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

Seong-Hi Park1, Yun Su Cho2, Mi Jeong Kwack3, Hee Seon Lee4, Chang-Bum Kang5
Korean Journal of Adult Nursing 2013;25(2):219-230.
Published online: April 18, 2013

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: December 7, 2012   • Accepted: April 23, 2013

© 2013 Korean Society of Adult Nursing

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.

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  • 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.
  • Key Words: Urinary incontinence; Exercise therapy; Prostatectomy; Review
Figure 1.
Study flow diagram.
kjan-25-219f1.jpg
Figure 2.
Risk of bias graph.
kjan-25-219f2.jpg
Figure 3.
Comparison outcomes of Kegel exercise versus control.
kjan-25-219f3.jpg
Figure 4.
Funnel plot of selected studies for effect size extraction.
kjan-25-219f4.jpg
Table 1.
Characteristics of Selected Studies
Year of publication Authors Country Participants Kegel exercise drop out n (%) Follow up (months) Outcomes measures
Inclusion criteria Total Exp. Cont. Age (year) 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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      Effect of Kegel Exercise on Urinary Incontinence after Radical Prostatectomy: Systematic Review of Randomized Controlled Trials
      Korean J Adult Nurs. 2013;25(2):219-230.   Published online April 30, 2013
      DOI: https://doi.org/10.7475/kjan.2013.25.1.219
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      Effect of Kegel Exercise on Urinary Incontinence after Radical Prostatectomy: Systematic Review of Randomized Controlled Trials
      Korean J Adult Nurs. 2013;25(2):219-230.   Published online April 30, 2013
      DOI: https://doi.org/10.7475/kjan.2013.25.1.219
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      Effect of Kegel Exercise on Urinary Incontinence after Radical Prostatectomy: Systematic Review of Randomized Controlled Trials
      Image Image Image Image
      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.

      Figure 1.

      Figure 2.

      Figure 3.

      Figure 4.

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

      Characteristics of Selected Studies

      Year of publication Authors Country Participants Kegel exercise drop out n (%) Follow up (months) Outcomes measures
      Inclusion criteria Total Exp. Cont. Age (year) 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.
      Table 1. Characteristics of Selected Studies

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

      Table 1.

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