Pelvic floor muscle training for erectile function in men undergoing radical prostatectomy: a systematic review of randomized controlled trials
In brief
Biofeedback-assisted pelvic floor training raised 12-month potency to 47% versus 13% with usual care
In a review of 12 randomized trials, pelvic floor muscle training showed mixed effects on post-prostatectomy erectile function, but one study using biofeedback reported a potency rate of 47.1% compared with 12.5% in controls at one year. Other trials showed modest or no benefit, and the overall evidence is limited by heterogeneity and bias, so further research is needed to define its role in rehabilitation.
- Journal
- World journal of urology (Q1)
- Published
- 31 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Zeynep Akdagcik, Halil Çağrı Aybal, Mustafa Karaaslan, Selcuk Guven, Lütfi Tunc, Mehmet Yilmaz
- PMID
- 42671634
- DOI
- 10.1007/s00345-026-06748-9
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 6 September 2026): Systematic review of PFMT for erectile function
Abstract
OBJECTIVE: We aimed to evaluate the effectiveness of pelvic floor muscle training (PFMT), with or without adjunctive biofeedback or electrical stimulation, in improving erectile function (EF) in men who have undergone radical prostatectomy (RP) for prostate cancer, by examining randomized controlled trials (RCTs). METHODS: PubMed, Scopus and Web of Science databases were systematically searched. Eligible studies were RCTs examining PFMT for post-RP erectile dysfunction (ED) according to predefined inclusion and exclusion criteria. The protocol was registered in PROSPERO (CRD420251162740). RESULTS: Twelve RCTs were included in the final analysis. PFMT-related effects on EF were inconsistent: four RCTs reported statistically significant EF benefits, one multimodal survivorship trial showed a favorable surgery-subgroup sexual-domain signal, and seven found no significant between-group EF difference. Across trials with extractable mean IIEF/IIEF-5 endpoint data, between-group differences ranged from - 0.97 to + 2.18 points, with a maximum change-score advantage of + 4.3 points. Selected favorable findings included higher 12-month potency rate after biofeedback-assisted PFMT (47.1% vs. 12.5%) and higher 15-month IIEF-EF scores after supervised PFMT initiated at 12 months for persistent ED (11.1 ± 8.8 vs. 9.3 ± 7.1; p = 0.025). Evidence quality was limited by substantial clinical and methodological heterogeneity and risk-of-bias concerns. CONCLUSIONS: PFMT may improve EF through enhancing the structural support for erections and the hemodynamic erectile response after RP. Men who prefer a holistic approach may benefit from PFMT as part of a multimodal rehabilitation program. Further research to clarify the role of PFMT in EF recovery after RP is needed.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.