How effective are pelvic floor muscle exercises for patients with erectile dysfunction following prostate removal?

This study examined if pelvic floor muscle exercises (PFME) were useful to treat patients with erectile dysfunction (ED) following surgical removal of the prostate. The results suggested that PFME may help patients with ED.

A side effect of prostate removal to treat prostate cancer is erectile dysfunction (ED). ED can be treated with medications or vacuum devices. However, ED persists in some men. Pelvic floor muscle exercises (PFME) are often used to treat incontinence in men following prostate surgery. PFMEs are sometimes combined with electrical stimulation or vibrational stimulation to strengthen muscles. It was observed that some patients performing PFME had an improvement in ED. It is unclear how effective PFME is for treating patients with ED after prostate removal surgery.

The results of 9 trials using PFME to treat patients with ED were analyzed. The number of patients who participated in the trials ranged from 3 patients to 411. The duration of the trials ranged from 3 months to 12 months. Studies differed in the type of PFME used. The number of contractions ranged from 3 to 90 repetitions, held for up to 10 seconds, and practiced 1 to 2 times per week or once every 2 weeks.

3 studies used PFME with electrical stimulations. One study showed that PFME with electrical stimulation improved erectile function scores compared to the untreated group. Another study that compared PFME with PFME plus electrical stimulation found no difference between the two groups of patients after 6 months.

One study examined the use of PFME with vibrational stimulation. Patients who completed PFME with vibrational stimulation had an improvement in erectile function compared to untreated patients.

Biofeedback is a technique that trains the brain to become aware and gain more control over certain bodily functions. One study showed that PFME and biofeedback improved ED.  47.1% of patients that completed PFME and biofeedback had a good erectile function, compared to 12.5% of patients that did not. Another study that used a different type of biofeedback did not find that PFME and biofeedback improved ED.

One study examined if PFME before the prostate removal surgery prevented ED after surgery. The results showed that PFME was effective when used before surgery.

The authors concluded that PFME may improve ED in patients who receive surgery to remove the prostate.  

The studies used in this analysis significantly differed in their setup and designs. Most studies reported that not all patients completed their prescribed PFME and there was evidence of bias in many studies. Focused clinical trials are needed to conclude what type of PFME is most effective.