Electrical pudendal nerve stimulation versus pelvic floor muscle training with transrectal electrical stimulation for post-radical prostatectomy incontinence: a cohort study

Electrical pudendal nerve stimulation (EPNS) has been proposed as a clinic-based option for post-prostatectomy incontinence (PPI), but comparative evidence is limited. We conducted a retrospective cohort study across three medical centers (2018-2022) comparing EPNS (24 sessions over eight weeks) with pelvic-floor muscle training plus transrectal electrical stimulation (PFMT + TES). Primary outcomes were changes from baseline to end of treatment in the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) score and 24-hr pad-test urine loss. The Incontinence Impact Questionnaire-7 (IIQ-7) score was assessed as a secondary outcome, and pad-free status was recorded at six months after treatment. In adjusted analyses using propensity-score overlap weighting of 389 men, EPNS was associated with larger improvements than PFMT + TES in ICIQ-UI SF (β - 4.34, 95% CI - 6.65 to - 2.02), 24-hr pad-test urine loss (β - 631.26 g, - 750.81 to - 511.70), and IIQ-7 (β - 2.86, - 5.14 to - 0.58). Unweighted within-group changes were directionally consistent. At the last follow-up, pad-free status was observed in 32.6% of men in the EPNS group versus 7.0% with PFMT + TES. These findings suggest that eight weeks of EPNS can reduce symptom burden and urine loss and yield patient-perceivable quality-of-life gains, although further studies are needed to evaluate the long-term effects.Trial registration: ClinicalTrial.gov (NCT06130306 Registration Date 11/05/2023).