Urinary incontinence (UI) is defined by the International Continence Society as "any
involuntary loss of urine complained by the patient". The anatomical and histological
specificities of the pelvic floor muscles (PFM) give them a key role in the control of
urination but also in the control of postural stability. These activities are involuntary
automatisms and the mechanisms that lead to post-prostatectomy stress urinary incontinence
are not only due to the loss of voluntary contraction of the pelvic floor muscles. The
mechanisms that lead to UI are more complex and may involve the loss of efficacy of all deep
muscle stabilizing lumbo-pelvic region. Rehabilitation of pelvic floor muscles is recommended
in the treatment of urinary incontinence after prostatectomy (Grade A), but there is a lack
of evidence to define the best treatment regimen for PFM rehabilitation.
Two kinds of PFM rehabilitation are are commonly practiced by specialized physiotherapists.
- The first one is made in individual box, in supine position. By analytic contractions of
the PFM, (exercises of Kegel type) +/- associated with an instrumental biofeedback. This
method used voluntary contractions of MPP.
- The second is realized in various positions following a gravity progression, in
individual and /or common room. This technique aims to restore a stabilization of the
entire lumbo-pelvic region by postural recruitment involving synergistic contractions of
These trials propose to compare these two rehabilitation programs on populations with
postoperative follow-up of more than 12 months.
We chose to objectify the urine leaks with the pad test (weighing of the protections urinary
over a period of 3 times 24h) which will be our main evaluation criterion. The home test pad
of 3 times in 24 hours has been used by numerous studies and its reproducibility and
reliability are established.
Urinary incontinence is a recognized factor of sedentary lifestyle, fatigue, impaired mental
health and decreased of physical fitness. We therefore wish to observe these parameters for
each of our two randomized groups