Behavioral Therapy Reduces Incontinence after Prostatectomy
Behavioral therapy with pelvic floor muscle exercises, bladder control techniques, and fluid management can reduce (but rarely eliminate) urinary incontinence after radical prostatectomy for early prostate cancer. These results were published in the Journal of the American Medical Association.
Men with early-stage prostate cancer have the option of being treated with surgery (radical prostatectomy), radiation therapy, or active surveillance. With active surveillance, men are followed closely but not treated for prostate cancer until the disease worsens. The choice of treatment can be difficult; for men with low-risk prostate cancer, there is no clear proof that early treatment prolongs survival compared with treatment that is deferred until there is evidence of disease progression.
For men who undergo radical prostatectomy, side effects may include urinary incontinence (leakage of urine) and erectile dysfunction. These side effects can have a profound effect on quality of life.
With the goal of reducing the frequency of incontinence, researchers conducted a study among 208 men who had undergone radical prostatectomy for early prostate cancer, and who had experienced urinary incontinence for at least a year.) Patients were assigned to one of three groups:
- Behavioral therapy consisting of pelvic floor muscle exercises, bladder control techniques (such as contracting pelvic floor muscles before and during activities that cause leakage), and instructions about fluid management.
- Behavioral therapy plus biofeedback and pelvic floor electrical stimulation
- Delayed treatment (the comparison group).
The average number of incontinence episodes per week decreased from 28 to 13 among men treated with behavioral therapy (55% reduction); from 26 to 12 among men treated with behavioral therapy plus biofeedback and electrical stimulation (51% reduction); and from 25 to 21 among men in the comparison group (24% reduction).
At the end of 8 weeks of treatment, complete elimination of incontinence occurred in 16% of men in the behavioral therapy group, 17% of men in the behavior-plus group, and 6% of men in the comparison group.
These results suggest that behavioral therapy can reduce the frequency of urinary incontinence among men who have undergone radical prostatectomy for early prostate cancer. The addition of biofeedback and pelvic floor electrical stimulation did not appear to improve the results of behavioral therapy.
An accompanying editorial notes that the most effective way to prevent incontinence among men with early-stage prostate cancer would be to increase utilization of active surveillance among men with low-risk disease.
 Goode PS, Burgio KL, Johnson TM et al. Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent prostatectomy incontinence: a randomized controlled trial. JAMA. 2011:305:151-159.
 Penson DF. Treatment for prostatectomy incontinence: is this as good as it gets? JAMA. 2011;305:197-198.