Effect of Kegel Exercise on Urinary Incontinence after Radical Prostatectomy: Systematic Review of Randomized Controlled Trials

Seong-Hi Park; Yun Su Cho; Mi Jeong Kwack; Hee Seon Lee; Chang-Bum Kang

doi:10.7475/KJAN.2013.25.1.219

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Park, Cho, Kwack, Lee, and Kang: Effect of Kegel Exercise on Urinary Incontinence after Radical Prostatectomy: Systematic Review of Randomized Controlled Trials

Original Research

Korean J Adult Nurs 2013;25(2):219-230.

Published online: 18 April 2013

DOI: https://doi.org/10.7475/KJAN.2013.25.1.219

Effect of Kegel Exercise on Urinary Incontinence after Radical Prostatectomy: Systematic Review of Randomized Controlled Trials

Seong-Hi Park¹, Yun Su Cho^2,, Mi Jeong Kwack³, Hee Seon Lee⁴, Chang-Bum Kang⁵

^¹School of Nursing, Pai Chai University, Daejeon

^²Department of Nursing Service, Korea University Anam Hospital, Seoul

^³Quality Improvement Team, Korea University Anam Hospital, Seoul

^⁴Department of Nursing Service, Korea University Anam Hospital, Seoul

^⁵Research Development Team, Korea Health Promotion Foundation, Seoul, Korea

Corresponding author: Cho, Yun Su Department of Nursing Service, Korea University Anam Hospital, 73 Inchon-ro, Seongbuk-gu, Seoul 136-705, Korea Tel: +82-2-920-5202, Fax: +82-2-920-5204, E-mail: yun0303@kumc.or.kr

Received 7 December 201220 April 2013 Accepted 23 April 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study is reviewed of the available literature to identify the evidence of the value of Kegel exercise programs as an intervention to decrease urinary incontinence and the improvement of the quality of life following a radical prostatectomy in localized prostate cancer.

Methods

We searched studies of randomized controlled trials that utilized the Kegel exercise programs with patient with a radical prostatectomy. The review was conducted electronic bibliographic database of Ovid-Medline, Embase, Scopus, KoreaMed and NDSL, etc. Of 630 publications identified, seven studies that met the inclusion criteria, and all studies analyzed by meta-analysis. To ensure the quality of the studies, we used Cochrane's Risk of Bias.

Results

Kegel exercise helped patient to achieve continence more quickly (after 1, 3, 6, 12 months) than men not using Kegel exercises. Especially, Kegel exercise significantly reduced the development of urinary incontinence at one month after prostatectomy. The effectiveness of Kegel exercise after prostatectomy was found to improve the quality of life at a significant level.

Conclusion

Based on available evidence, Kegel exercise that nurses can teach improved the return to continence more than usual care in men with prostatectomy urinary incontinence.

Keywords: Urinary incontinence, Exercise therapy, Prostatectomy, Review

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Figure 1.

Study flow diagram.

Figure 2.

Risk of bias graph.

Figure 3.

Comparison outcomes of Kegel exercise versus control.

Figure 4.

Funnel plot of selected studies for effect size extraction.

Table 1.

Characteristics of Selected Studies

Year of publication	Authors	Country	Participants					Kegel exercise	drop out n (%)	Follow up (months)	Outcomes measures
Year of publication	Authors	Country	Inclusion criteria	Total	Exp.	Cont.	Age (year)	Kegel exercise	drop out n (%)	Follow up (months)	UI	Severe UI	UI Sx & QoL
2012	Tienforti et al.	Italy	cT1a-cT2b prostate cancer with RP	32	16	16	64~67	Supervised training 3 sets daily of 10 min each 5 seconds contraction and relaxation	none	1, 3, 6	○
2011	Glazner et al.	UK	Prostate cancer with RP	411	205	206	62.3	3 months training with therapist	20 (4.7)	12	○	○	○
2010	Centemero et al.	Italy	cT1a-cT2a-b prostate cancer with open nerve-sparing RP	118	59	59	58~60	Training guided by a single physiotherapist twice per week for 1 month	None	1, 3	○	○	○
2010	Dubbelman et al.	Netherlands	Prostate cancer with RP	79	35	44	64	Therapist guided training One series of 10 contractions performed during a period of 1~3 min; 150 contractions per daily	13 (16.5)	6	○	○
2008	Overgard et al.	Norway	clinically localized prostate cancer operated with open RP	85	42	43	60~62	Training guided by physiotherapist for 45 min once weekly; 3 sets of 10 contractions daily	5 (5.9)	1, 3, 6, 12	○
2007	Manassero et al.	Italy	clinically localized prostate cancer operated with RP	107	54	53	67~68	Training program; 45 contractions (3 sessions of 15 per daily)	13 (12.1)	1, 3, 6, 12	○
2005	Filocamo et al.	Italy	T1 or T2 prostate cancer with RP	300	150	150	66.8	Daily 3 sets of exercises; 10 contractions lasting 5 seconds with 10 seconds of muscle relaxation	2 (0.7)	1, 3, 6, 12	○	○

RP=radical prostatectomy; Exp.=experimental group; Cont.=control group; UI=urinary incontinence; UI Sx & QoL=urinary incontinence symptoms and quality of life.

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