiving physical therapy with Kegel exercises post-surgery. A study needs to be done comparing men receiving therapy pre-surgically with those receiving no therapy before prematurely dismissing Kegel exercises as beneficial.

  4. Dear Ted:

    Such a study has actually been done. Click here for more info.

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