Male urinary incontinence (UI) following prostate surgeries, including robotic-assisted radical prostatectomy (RARP), conventional radical prostatectomy, transurethral resection of the prostate (TURP), and holmium laser enucleation of the prostate (HoLEP), remains an underexplored area in rehabilitation research. Current pelvic floor physiotherapy protocols often mirror female UI management strategies despite distinct anatomical and functional differences. This study aims to assess the efficacy of digital electromyography biofeedback (EMG-BF) therapy in managing male urinary Incontinence following prostate surgeries

A total of 46 patients with post-prostatectomy urinary incontinence (33 post-RARP, 2 post-radical prostatectomy, 9 post-TURP, and 2 post-HoLEP) were treated using a digital EMG-BF therapeutic device. This system utilized specialized surface/cloth electrodes, with one pair over the ischiocavernosus muscles and the other over the perineal body. The device provided real-time biofeedback through graphical representations, detecting muscle recruitment essential for continence by optimizing urethral closure pressures.
The therapy protocol included structured pelvic floor muscle training (PFMT) focused on targeted muscle strengthening (upward training/Kegel’s exercise program incorporating static and dynamic training to control the urinary incontinence), bladder retraining via bladder diaries, and an individualized home exercise program. Therapy sessions were conducted by therapists once per week over a 10-week period, with each session lasting between 60 to 90 minutes. Outcome measures included validated tools such as the Cozean Pelvic Dysfunction Scale, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), and the Incontinence Impact Questionnaire-7 (IIQ-7). Objective assessments incorporated EMG-BF readings and the PERFECT scoring system (Power, Endurance, Repetitions, Fast Contractions, Every Contraction Time) to evaluate urogenital muscle function pre- and post-intervention.

After 10 weeks of EMG-BF therapy, significant reduction was observed in ICIQ-UI SF (66.41%), IIQ-7 (87.28%), and Cozean (67.75%) scores in UI patients. There was significant increase in PERFECT score. The mean, standard deviation, paired t-test, and p-value were calculated to compare pre- and post-intervention outcomes, assessing the statistical significance of the observed changes. (Refer to uploaded image)

The study demonstrates that digital EMG-BF therapy significantly enhances pelvic floor muscle tone, reducing symptom severity as reflected in questionnaire scores. EMG-BF enables precision muscle retraining with measurable outcomes, facilitating neuroplasticity and improving continence outcomes. The findings highlight the potential of this intervention for active patient monitoring supporting the learning of muscle control following prostate surgery. Clinical improvement corroborated by the significant improvement observed in all functional parameters after 10 weeks of EMG-BF therapy.

Digital EMG-BF therapy presents a promising, structured, and evidence-based approach for managing post-prostatectomy incontinence. By incorporating individualized muscle recruitment strategies under therapist supervision, this modality offers superior outcomes compared to conventional PFMT alone. The active engagement of patients in therapy contributes to neuroplastic changes in the brain as they learn or re-learn to control their muscle activity which helps in continence recovery. Future research should focus on long-term efficacy and the integration of EMG-BF into standard postoperative rehabilitation protocols.

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Hodges PW, Stafford RE, Hall L, Neumann P, Morrison S, Frawley H, Doorbar-Baptist S, Nahon I, Crow J, Thompson J, Cameron AP. Reconsideration of pelvic floor muscle training to prevent and treat incontinence after radical prostatectomy. In Urologic Oncology: Seminars and Original Investigations 2020 May 1 (Vol. 38, No. 5, pp. 354-371). Elsevier
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