Structured and supervised pelvic floor muscle training following confirmed contraction in post-prostatectomy urinary incontinence: a systematic review of randomized controlled trials

Purpose: Prostate cancer is the second most commonly diagnosed malignancy in men worldwide. Post-prostatectomy urinary incontinence (PP-UI) is a common and distressing complication that significantly reduces quality of life in prostate cancer survivors. This systematic review aimed to evaluate the effectiveness of structured and supervised pelvic floor muscle training (PFMT), initiated after confirmed pelvic floor muscle activation, delivered pre- or postoperatively, with or without biofeedback (BF), on symptom severity and continence-related quality of life. Methods: A comprehensive search of MEDLINE and Web of Science was conducted in December 2024. Twenty randomized controlled trials (RCTs) involving 2444 participants met inclusion criteria. All studies confirmed correct pelvic floor muscle contraction prior to intervention and implemented structured, supervised PFMT protocols. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and study quality was evaluated using the GRADE framework. Due to heterogeneity in interventions and outcomes, a narrative synthesis was performed. Results: Thirteen of the twenty RCTs (65%) reported significant improvements in continence recovery and symptom severity with structured and supervised PFMT. Early initiation, higher training intensity, anterior compartment-focused training, and use of BF were associated with greater benefits. However, protocol and outcome variability limited consistency across studies. Conclusions: Structured and supervised PFMT based on confirmed muscle activation is a key component of effective PP-UI management. Early, intensive training under therapist guidance is likely to accelerate recovery and enhance continence outcomes. Implications for Cancer Survivors: Targeted PFMT programs with confirmed muscle activation and professional supervision provide a safe, non-invasive, and potentially effective strategy to improve urinary continence and overall quality of life after prostate cancer treatment. Trial registration: PROSPERO ID: CRD42023387493.