The Effect of Pelvic Floor Biofeedback Training for Urinary Incontinence in Prostate Cancer Survivors: A Meta-Analysis of Randomized Controlled Trials

Hsu, Lan-Fang

Background: Urinary incontinence (UI) is a distressing problem after radical prostatectomy (RP) and impairs the quality of life of prostate cancer survivors. Pelvic floor biofeedback training (PFBT) is a treatment intended to improve UI.

Objective: To determine the effect of PFBT in prostate cancer survivors with UI.

Method: A systematic search of CINAHL, Cochrane Library, BioMed, Pubmed/Medline, and Web of science was carried out. Randomized controlled trials (RCTs) studying the effects of PFBT on UI in comparison to pelvic muscle training (PMT) alone in prostate cancer survivors were included. The Cochrane Handbook for Systematic Review of Intervention 5.1.0 was used to assess the methodological quality of included RCTs. Self-reported UI was the primary outcome measure. Data were analyzed using the Comprehensive Meta Analysis software 2.0.

Results: Seven RCTs involving 460 prostate cancer survivors with UI were included. Overall, the post-treatment and the long-term effects (up to the 3^rd and 6^th month) of PFBT on self-reported UI were not statistically significant (mean ES= -0.084, -0.303, and -0.366, respectively) in compared to PMT without biofeedback. Moderator analyses showed that included studies of high quality had larger and significant long-term effects on self-reported UI in the 3^rd month (mean ES, -0.860; 95% CI, -1.35, -0.37) and 6^th month (mean ES, -0.764; 95% CI, -1.27, -0.25) in comparison with those of poor quality (P=0.002 and 0.021). No heterogeneity or publication bias was found across individual studies.

Conclusion: Based on available evidence, this review evidence suggests that PFBT did not yield significant effect on improving UI in prostate cancer survivors in comparison with PMT without biofeedback. However, when only studies of high quality were analyzed, PFBT significantly improved self-reported UI in prostate cancer survivors. Additional high quality studies for further investigating the efficacy of PFBT on UI are needed.