PFME-based combined rehabilitation for post-prostatectomy urinary incontinence: a systematic review and meta-analysis
Background: Urinary incontinence (UI) is a common complication after radical prostatectomy and can affect daily functioning, social participation, emotional well-being, and quality of life. Pelvic floor muscle exercise (PFME) is a first-line conservative intervention, but the added value of combining PFME with other rehabilitation modalities remains uncertain. This review evaluated continence outcomes and explored reported quality-of-life and psychosocial outcomes. Methods: CNKI, WanFang, the Chinese Biomedical Literature Database, CENTRAL, Embase, Web of Science, and PubMed were searched for randomized controlled trials published from January 2000 to June 2025. Eligible studies compared a PFME-based combined intervention with PFME alone after radical prostatectomy. Continuous outcomes were synthesized using mean differences (MDs) or standardized mean differences (SMDs), and continence-recovery events were synthesized using risk ratios (RRs) based on the original studies' definitions. Leave-one-out analyses assessed robustness. Certainty was evaluated using GRADE; heterogeneous quality-of-life and psychosocial outcomes were summarized narratively. Results: Eleven studies contributed 839 participants to the relevant pairwise comparisons. Pooled estimates favored PFME plus acupuncture for 1-hour pad-test leakage (SMD = −1.65, 95% CI −2.00 to −1.30), PFME plus electrical stimulation for International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI SF) scores (SMD = −0.85, 95% CI −1.20 to −0.50), PFME plus biofeedback for continence recovery (RR = 1.49, 95% CI 1.24 to 1.79), and PFME plus vibratory therapy for 24-hour pad-test leakage (MD = −17.10 g, 95% CI −20.39 to −13.81). Certainty was low for the continuous outcomes and very low for continence recovery. Leave-one-out findings were stable except for vibratory therapy, for which removal of the dominant study rendered the estimate non-significant. Two studies reported heterogeneous quality-of-life or psychosocial outcomes; no dedicated psychological outcome could be pooled. Conclusions: Low certainty evidence suggests that selected adjuncts may improve specific continence outcomes when added to PFME. Because each adjunct was evaluated using a different outcome and no head-to-head evidence was available, the modalities cannot be ranked. The psychological effects of improved continence also remain uncertain. Larger multicenter trials should use standardized continence definitions, common follow-up points, and validated psychological and quality-of-life measures.