The efficacy and optimal timing of pelvic floor muscle training for post‐prostatectomy incontinence in BPH patients: A systematic review

Abstract Surgical intervention for benign prostatic hyperplasia (BPH) can lead to postoperative stress urinary incontinence. Pelvic floor muscle exercises (PFME) are proposed as a non‐invasive strategy to mitigate symptoms, but their efficacy and optimal timing remain unclear. A systematic review of six studies (five randomized controlled trials and one prospective cohort) was conducted, evaluating PFME in men undergoing BPH surgery. Three studies investigated preoperative PFME, and three evaluated postoperative interventions. Outcomes included incontinence rates, lower urinary tract symptoms (LUTS), pelvic floor muscle strength, and quality of life. Evidence for preoperative PFME was mixed; one trial ( n = 70) demonstrated significantly reduced incontinence at 3 months (3% vs. 26%; p = 0.01), while another ( n = 49) found improved muscle endurance without clinical benefits. In contrast, postoperative PFME showed more consistent improvements. One randomized controlled trial (RCT) ( n = 61) reported significantly better LUTS at 12 weeks (IPSS: 3.32 vs. 6.33; p < 0.001) and better quality of life. Another ( n = 58) noted fewer incontinent episodes at 1–3 weeks ( p < 0.01). However, a large multicenter randomized controlled trial ( n = 442 TURP patients) found no long‐term benefit in incontinence rates at 12 months (65% vs. 62%). In conclusion, PFME may enhance the postoperative recovery of continence and LUTS, particularly when initiated early and performed consistently. Preoperative PFME shows promise but requires further validation. Heterogeneity in study designs highlights the need for standardized, large‐scale trials to define optimal PFME protocols for this population.