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. 2015 Jan 20;2015(1):CD001843. doi: 10.1002/14651858.CD001843.pub5

1. Details of interventions.

Study ID Intervention Control
Ahmed 2012 A: At catheter removal received standard care of verbal and written instructions, instructed by physiotherapist to perform 3 sets of 15‐20 contractions daily, for a duration of 3‐5 seconds with a 6‐10 second rest period, encouraged to perform exercises before functional activities such as sneezing, coughing, or lifting weight, also in the supine position, sitting, squatting and going up and down stairs
 
B: ES, treatment started one week after catheter removal, patients received 15 minutes of twice weekly electrical stimulation for 12 weeks
 
C: PFMT + BFB + ES: Treatment started one week after catheter removal, patients received twice weekly treatment with 15 minutes of electrical stimulation and 15 minutes of biofeedback for 12 weeks, instructed to perform 3 series of 10 rapid contractions, 3 sustained contractions of 5, 7 or 10 seconds and then 10 contractions during prolonged expiration in the supine position
 
All patients were given a logbook to complete daily regarding self‐report of exercises   
 
Bales 2000 PFMT + biofeedback
45 minute session with nurse trained in biofeedback. Patients were instructed to perform graded PFMT. Contractions of 5‐10 seconds, 10‐15 repetitions were performed with biofeedback (surface electrodes used to measure muscle strength). Advised to practice the exercises 4 times per day until surgery
No biofeedback training
Written and brief verbal instructions from a nurse on how to perform PFMT (isolate muscle that stops urine flow, practice 4 times per day, 10‐15 repetitions).
Burgio 2006 PFMT + biofeedback
Single session of biofeedback (rectal probe to measure intra‐abdominal rectal pressure and external anal sphincter contraction) assisted behavioural training. Feedback and verbal instruction used to teach control of pelvic muscles. Taught to contract sphincter during 2‐10 seconds periods separated by 2‐10 seconds of relaxation, dependent on ability.
Written instructions for daily at home practice of 45 PFM exercises daily (3 sessions of 15 exercises each time). Additionally instructed to slow or interrupt voiding once daily. Encouraged to exercise daily preoperatively, then resume when catheter removed post‐operatively
Usual care of brief verbal instructions post operatively to interrupt the voiding stream plus any instruction from physician.
Centemero 2009 Intervention A: PFMT both pre and post‐operatively. A structured PFMT program 30 and 15 days before surgery, previous physiotherapist evaluation to provide the patients with feedback about the quality of pelvic floor muscle function, PC teste (endurance and contraction quality), breathing coordination, typify muscle contraction as tonic and modify incorrect physical attitudes. This was also repeated after the procedure
Intervention B: PFMT post‐operatively only
 
Dijkstra‐Eshuis 2013 30 mins of guided PFMT + biofeedback weekly for 4 weeks before surgery, received written instructions to: carry out two sets of 30 contractions during abdominal breathing, one breath between each contraction; restart PFMT after catheter removal (7‐10 days after surgery)
All men were seen before surgery by a physiotherapist, who explained relevant anatomy, anal visual inspection and digital palpation, biofeedback registration with rectal probe, All patients received PFMT + biofeedback or electrical stimulation, or both, if still incontinent after 6 weeks
Received written instructions on PFMT after catheter removal (7‐10 days after surgery)
Dubbelman 2004 Nine or less sessions of physiotherapy guided pelvic floor exercises after surgery Exercise instruction through information folder
Filocamo 2005 Formal instruction (3 treatment sessions plus at home exercises) in PFMT using verbal explanation, palpation and visualization of the base of the penis with a mirror, in different positions and prior to sneezing, coughing or lifting No formal instruction
Floratos 2002 Initiated after catheter removal, 15 treatment sessions (3 times per week for 30 minutes) of PFMT with EMG (surface) biofeedback in clinic Instruction with verbal feedback and an information pamphlet with instructions to perform PFMT 50‐100 times daily at home
Fode 2014 Pre‐operative session guided PFMT + instruction on how to use penile vibratory stimulation device. Instructed to stimulate frenulum once daily, 10 seconds of stimulation then 10 second pause, repeated 10 times for 1 week pre‐operatively, instructed to restart stimulation after catheter removal for 6 weeks
All men were offered a PDE5 inhibitor after 1 month post‐operatively and also received telephone contact to ensure compliance with treatment 
Preoperative session guided PFMT
Franke 1998 Biofeedback (perineal patch EMG) enhanced PFMT; exercise treatment sessions at 6, 7, 9, 11, and 16 weeks post‐operatively No treatment.
Geraerts 2013 Intervention A: PFMT + biofeedback
30 mins of guided PFMT + biofeedback weekly for 3 weeks before surgery. Patients were instructed to carry out 60 contractions a day at home; contract their pelvic floor while coughing, and sitting down or getting up from a chair. Patients were also instructed to restart PFMT on day 4 after surgery while catheter was in situ
Intervention B: Instructed to start PFMT on the day after catheter removal (e.g. 2‐3 weeks after surgery)
All men: Received weekly individual guided exercise programme with digital or EMG biofeedback after surgery. Advice was given on how to contract pelvic floor muscles to prevent leakage during functional activities. When patients carried out the instructed 60 contractions, they were asked to colour in three squares in their diary to assess compliance
 
Ghanem 2013 Pre‐operative PFMT for 2 weeks + postoperative PFMT programme       Postoperative PFMT programme only
Goode 2009 Intervention A: Behavioural therapy with PFMT for 8 weeks
Intervention B: Behavioural therapy with biofeedback and electrical stimulation for 8 weeks
Behavioural therapy consisted of pelvic floor muscle exercises and bladder control strategies in both groups
No treatment
Hoffman 2005 Intervention A: perineal EStim plus physiotherapy (PFMT)
Intervention B: anal EStim plus physiotherapy (PFMT)
PFMT alone
Hou 2013 Guided PFMT + biofeedback after catheter removal (2 days post‐operatively), instructed to: contract pelvic muscles for 5 seconds and relax for 10 seconds. After discharge, patients were instructed to carry out 5 mins of each PFE three times daily. Patients also received motivational telephone interviews once weekly No description
Joseph 2000 Intervention A: Instruction in PFMT including biofeedback with visual feedback as well as verbal to assist in identifying and discriminating muscles
Intervention B: Instruction in PFMT, squeezing of finger during digital rectal examination
 
Koo 2009 ExMI, treatment sessions were for 20 minutes twice weekly for 8 weeks PFMT alone
Laurienzo 2013 A (15): Standard treatment with verbal instructions for PFMT
B (17): Pre‐operative guided PFMT, with 10 physiotherapy sessions: contractions of the pelvic floor muscles for 5 seconds in “dorsal decubitus” position for 10 times, in the same position with the waist elevated (10 times), lying down with legs adducted against a plastic ball performed 10 times and standing and flexing the hips to 60̊ (10 times)
C (17): Pre‐operative PFMT + ES during 10 physiotherapy sessions, ES was with an anal probe lasting 15 minutes in total, and men also received guided PFMT and followed the same training regime as above
Men did not receive treatment post‐operatively
Instructed to start PFMT at home 15 weeks before surgery.
Liu 2008 Extra‐corporeal magnetic innervation (ExMI), the frequency of the pulse field was 10Hz for 10 minutes, followed by a 3 minute rest and a second treatment of 50 Hz for 20 minutes. This was done twice a week PFMT alone, instructions given to carry out 20mins x 3 a day.
Manassero 2007 PFMT re‐education program, verbal feedback
The training program involved active PFE. verbal feedback of the contraction was used to instruct the patients to correctly and selectively contract their pelvic muscles while relaxing the abdominal muscles. the strength of the pelvic floor muscles was measured by digital anal control using a score of 0 to 5 ( 0 = no contraction, 5 = good contraction against strong resistance)
Initially home practice comprised 45 contractions (3 sessions of 15) per day at home, progressively increasing the number until 90 per day. This was taught by two experienced urologists
No treatment.
Marchiori 2010 Guided PFMT + biofeedback during first session, second session involved 10 sets of pelvic floor electrical stimulation lasting 15 mins each, instructed to: carry out three sets of 30 contractions a day at home for the first month after catheter removal (16 days after surgery)
All men received oral and written information on pelvic floor anatomy and on PFME, pelvic floor muscle endurance assessed by digital anal control
Received oral and written information on pelvic floor anatomy and on PFME, instructed to: perform 30 contractions a day at home for the first month after catheter removal (16 days after surgery)
Mariotti 2009 PFMT plus ES and biofeedback twice a week for 6 weeks
ES ‐ a surface electrodes was inserted into the anus and pulsed, the intensity was adequate to induce visual lifting of the levator ani and pubococcygeus muscle, considering the level of comfort to the patient
Biofeedback ‐ via surface electrodes both perineal and abdominally
Instructions to conduct PFMT ‐ verbal and written instructions at catheter removal and follow up visits.
Martini 2011 PFMT: 5 sessions of guided PFMT for 2‐3 weeks pre‐operatively and continued post‐operatively
All men underwent clinical examination of pelvic muscles function using digital perineal testing according to “AIPDA score” and evaluation of voiding symptoms
Postoperative standard care, written instructions for PFMT
Mathewson‐Chapman 97 Pre‐operatively received further instruction and practice with PME protocol Home exercises and biofeedback (anal probe) (Incare 8900); practiced at home 3 times a week, starting with daily 15 PFMT and increasing by 10 every 4 weeks to a maximum of 35 PFMT. Post‐operatively no further interventions until week 5 when pelvic muscle strength was assessed.
Moore 1999 Intervention A: PFMT alone
Intervention B: PFMT plus rectal ES treated by one physiotherapist 30 minutes twice a week for 12 weeks
Both included home exercises 3x/day gradually working up to 30 minutes per session lying, standing, sitting; strength, endurance, speed and control with maximum contractions of 5‐10 seconds, 10‐20 second relaxation and 12‐20 repetitions; submaximum contractions at 65‐75% of maximum strength with hold 20‐30 seconds and equal rest time, 8‐10 repetitions; speed was sets of quick repetitive contractions in a 10 second time span; control involved gradual recruitment to maximum contraction in 3 stages with 5 second hold at each stage and a slow release with rest 15‐30 seconds
oral and written information about PFMT pre and post‐ operatively (standard treatment)
Moore 2004 Each participant had 4 periods (each lasted 1 day)
 Group A: No device
 Group B: C3 device
 Group C: U‐Tex device
 Group D: Cunningham clamp  
Moore 2008 Maximum 24 weekly, 30‐minute treatment protocol (30 min biofeedback‐assisted PFMT) and home exercise protocol of 2‐3 times a day Verbal and written information on PFME and weekly telephone contact by a urology nurse
Morihiro 2011  PFMT + sacral surface therapeutic electrical stimulation (ssTES), ssTES 2x a day for 15 minutes each, lasting 1 month after catheter removal (day 5) PFME only, carried out alone
Nowak 2007 Extra‐corporeal magnetic innervation (EXMI) based pelvic floor device PFMT alone
Opsomer 1994; PFMT plus biofeedback plus electrical stimulation directed by physiotherapist PFMT on their own without medical supervision.
Overgard 2008; Instructions on PFMT and physiotherapy, 45 minutes weekly
Patients were instructed to perform 3 sets of contractions daily at home, in either a supine, sitting or standing position. Digital anal palpation to teach correct contractions, as well as oral and written instructions
DVD of instructions given to those living too far from hospital
Instructions on PFMT alone.
Parekh 2003 Two treatment sessions preoperatively. Session 1 consisted of PFMT in a hook lying position
 Session 2 was on an exercise ball. Teaching methods varied and included verbal cues, visualization with an anatomical model, palpation or biofeedback with rectal probe. Post‐operatively, PFMT was reviewed and participants were seen every 3 weeks for 3 months by a physiotherapist
 Home exercise for 6 months or more for those requiring further physical therapy guidance No formal education on PFMT pre‐operatively, telephone or face to face follow‐up at least monthly.
Park 2012 Patients performed Kegel exercises together with other types of exercises which included resistance training and pelvic flexibility. The intervention started 3 weeks after surgery and lasted 12 weeks
Details of the combined exercise regime:
Post‐operative weeks 1‐4
1) Education about postoperative symptoms
2) Performing Kegel exercises, recognizing the parapelvic muscles
3) Pelvic floor flexibility fitness: performing pelvic exercises while sitting on a ball
Post‐operative weeks 5‐8 (ball exercises)
1) Performing pelvic exercises while sitting on a ball
2) Performing lower extremity exercises while placing a ball on the wall
3) Lifting a heel on the ball while standing face‐to‐face with the wall
4) Lifting up and down on the ball while spreading and bending legs
5) Performing flank exercises while having a ball in the hand
6) Squeezing the ball with the adductor muscles while lying on a table
Post‐operative weeks 9‐12 (elastic band exercises)
1)  Lifting the object with an elastic band lateral, anterior, and posterior to the patient’s arms
2) Lifting the legs and then spreading them while attaching an elastic band to the foot
In the control group, only Kegel exercises were performed
Perissinotto 2008 Early pelvic floor rehabilitation program at home twice dally, Kegel exercises No formal PFMT
Porru 2001 Initial visit before surgery, digital evaluation of pelvic muscle contraction strength. Verbal instruction, feedback and reinforcement on contraction was given to teach selective contraction of anal sphincter and relaxation of abdominal muscles. Verbal and written instruction given for home PFMT. Weekly digital anal reassessment and grading of pelvic muscle contraction by the therapist. Instructed to practice contractions 45 times per day (3 groups of 15 contractions) Not specified
Ribeiro 2008 PFMT plus BF weekly for 3 months PFMT oral instructions only
Robinson 2008 Intervention A: Brief verbal instruction in PFMT before operation and offer of one biofeedback session at 2 months after surgery (uptake 33%) plus PFMT for four weeks with biofeedback
Intervention B: Brief verbal instruction in PFMT before operation and offer of one biofeedback session at 2 months after surgery (uptake 46%)
 
Robinson 2009 Intervention A: routine brief verbal and written PFMT plus one PFMT session and 3 weekly nurse phone calls
Intervention B: routine brief verbal and written PFMT plus four BF enhanced PFMT sessions and 4 weekly nurse phone calls
Routine brief verbal and written PFMT.
Seleme 2008 Verbal instruction and information on PFMT plus information on life style changes. Additional 15 physiotherapy sessions consisting of intensive PFMT with BF and ES Verbal instruction and information on PFMT plus information on life style changes.
Tibaek 2007 One hour individual session with physiotherapist to teach correct contraction for PFMT, three 1 hour group lessons and home training programme No pre operative physiotherapy. Information about anatomy and physiology and verbal instructions for 2 to 3 days after TURP in the ward.
Tienforti 2012 PFMT + biofeedback
Patients received guided PFMT + biofeedback + information about the anatomy of pelvic floor muscles the day before surgery and after catheter removal. They were also given oral and written instructions on Kegel exercises to be performed at home which involved three sets of contractions daily for 10 mins, contracting their pelvic floor while lying, sitting and standing. The frequency of contractions was recorded in a training diary and visits at monthly intervals after catheter removal involved assisted biofeedback and motivation for 20 min
No biofeedback training
Received standard care, oral and written instructions from urologist on PFMT, Instructed to: start PFMT after catheter removal (e.g. 2‐3 weeks after surgery)
Tobia 2008 PFMT No PFMT
van Kampen 1998 1 session of PFMT in hospital before discharge and then saw the physiotherapist for 1‐2 weeks for as long as UI persisted. 90 daily home exercises sitting, standing and lying. 7 men unable to contract PFM or with weak contraction received electrical stimulation by anal probe No formal PFMT instruction but saw the therapist at 1‐2 weeks and received placebo stimulation and information about aetiology of UI.
Wille 2003 Intervention A: PFMT alone
Intervention B: PFMT + ES; PFMT as above plus instructed by dedicated in ES via surface anal electrode and bio‐impulser (biphasic pulse with 1 second bursts, 5 second pulse width, 2 second pulse trains
Intervention C: PFMT + ES + biofeedback. As above plus biofeedback (anal probe) 15 minutes twice daily for 3 months
All groups: PFMT by physiotherapist, 20‐30 minute sessions for 3 days, instructed to perform exercises twice daily for 3 months plus 3 week rehabilitation program after dischargeRegular interaction with health professional for 6 weeks after surgery, encouraged to performed treatment for 3 months post‐surgery
 
Yamanishi 2006 Oral PFMT plus ES for 15 minutes twice daily
Instructed pre‐operatively PFMT by nurses and continued after catheter removal
Oral PFMT plus sham device.
Instructed pre‐operatively PFMT by nurses and continued after catheter removal.
Yokoyama 2004 Intervention A: anal electrode for 15 minutes twice a day for 1 month
Intervention B: extra‐corporeal magnetic innervation, neocontrol system, treatment sessions 20 minutes, twice a week for 2 weeks
PFMT, digital anal teaching of correct contractions, then verbal and written instructions for home practice.
Zhang 2007 PFMT plus BF using rectal electrical sensor, initial 45 minute session with physical therapist then written instructions to carry out at home three times a day for 10 minutes. Plus support group, 6 meetings in 3 months with a health psychologist PFMT plus BF using rectal electrical sensor, initial 45 minute session with physical therapist then written instructions to carry out at home three times a day for 10 minutes