Biofeedback for men with Urinary Incontinence After Prostate Surgery

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Biofeedback (BF) is a technique that measures bodily functions and gives you information about them in order to help train you to control them.




The BF approach for treating urinary incontinence was pioneered by Arnold Kegel in the 1940’s. His work was the basis for the pelvic muscle work being performed today.  Currently, simple to use yet highly sophisticated EMG instruments monitor not only the pelvic muscles but the nearby accessory muscles, that patients frequently substitute in an effort to contract the seldom used, weak or damaged, muscles of the pelvic floor.


Research – BF for men after prostatectomy for urinary incontinence


Dr. Kathryn L. Burgio and colleagues from the University of Alabama at Birmingham evaluated the effectiveness of pre-op biofeedback to hasten the recovery of urinary control, decrease the severity of incontinence, and improve the quality of life in the 6 months following prostate removal (Burgio et al. 2006).


Of the 51 men in the biofeedback group, 70 percent reported that they were still doing the exercises they learned preoperatively at the 6-month follow-up.


The time taken to achieve continence in the biofeedback-training group hovered around 3.5 months, the investigators report. On the other hand, fewer than half of the 51 men in the comparison group achieved continence by the 6-month follow-up.


At 6 months, men in the biofeedback group reported an average of 73 days with no leakage, compared with 54 days reported by men in the comparison group.


Severe or continual leakage was still present in nearly 20 percent of comparison subjects  (no BF group) at the 6-month mark, the researchers note, compared to 6 percent of those in the biofeedback group.


Another Italian study has demonstrated that several treatment sessions each of 35 mins duration, starting very soon after a radical prostatectomy, and using BF equipment resulted in almost all men regaining continence at 6 months. (Mariotti, 2009)


More technical information from a review from the Urologic Nursing Journal


Three of the Level 1 reviews examined the effect of biofeedback. Moore et al. (2002) found that there was no difference in trials where biofeedback was used, while Hunter et al. (2004) concluded that there might be some benefit in the use of biofeedback with PFMT to promote an earlier return to continence. Moore and Dorey (1999) argued that results of four papers were encouraging but limited by nonobjective outcome measures and the lack of control groups.


Two of the Randomized Clinical Trial (RCT) (Floratos et al., 2002; van Kampen et al., 2000) found that there was some evidence to support the use of biofeedback while three found no significant effect (Bales et al., 2000; Franke et al., 2000; Wille, Sobottka, Heidenreich, & Hofmann 2003). Of the two supporters, Floratos et al. (2002) did not take into account the effect of normal healing as did van Kampen et al. (2000). The protocol of the latter is clinically impractical due to the huge commitment of time required (one session per week for a year). Wille et al. (2003) concluded that including biofeedback to PFMT added nothing except cost to the recovery process. The other two non-supportive studies had flaws in their designs. Franke et al. (2000) commented on the high risk of error due to the small numbers. Bales et al. (2000) did not describe their outcome measures or comment on the normal healing over time in the early postoperative stages.


There is little Level 3 evidence that biofeedback is of use in the rehabilitation of pelvic floor muscles post surgery. Burgio, Stutzman, and Engel (1989) concluded that biofeedback was useful in treating episodic stress or urge incontinence but less so if the incontinence was continuous. The highly significant improvement in the outcomes found in a study by Jackson, Emerson, Johnston, Wilson, and Morales (1996) were compromised by insufficient analysis and lack of blinding.


Knight and Laycock (1994) examined the evidence for using biofeedback in pelvic floor reeducation and found strong evidence for its use although they concluded there was a need for further trials. This was supported by a study by Carlson and Nitti (2001). High scoring articles by Dorey (2001, 2000a, 2000b), Rigby (2003), Robinson (2000), Harris (1997), and Moul (1998, 1994) found that there were grounds for the continued use of biofeedback, but noted a need for further research. Diokno (1998) and Joseph and Sueppel (2000) also concurred with the use of biofeedback as an adjunct to PFMT.

Overall, though the high level evidence is scant, there is a trend towards support for using biofeedback as an adjunct to PFMT. Lack of good evidence points to the need for further research on protocol and effectiveness. (Nahon et al. 2006)




Lastly, the most recent study suggest that pelvic muscle exercises are effective for post- prostate surgery with or without BF. (Goode et al. 2011)




Bottom line


BF helps many men with post prostatectomy incontinence while others do well with pelvic floor exercises without BF. Some men seem to have a hard time learning what pelvic muscles are most important for urine control and can benefit from this technology.


If you or anyone you know is suffering from any level of urinary incontinence, we at NYU Urology are offering a FREE biofeedback session for men, after prostate surgery, who are still incontinent. This is part of a training program from a national expert on BF for pelvic dysfunction and incontinence, Stacy Futterman.

Date: June 30th, 2011 –  Thursday

Time: Between 11am and 6pm

Where: NYU Smilow Comprehensive Prostate Cancer Center – 135 East 31st, corner of Lexington Avenue


If you are interested, Please call Marie at 646-744-1515. If you call over the weekend she will call you on Monday at first call first serve.

In Optimal Health,

Dr. Geo



Goode PS et al. Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy incontinence: a randomized controlled trial. JAMA. 2011 Jan 12;305(2):151-9.

Nahon I, Dorey G, Waddington G, Adams R. Systematic review of the treatment of post-prostatectomy incontinence. Urol Nurs. 2006 Dec;26(6):461-75, 482.

Burgio KL et al, Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinence: a randomized, controlled trial. J Urol. 2006 Jan;175(1):196-201

Mariotti et al. Early recovery of urinary continence after radical prostatectomy using early pelvic floor electrical stimulation and biofeedback associated treatment. Journal of Urology, 2009 April: 181(4) 1788-93.

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by Dr. Geo

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