Pelvic floor muscle training after prostate surgery

The conclusion of the scientifically robust study by Cathryn Glazener and colleagues (July 23, p 328),1 that pelvic-floor muscle exercise taught by a continence health professional after prostate surgery is unlikely to be effective or cost effective, is misleading and possibly erroneous. Glazener and colleagues should have considered that their intervention was not effective and provided a more critical appraisal of its failure. The intervention was weak on several counts but particularly lacked a plausible biological rationale, since it did not address the importance of control of the urethral sphincter, which did not rate a mention anywhere. Men were only—and repeatedly—instructed to “contract the pelvic floor as if holding on to wind” and assessed at each of four visits per anum. This not only provided inappropriate sensory feedback but also taught and reinforced inappropriate motor control.