Abstract
Background
Benign prostatic hyperplasia (BPH) commonly affects men over 50, often requiring interventions like TURP. Postoperative pelvic floor muscle training (PFMT), guided by the Health BeliefModel (HBM), may enhance recovery, particularly in urinary and erectile function.
Methods
Outcomes assessed included Health Promotion Lifestyle Profile II (HPLP-II) scores, International Prostate Symptom Scores (IPSS), International Index of Erectile Function-5 (IIEF-5), psychological states, and compliance behaviors.
Results
In this retrospective case–control study, 180 men with BPH post-TURP were divided into a control group (standard care, n = 97) and an intervention group (PFMT based on HBM, n = 83). Post-intervention, the intervention group showed a significant improvement in HPLP-II, IPSS, and IIEF-5 scores compared to controls (P < 0.001). Prostate symptoms and erectile function improved markedly in the intervention group (IPSS: 5.16 vs. 8.39; IIEF-5: 20.08 vs. 20.99). Psychological assessments revealed lower anxiety and depression scores in the intervention group (SAS: 46.09 vs. 54.97; SDS: 42.15 vs. 53.29; P < 0.001). However, no significant differences in quality of life measures were reported between groups.
Conclusion
PFMT guided by the HBM significantly improved urinary and erectile function, reduced postoperative complications, and enhanced psychological well-being in patients with BPH following TURP. These benefits should be evaluated in future longitudinal studies to assess their sustainability.
Keywords: Pelvic floor function exercise, Health belief model, Benign prostatic hyperplasia, Electrocautery
Introduction
Benign prostatic hyperplasia (BPH) is a prevalent urological condition affecting men, particularly those aged 50 years and older, with increasing incidence in aging populations [1, 2]. The condition is characterized by the enlargement of the prostate gland, leading to lower urinary tract symptoms (LUTS) including urinary frequency, urgency, nocturia, weak stream, and incomplete bladder emptying [3]. While various treatment modalities exist, transurethral resection of the prostate (TURP) remains a standard surgical intervention for managing moderate to severe BPH [4]. Although effective in relieving obstruction, TURP is associated with postoperative complications such as bleeding, infection, and erectile dysfunction, which can significantly impact patient quality of life [5–7].
Pelvic floor muscle training (PFMT) has emerged as a non-invasive method to enhance urinary continence and potentially improve erectile function in men after prostate surgery [8]. These exercises strengthen the pelvic musculature, improving bladder control and potentially enhancing erectile function through better pelvic stability and increased blood flow [9, 10]. Despite its advantages, adherence to PFMT regimens is often suboptimal due to factors including lack of motivation, insufficient understanding of benefits, and absence of structured guidance [11–13].
The Health Belief Model (HBM) provides a theoretical framework to predict and explain health behaviors by assessing individual’s perceptions of susceptibility, severity, benefits, barriers, cues to action, and self-efficacy [14]. When applied to rehabilitation protocols, the HBM can help structure interventions that address patient’s beliefs and motivations, potentially improving adherence and outcomes.
Previous studies have documented the physiological benefits of PFMT for urinary incontinence and erectile dysfunction following prostate procedures [15]. However, the potential psychological and quality of life improvements from such interventions, particularly when guided by an established health behavior framework, remain underexplored [16]. Furthermore, the role of patient education in enhancing self-efficacy and engagement with prescribed rehabilitation exercises warrants further investigation [17, 18].
The purpose of this study is to examine the application effect of pelvic floor function exercises based on the HBM in patients with BPH post-electrocautery, addressing both functional and psychological outcomes.
Materials and methods
Case selection
This study utilizes a retrospective case–control design, incorporating a total of 180 patients diagnosed with BPH over a period from October 2022 to October 2023. Demographic and patient-specific data were gathered via medical record systems. These data included general patient information, health behaviors, psychological status, prostate function, postoperative recovery and complications, bladder function, and adherence to medical advice.
The Institutional Review Board and Ethics Committee of our institution granted approval for this study. Since the research involved only de-identified patient data, posing no risk to patient care, informed consent was waived. This waiver was granted in compliance with regulatory and ethical guidelines appropriate for retrospective research.
Inclusion and exclusion criteria
Inclusion criteria
(1) underwent pre-operative radical prostatectomy; (2) utilized open or robotic-assisted approaches; (3) aged over 18 years with the capacity to understand and cooperate with various treatments and examinations; (4) diagnosed with prostate cancer and referred for PFMT [19]; (5) possession of complete general information; (6) provided informed consent.
Exclusion criteria
(1) presence of acute illness; (2) current smokers; (3) Impaired mental status; (4) history of prior prostate surgery; (5) undergoing or having undergone radiation therapy; (6) undergoing or having undergone androgen deprivation therapy.
Grouping and intervention methods
Grouping criteria: a total of 180 patients hospitalized after undergoing TURP were randomly divided into 2 groups: a control group with 97 patients and an experimental group with 83 patients. The control group received standard care, while the experimental group received pelvic floor exercises guided by the HBM in addition to standard care. This approach involved cognitive and behavioral nursing interventions and health education to encourage active participation in pelvic floor rehabilitation exercises. The intervention period lasted for 12 weeks, after which the effects on both groups were compared.
Treatment approach
One week after catheter removal, patients in the control group received standard care along with routine health education about postoperative care, medication management, and general activity guidelines. Patients in the intervention group received a comprehensive HBM-based program that addressed six key components—perceived susceptibility: patients were educated about their individual risk factors for postoperative complications and functional decline following TURP through personalized counseling sessions and illustrated materials. Perceived severity: educational sessions highlighted potential consequences of inadequate rehabilitation, including persistent urinary symptoms, erectile dysfunction, and reduced quality of life. Perceived benefits: detailed information was provided about how PFMT specifically improves pelvic blood flow, muscle tone, urinary control, and erectile function, using simple physiological explanations and success stories. Perceived barriers: common obstacles to exercise adherence were identified through individual assessment, and tailored strategies were developed to address each patient’s specific barriers (time constraints, discomfort, forgetfulness, etc.). Cues to action: patients received daily reminders through mobile applications, written exercise schedules, and family involvement to prompt regular exercise performance. Self-efficacy: progressive exercise protocols with achievable milestones were established, and patients received positive reinforcement for accomplishments to build confidence in their ability to perform the exercises correctly. The PFMT program itself consisted of daily exercises including pelvic floor contractions (10 s hold, 10 s rest, 10 repetitions, three times daily), progressive resistance training, and functional integration of pelvic floor activation into daily activities. Patients received illustrated guides, in-person demonstrations, and regular technique assessments throughout the 12-week intervention period.
Health behavior rating
The Health Promoting Lifestyle Profile II (HPLP-II) was utilized to assess the patient’s health behaviors both 2 days following admission (prior to intervention) and post-intervention. This scale comprises 52 items, each rated on a 4-point scale, resulting in a maximum possible score of 208. Higher scores indicate more favorable health behaviors. The scale demonstrates a high level of reliability, with a Cronbach’s alpha coefficient of 0.93 [20], and a test–retest validity of 0.89.
Health belief assessment
A self-designed health belief gauge developed by the researchers was employed to assess patient’s adherence to comprehensive rehabilitation exercises for pelvic floor muscles. In addition, the Self-Efficacy Rating Scale, as developed by Lorig et al. (1971), was used to evaluate patients’ self-efficacy.
Prostate function and erectile function assessment
Prostate function: the International Prostate Symptom Score (IPSS) [21] was used to evaluate prostate function both preoperatively and 6 months postoperatively, with a maximum score of 35. Higher scores indicate more severe symptoms.
Erectile function: the International Index of Erectile Function Questionnaire-5 (IIEF-5) [22] assessed erectile function before and 6 months after surgery, with a total possible score of 25. Contrary to the IPSS, a higher score on this scale suggests better erectile function. The scale’s reliability is indicated by a Cronbach’s alpha coefficient of 0.96 [23].
Urinary control rate evaluation
Following the criteria established by Eastham and Lepor et al. [24, 25], patients using fewer than one urine pad per day post-surgery were considered to have achieved basic urinary control. All patients were monitored for 6 months following discharge, utilizing both outpatient visits and telephone follow-ups. Follow-ups were conducted monthly to assess and calculate the urinary control rate of each patient.
Quality of life assessment
The World Health Organization Quality of Life Scale, Brief Version (WHOQOL-BREF) [26], was administered to evaluate quality of life before and after the intervention. This scale assesses four dimensions (environmental, physiological, psychological, and social), each on a percentage basis, with higher scores indicating an improved quality of life. The scale’s reliability is supported by a Cronbach’s alpha coefficient of 0.897 [27].
Psychological state assessment
Before and after the intervention, the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS) [28] were used for evaluation. A SAS score above 50 indicates severe anxiety, while an SDS score over 53 denotes severe depression. The reliability of the SDS is reflected in a Cronbach’s alpha coefficient of 0.88 [29].
Assessment of medical compliance behavior
The compliance behavior assessment form [30] was used to evaluate four areas—drinking water, diet, emotional management, and daily activities—both before and after the intervention. Each item is scored on a scale from 0 to 3, with higher scores reflecting better compliance behavior.
Data cleaning and management
Before conducting data analysis, this study followed a standardized data cleaning process to identify and correct any inconsistencies, errors, or missing values. This process involved thoroughly reviewing the dataset, removing duplicate entries, correcting data entry errors, and addressing missing values. Missing data were imputed using the Impyute library in Python 3.6.0, employing the K-Nearest Neighbors (KNN) method. This method involved creating a basic mean imputation to build a KDTree using a complete list, which was then used to calculate the nearest neighbors (NN). The weighted average of the K nearest points was taken to fill in missing values. Missing data were controlled to within 5% to mitigate potential selection bias. Sensitivity analysis was conducted by calculating the outcomes of lost-to-follow-up cases under both worst-case and best-case scenarios. If the conclusions showed no significant difference, the impact of missing data on the overall conclusions was considered minimal, rendering the findings relatively reliable. The final results were presented using the imputed data.
Statistical analysis
Data analysis was performed using SPSS version 29.0 (SPSS Inc., Chicago, IL, USA). Categorical variables were expressed as n (%). For sample sizes of 40 or more with theoretical frequencies (T) ≥ 5, Chi-square tests were conducted using basic formulas. When the sample size was ≥ 40 but the theoretical frequency was between 1 and 5 (1 ≤ T < 5), corrected Chi-square tests were employed. For sample sizes less than 40 or theoretical frequencies (T) < 1, Fisher’s exact probability test was utilized for statistical analysis. Normality of continuous variables was assessed using the Shapiro–Wilk test. Continuous variables that followed a normal distribution were expressed as (Mean ± SD) and analyzed using a t test for equality of means with adjusted variances. A two-tailed P value of < 0.05 was considered indicative of statistical significance. Confidence intervals (95% CI) were calculated for primary outcome measures to provide precision estimates.
Results
Baseline characteristics of participants
The mean age was 63.49 ± 6.74 years in the control group and 62.59 ± 6.91 years in the intervention group (t = 1.762, P = 0.08) (Table 1). Body mass index (BMI) was similar in both groups (P = 0.632). No significant differences were observed in the employment status, smoking and drinking history, diabetes prevalence, disease duration, pre-surgery training weeks, prostate size, operation type, nerve sparing procedure, catheter duration, and pre-operative activity levels (P > 0.05). However, significant differences were found in education level (χ2 = 7.474, P = 0.024) and hypertension prevalence, with a higher rate in the intervention group (74.7 vs. 59.79%, χ2 = 4.471, P = 0.034). These significant differences should be considered when interpreting subsequent outcomes related to the pelvic floor function exercise intervention.
Table 1.
Baseline characteristics of participants
| Parameters | Control group (n = 97) | Intervention group (n = 83) | t/χ2 | P |
|---|---|---|---|---|
| Age (years) | 63.49 ± 6.74 | 62.59 ± 6.91 | 1.762 | 0.08 |
| BMI (kg/m2) | 25.28 ± 2.63 | 25.47 ± 2.62 | 0.48 | 0.632 |
| Education level [n/(%)] | 7.474 | 0.024 | ||
| Primary school | 53 (54.64%) | 40 (48.19%) | ||
| Secondary school | 22 (22.68%) | 33 (39.76%) | ||
| College | 22 (22.68%) | 10 (12.05%) | ||
| Employment [n (%)] | 52 (53.61%) | 50 (60.24%) | 0.801 | 0.371 |
| Smoking history [n (%)] | 25 (25.77%) | 19 (22.89%) | 0.201 | 0.654 |
| Drinking history [n (%)] | 13 (13.4%) | 15 (18.07%) | 0.743 | 0.389 |
| Hypertension [n (%)] | 58 (59.79%) | 62 (74.7%) | 4.471 | 0.034 |
| Diabetes [n (%)] | 49 (50.52%) | 45 (54.22%) | 0.246 | 0.62 |
| Disease duration (years) | 4.30 ± 1.26 | 4.15 ± 1.37 | 0.746 | 0.457 |
| Pre-surgery training (weeks) | 6.52 ± 2.03 | 6.79 ± 2.11 | 0.865 | 0.388 |
| Prostate size (g) | 49.47 ± 15.48 | 50.96 ± 16.67 | 0.62 | 0.536 |
| Operation type | 1.616 | 0.204 | ||
| Open [n (%)] | 17 (17.53%) | 9 (10.84%) | ||
| Robotic-assisted [n (%)] | 80 (82.47%) | 74 (89.16%) | ||
| Nerve sparing procedure | 0.357 | 0.837 | ||
| Unilateral [n (%)] | 16 (16.49%) | 16 (19.28%) | ||
| Bilateral [n (%)] | 75 (77.32%) | 63 (75.9%) | ||
| Nil [n (%)] | 6 (6.19%) | 4 (4.82%) | ||
| Catheter in situ (days) | 8.51 ± 2.93 | 8.44 ± 2.86 | 0.154 | 0.878 |
| Pre-operative activity levels | 2.563 | 0.278 | ||
| Low (40–50% MHR) [n (%)] | 45 (46.39%) | 43 (51.81%) | ||
| Medium (50–70% MHR) [n (%)] | 41 (42.27%) | 36 (43.37%) | ||
| High (70–85% MHR) [n (%)] | 11 (11.34%) | 4 (4.82%) |
BMI body mass index
HPLP-II scores before and after intervention
Before the intervention, the Health Promotion Lifestyle Profile II (HPLP-II) scores were similar between the control group (133.91 ± 10.74) and the intervention group (135.13 ± 11.11), showing no statistically significant difference (t = 0.748, P = 0.455) (Fig. 1). However, after the intervention, both groups showed a significant increase in HPLP-II scores, with the control group at 164.86 ± 15.67 and the intervention group markedly higher at 179.56 ± 12.56 (95% CI: 10.56–18.84). The difference between the groups after the intervention was statistically significant (t = 6.984, P < 0.001).
Fig. 1.
Comparison of HPLP-II scores between two groups before and after intervention
Within-group analyses revealed significant improvements in both groups from baseline to post-intervention scores (control group: t = 10.456, P < 0.001; intervention group: t = 25.136, P < 0.001), with the intervention group demonstrating a more pronounced increase. As shown in Fig. 1, the slope of improvement was steeper for the intervention group, suggesting a stronger beneficial effect of the pelvic floor function exercise regimen based on the HBM on overall health-promoting behaviors.
Health belief scores and self-efficacy scores before and after intervention
Before the intervention, the health belief scores were comparable between the control group and the intervention group, with no statistically significant difference (P = 0.476) (Table 2). Similarly, self-efficacy scores showed no significant difference between the control group and the intervention group before the intervention (P = 0.988). After the intervention, both groups experienced significant increases in their health belief and self-efficacy scores; however, these increases were statistically similar between the control and intervention groups for both health belief (P = 0.247) and self-efficacy scores (P = 0.982). These findings indicate that while both groups exhibited improvements post-intervention, there was no significant difference in the magnitude of improvements attributed to the specific intervention between the two groups.
Table 2.
Two groups of health belief scores and self-efficacy scores before and after intervention
| Parameters | Health belief rating | t | P | Self-efficacy rating | t | P | ||
|---|---|---|---|---|---|---|---|---|
| Group | Control | Intervention | Control | Intervention | ||||
| Before intervention | 50.35 ± 11.50 | 49.17 ± 10.56 | 0.714 | 0.476 | 23.36 ± 7.26 | 23.34 ± 7.28 | 0.015 | 0.988 |
| After intervention | 74.15 ± 10.26 | 72.55 ± 8.72 | 1.161 | 0.247 | 49.56 ± 9.63 | 49.58 ± 5.44 | 0.023 | 0.982 |
Prostate and erectile function before intervention
Prior to the intervention, the International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5) scores were assessed in both the control and intervention groups (Table 3). The IPSS scores were 20.78 ± 3.17 in the control group and 20.35 ± 3.16 in the intervention group, showing no statistically significant difference (t = 0.909, P = 0.365). Similarly, the IIEF-5 scores were 23.05 ± 0.96 for the control group and 23.31 ± 1.02 for the intervention group, which were also not significantly different (t = 1.767, P = 0.079). These baseline assessments suggest that both groups were comparably matched in terms of prostate and erectile function before the implementation of the pelvic floor exercise intervention.
Table 3.
Comparison of prostate and erectile function between two groups of patients before intervention
| Parameters | Control group (n = 97) | Intervention group (n = 83) | T | P |
|---|---|---|---|---|
| IPSS score | 20.78 ± 3.17 | 20.35 ± 3.16 | 0.909 | 0.365 |
| IIEF-5 score | 23.05 ± 0.96 | 23.31 ± 1.02 | 1.767 | 0.079 |
IPSS International prostate symptom score, IIEF-5 International index of erectile function-5
Prostate and erectile function after intervention
After the intervention, significant differences were observed between the control and intervention groups in both prostate and erectile function (Fig. 2). The IPSS was markedly lower in the intervention group (5.16 ± 1.08, 95% CI: 4.92–5.40) compared to the control group (8.39 ± 1.12, 95% CI: 8.16–8.62), indicating a substantial improvement with statistical significance (t = 19.509, P < 0.001). The mean difference of 3.23 points (95% CI: 2.90–3.56) represents a clinically meaningful improvement in urinary symptoms.
Fig. 2.
Comparison of prostate and erectile function between two groups of patients after intervention
In addition, the International Index of Erectile Function-5 (IIEF-5) scores showed a significant reduction in the intervention group (20.08 ± 1.10, 95% CI: 19.84–20.32) compared to the control group (20.99 ± 1.11, 95% CI: 20.77–21.21), again demonstrating a statistically significant difference (t = 5.504, P < 0.001). As illustrated in Fig. 2, both IPSS and IIEF-5 scores show more favorable outcomes in the intervention group, suggesting that the pelvic floor function exercise regimen based on the HBM significantly enhanced both urinary and erectile function in patients with BPH following electrocautery.
Postoperative recovery
Following the intervention, the results demonstrated significant improvements in both prostate and erectile function in the intervention group compared to the control group (Table 4). The IPSS was significantly lower in the intervention group (5.16 ± 1.08) compared to the control group (8.39 ± 1.12), with a highly significant statistical difference (t = 19.509, P < 0.001). Similarly, the International Index of Erectile Function-5 (IIEF-5) score was significantly lower in the intervention group (20.08 ± 1.10) than in the control group (20.99 ± 1.11), also showing a statistically significant difference (t = 5.504, P < 0.001).
Table 4.
Comparison of postoperative recovery between two groups of patients
| Parameters | Control group (n = 97) | Intervention group (n = 83) | t | P |
|---|---|---|---|---|
| Retention time of urinary catheter (days) | 2.21 ± 0.67 | 2.04 ± 0.55 | 1.919 | 0.057 |
| Length of hospital stay (days) | 2.86 ± 0.70 | 2.66 ± 0.59 | 2.046 | 0.042 |
Length of hospital stay was significantly shorter in the intervention group (2.66 ± 0.59 days) compared to the control group (2.86 ± 0.70 days) (t = 2.046, P = 0.042), while the retention time of the urinary catheter showed a trend toward reduction in the intervention group but did not reach statistical significance (P = 0.057). These findings indicate that the pelvic floor function exercise based on the HBM effectively improved both prostate and erectile function in patients with BPH after electrocautery and may contribute to faster postoperative recovery.
Postoperative complications
The analysis of postoperative complications revealed a statistically significant reduction in the intervention group compared to the control group (Table 5). The overall incidence of complications was lower in the intervention group (6.02%, 5/83 patients) than in the control group (15.46%, 15/97 patients), with a significant difference (χ2 = 4.036, P = 0.045). Specifically, the intervention group experienced fewer cases of postoperative bleeding (2 cases vs. 6 cases), urinary tract infections (1 case vs. 4 cases), membrane perforation (1 case vs. 2 cases), and bladder spasm (1 case vs. 3 cases). The relative risk reduction for overall complications was 61% (95% CI: 8.9–83.4%). These results suggest that the application of pelvic floor function exercises based on the HBM may effectively reduce postoperative complications in patients with BPH after electrocautery.
Table 5.
Comparison of postoperative complications between two groups of patients
| Parameters | Control group (n = 97) | Intervention group (n = 83) | χ2 | P |
|---|---|---|---|---|
| Postoperative bleeding [n (%)] | 6 | 2 | ||
| Urinary tract infection [n (%)] | 4 | 1 | ||
| Membrane perforation [n (%)] | 2 | 1 | ||
| Bladder spasm [n (%)] | 3 | 1 | ||
| Total [n (%)] | 15 (15.46%) | 5 (6.02%) | 4.036 | 0.045 |
Urinary control rates before and after intervention
Before the intervention, urinary control rates were similar between the control group (10.31%, 10/97 patients) and the intervention group (9.64%, 8/83 patients), with no statistically significant difference (χ2 = 0.022, P = 0.881) (Table 6). However, after the intervention, an increase in urinary control rates was observed in both groups, with the control group improving to 24.74% (24/97 patients) and the intervention group achieving a higher rate of 37.35% (31/83 patients).
Table 6.
Comparison of urinary control rates between two groups of patients before and after intervention [n (%)]
| Parameters | Control group (n = 97) | Intervention group (n = 83) | χ2 | P |
|---|---|---|---|---|
| Before intervention | 10 (10.31%) | 8 (9.64%) | 0.022 | 0.881 |
| After intervention | 24 (24.74%) | 31 (37.35%) | 3.35 | 0.067 |
| χ2 | 7.107 | 17.016 | ||
| P | 0.008 | < 0.001 |
Although the post-intervention difference between the groups did not reach statistical significance (χ2 = 3.35, P = 0.067), within-group analysis revealed significant improvements over time. Specifically, the control group showed a significant increase in urinary control rates (χ2 = 7.107, P = 0.008), and the intervention group showed an even more significant improvement (χ2 = 17.016, P < 0.001). As shown in Table 6, the intervention group demonstrated a nearly fourfold improvement in urinary control rates compared to baseline, suggesting that pelvic floor function exercises, as guided by the HBM, may enhance urinary control in patients with BPH following electrocautery.
Quality of life before intervention
Prior to the intervention, the quality of life parameters assessed—including environment, physiology, psychology, and social aspects—was comparable between the control and intervention groups (Table 7). The environment scores were 50.19 ± 4.79 for the control group and 50.22 ± 4.56 for the intervention group (t = 0.04, P = 0.968). Physiology scores showed similar results, with 51.87 ± 4.21 in the control group and 51.67 ± 4.33 in the intervention group (t = 0.32, P = 0.75). The psychology scores were 51.71 ± 4.82 for the control group versus 51.49 ± 4.74 for the intervention group (t = 0.303, P = 0.763). Lastly, the social aspect scores were 52.45 ± 5.28 in the control group and 52.54 ± 5.34 in the intervention group (t = 0.113, P = 0.91). Each parameter showed no statistically significant differences between the groups, indicating that both groups were well-matched in terms of quality of life before the intervention.
Table 7.
Comparison of quality of life between the two groups before intervention
| Parameters | Control group (n = 97) | Intervention group (n = 83) | t | P |
|---|---|---|---|---|
| Environment | 50.19 ± 4.79 | 50.22 ± 4.56 | 0.04 | 0.968 |
| Physiology | 51.87 ± 4.21 | 51.67 ± 4.33 | 0.32 | 0.75 |
| Psychology | 51.71 ± 4.82 | 51.49 ± 4.74 | 0.303 | 0.763 |
| Society | 52.45 ± 5.28 | 52.54 ± 5.34 | 0.113 | 0.91 |
Quality of life after intervention
After the intervention, the quality of life measures—including environment, physiology, psychology, and social parameters—did not show statistically significant differences between the control and intervention groups (Table 8). The environmental quality of life scores were 80.23 ± 5.32 for the control group and 81.14 ± 6.94 for the intervention group (t = 0.981, P = 0.328). The physiological scores were 82.44 ± 5.47 for the control group compared to 83.53 ± 5.99 for the intervention group (t = 1.274, P = 0.204). Psychological well-being scores were 81.63 ± 5.73 in the control group and 82.57 ± 6.56 in the intervention group (t = 1.032, P = 0.303). Lastly, the social dimension scores were 82.72 ± 5.64 in the control group and 81.91 ± 6.87 in the intervention group (t = 0.864, P = 0.389). These results suggest that the intervention, based on pelvic floor function exercise and the HBM, did not result in significant differences in quality of life between the groups post-intervention.
Table 8.
Comparison of quality of life between two groups after intervention
| Parameters | Control group (n = 97) | Intervention group (n = 83) | t | P |
|---|---|---|---|---|
| Environment | 80.23 ± 5.32 | 81.14 ± 6.94 | 0.981 | 0.328 |
| Physiology | 82.44 ± 5.47 | 83.53 ± 5.99 | 1.274 | 0.204 |
| Psychology | 81.63 ± 5.73 | 82.57 ± 6.56 | 1.032 | 0.303 |
| Society | 82.72 ± 5.64 | 81.91 ± 6.87 | 0.864 | 0.389 |
Psychological states before and after intervention
Before the intervention, SAS scores were similar between the control group (65.82 ± 4.15) and the intervention group (66.13 ± 4.03), with no significant difference (t = 0.509, P = 0.612) (Fig. 3). After the intervention, the intervention group showed a remarkable reduction in SAS scores (46.09 ± 2.14, 95% CI: 45.63–46.55) compared to the control group (54.97 ± 3.51, 95% CI: 54.26–55.68), which was statistically significant (t = 20.811, P < 0.001).
Fig. 3.
Comparison of psychological states between two groups
Similarly, before the intervention, SDS scores did not significantly differ between the control group (65.15 ± 3.61) and the intervention group (64.82 ± 4.11) (t = 0.583, P = 0.561). Post-intervention, the intervention group exhibited significantly lower SDS scores (42.15 ± 1.87, 95% CI: 41.74–42.56) than the control group (53.29 ± 2.74, 95% CI: 52.74–53.84), with a statistically significant difference (t = 32.219, P < 0.001).
As Fig. 3 clearly illustrates, both groups started with comparable levels of anxiety and depression, but the intervention group showed a much more pronounced improvement in psychological state after the intervention. The mean differences between groups were clinically significant: 8.88 points for SAS (95% CI: 8.04–9.72) and 11.14 points for SDS (95% CI: 10.45–11.83). These findings suggest that the pelvic floor function exercise based on the HBM significantly mitigated anxiety and depression in patients with BPH after electrocautery.
Compliance behaviors with medical advice before and after intervention
The analysis of compliance behaviors with medical advice8 between the control and intervention groups showed varying results across different parameters (Table 9). Regarding water intake, there were no statistically significant differences between the groups both before (control: 1.47 ± 0.26, intervention: 1.44 ± 0.28; t = 0.881, P = 0.379) and after the intervention (control: 2.58 ± 0.34, intervention: 2.51 ± 0.37; t = 1.407, P = 0.161).
Table 9.
Comparison of two group’s compliance behaviors with medical advice
| Parameters | Control group (n = 97) | Intervention group (n = 83) | t | P |
|---|---|---|---|---|
| Drinking water | ||||
| Before intervention | 1.47 ± 0.26 | 1.44 ± 0.28 | 0.881 | 0.379 |
| After intervention | 2.58 ± 0.34 | 2.51 ± 0.37 | 1.407 | 0.161 |
| Diet | ||||
| Before intervention | 1.59 ± 0.18 | 1.67 ± 0.15 | 3.119 | 0.002 |
| After intervention | 2.59 ± 0.21 | 2.51 ± 0.23 | 2.344 | 0.02 |
| Emotional management | ||||
| Before intervention | 1.67 ± 0.23 | 1.65 ± 0.18 | 0.71 | 0.479 |
| After intervention | 2.18 ± 0.35 | 2.33 ± 0.46 | 2.438 | 0.016 |
| Daily activities | ||||
| Before intervention | 1.64 ± 0.11 | 1.66 ± 0.18 | 0.631 | 0.529 |
| After intervention | 2.09 ± 0.26 | 2.04 ± 0.37 | 0.958 | 0.34 |
In terms of diet, statistically significant differences were observed both before (control: 1.59 ± 0.18, intervention: 1.67 ± 0.15; t = 3.119, P = 0.002) and after the intervention (control: 2.59 ± 0.21, intervention: 2.51 ± 0.23; t = 2.344, P = 0.02), with the intervention group showing greater compliance.
For emotional management, no significant difference was noted before the intervention (control: 1.67 ± 0.23, intervention: 1.65 ± 0.18; t = 0.71, P = 0.479), but after the intervention, the intervention group demonstrated significantly better compliance (control: 2.18 ± 0.35, intervention: 2.33 ± 0.46; t = 2.438, P = 0.016).
Daily activities showed no significant differences between groups both before (control: 1.64 ± 0.11, intervention: 1.66 ± 0.18; t = 0.631, P = 0.529) and after the intervention (control: 2.09 ± 0.26, intervention: 2.04 ± 0.37; t = 0.958, P = 0.34).
Overall, the intervention based on the HBM led to improved compliance in dietary habits and emotional management among patients with BPH after electrocautery.
Discussion
In this study, we investigated the effects of pelvic floor function exercises guided by the HBM on patients with BPH following electrocautery, measuring functional, psychological, and quality of life outcomes.
One of the most prominent findings is the marked improvement in prostate and erectile function as measured by the IPSS and IIEF-5. The intervention group exhibited significantly better urinary function, suggesting that the targeted nature of pelvic floor muscle exercises enhanced muscle tone and control. Pelvic floor muscles are crucial in supporting pelvic organs and maintaining continence [31]. The structured HBM-based approach, which addressed patient’s health beliefs and provided motivation for consistent exercise, likely contributed to the observed improvements.
The physiological mechanisms underlying these improvements involve enhanced blood circulation and neuromuscular function in the pelvic region [32]. Stronger pelvic floor muscles provide better structural support and may facilitate improved neural control of the urethral sphincter, resulting in better urinary function. Similarly, the improvements in erectile function can be attributed to increased pelvic blood flow and enhanced neural function resulting from consistent pelvic floor exercises [33].
The significant reduction in postoperative complications observed in the intervention group is another critical outcome. The lower incidences of bleeding, infections, membrane perforation, and bladder spasms suggest that the exercise regimen may have facilitated faster healing and better tissue recovery. In addition, improved bladder function and control could minimize urinary stasis, reducing the risk of infections. The HBM’s emphasis on perceived susceptibility and severity likely enhanced patients’ adherence to postoperative care protocols, contributing to fewer complications [34].
Psychological well-being showed substantial improvement in the intervention group, with significant reductions in anxiety and depression scores. This psychological benefit could be attributed to several factors. First, the HBM’s educational components improved patients’ understanding of their condition and recovery process, potentially reducing fear and uncertainty. Second, the structured exercise program provided patients with a sense of active participation in their recovery, enhancing perceived control. Third, the improvement in functional outcomes (urinary and erectile function) likely contributed to better psychological well-being [35].
Interestingly, despite improvements in functional outcomes and psychological states, the intervention did not produce significant differences in quality of life measures between the two groups. This discrepancy warrants careful consideration. Quality of life is a multidimensional construct influenced by physical, psychological, social, and environmental factors. While our intervention targeted specific physiological functions and addressed psychological aspects through education and support, it may not have adequately addressed all dimensions that contribute to overall quality of life.
Several factors might explain this finding. First, the WHOQOL-BREF instrument used in this study may not have been sensitive enough to detect domain-specific improvements relevant to BPH patients. Second, the relatively short follow-up period (6 months) might be insufficient for quality of life changes to manifest fully, as adaptation to improved function occurs gradually. Third, other aspects of life beyond urinary and erectile function—such as social relationships, financial concerns, and general health perceptions—contribute significantly to quality of life and were not directly targeted by our intervention.
This discrepancy highlights the complex relationship between functional improvements and perceived quality of life, suggesting that future interventions should adopt a more holistic approach addressing multiple dimensions of well-being. It also underscores the importance of using condition-specific quality of life measures in addition to generic instruments to capture relevant changes more effectively.
Compliance behavior with medical advice showed improvements in dietary habits and emotional management in the intervention group. The HBM’s strategy of enhancing patient awareness and motivation likely contributed to these behavioral changes. The improved compliance in emotional management aligns with reduced anxiety and depression scores, supporting the psychological impact of the intervention. However, the lack of significant differences in water intake and daily activities compliance suggests that the intervention’s effects on health behaviors were selective rather than comprehensive.
The study has several limitations that should be considered when interpreting the results. First, as a retrospective case–control study, it is subject to selection bias and confounding variables, despite our efforts to match groups on baseline characteristics. The significant differences in education level and hypertension prevalence between groups could have influenced outcomes. Second, the follow-up period of 6 months may be insufficient to assess the long-term sustainability of the observed benefits. Future studies with longitudinal designs are needed to determine whether the improvements persist over time and whether quality of life differences emerge with longer follow-up.
Third, the use of self-reported measures for psychological assessments introduces the potential for response bias. Fourth, our sample was drawn from a single institution, which may limit the generalizability of findings to diverse populations with varying healthcare practices and resources. Finally, the absence of a structured protocol for measuring adherence to the exercise regimen limits our ability to establish a dose–response relationship between exercise compliance and outcomes.
Despite these limitations, our findings have important clinical implications. The integration of pelvic floor function exercises guided by the HBM into postoperative care for BPH patients appears to offer significant benefits for urinary and erectile function, psychological well-being, and reduction of complications. The structured approach to patient education and motivation provided by the HBM framework seems particularly valuable in enhancing exercise adherence and outcomes.
Conclusion
This study demonstrates that pelvic floor function exercises based on the HBM provide significant benefits for patients with BPH post-electrocautery, particularly in improving urinary and erectile function, reducing postoperative complications, and enhancing psychological well-being. These findings support the integration of structured, belief-driven exercise regimens into standard care protocols for BPH patients. However, the lack of significant differences in quality of life measures despite functional improvements highlights the complex relationship between physical function and perceived well-being. This discrepancy suggests that future interventions should adopt more comprehensive approaches that address multiple dimensions of patient experience. In addition, the limitations of our retrospective design and relatively short follow-up period indicate the need for prospective, longitudinal studies to confirm the sustainability of these benefits and explore whether quality of life improvements emerge over longer time frames. Future research should also incorporate more objective measures of exercise adherence and investigate factors that might moderate intervention effectiveness across diverse patient populations. Despite these limitations, our findings provide valuable evidence supporting the clinical utility of structured pelvic floor exercise programs guided by health behavior models in improving functional and psychological outcomes for BPH patients after electrocautery.
Author’s contributions
JX, JJZ, and LJG were involved in the conception and design, or analysis and interpretation of the data; HJY and CHL contributed to the drafting of the paper, revising it critically for intellectual content; SYY and FX contributed to the final approval of the version to be published, and all authors agree to be accountable for all aspects of the work.
Funding
No funding was received.
Data availability
No datasets were generated or analysed during the current study.
Declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
The study was approved by College of Fuzhou Medical College of Nanchang University (JX-NC-2023-024).
Consent for publication
All authors have agreed to publish.
Consent to participate
All patients have signed written informed consent.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
No datasets were generated or analysed during the current study.