Should Prostate Cancer Patients Start Doing Kegels Before Surgery?

The “New” Prostate Cancer InfoLink has always believed that preoperative training of the pelvic floor muscles (using Kegel exercises) would be likely to improve recovery of continence after radical prostatectomy,but there have never (as far as we know) been any good data to substantiate this belief.

An Italian group has now published data from a small, randomized clinical trial suggesting that, indeed, men who started to train their pelvic floor muscles prior to radical prostatectomy and continued the Kegel exercises after surgery did indeed seem to recover continence sooner than men who only started Kegel exercises after their surgery.

Centemero et al. enrolled 118 patients who had been diagnosed with localized prostate cancer and who were scheduled for radical retropublic prostatectomy (RP) at their institution. The patients were then randomized to one or other of two groups:

• Group A (the active pre-treatment group), in which the patients were asked to start pelvic floor muscle exercise (PFME) 30 days before RP and to continue PFME postoperatively
• Group B (the control group), in which the patients were asked to start PFME only after surgery

The patients were asked to self-report on their continence after surgery. In addition, the patients’ quality of life (HRQOL) was assessed using the male short form of the International Continence Society.

The results of the study can be summarized as follows:

• 59 patients were randomized to each group.
• At 1 month after surgery:
  • 26/59 men (44.1 percent) in Group A were continent compared to 12/59 men (20.3 percent) in Group B.
  • The HRQOL of men in Group A was better than that of men in Group B (14.6 vs 18.3).
  • After age-adjusted logistic regression analysis, men in Group A had an 0.41-fold lower risk of being incontinent than men in Group B.
• At 3 months after surgery:
  • 35/59 men (59.3 percent) in Group A were continent compared to 22/59 men( 37.3 percent in Group B).
  • The HRQOL of men in Group A was still better than that of men in Group B (8.1 vs 12.2).
  • After age-adjusted logistic regression analysis, men in Group A had an 0.38-fold lower risk of being incontinent than men in Group B.

The authors conclude that, “Preoperative PFME may improve early continence and [HRQOL] outcomes after RP.”

If you think about it, a man who starts to learn how to train his pelvic floor muscles 30 days before surgery is going to have a 30-day advantage over the man who waits to do this until after surgery. In addition, the surgery itself may delay the training process for the man who isn’t pre-trained. Postoperative pain may make it more difficult to start Kegel exercises for the men who have had no preoperative training.

Although this is only a small study, and we would like to see these data replicated in a larger patient cohort. The “New” Prostate Cancer InfoLink at least feels there is now some justification behind the recommendation to start Kegel exercises well before surgery if that is the form of treatment a patient is to undergo, and this is likely to be true regardless of type of surgery.