Lifestyle recommendations and pelvic floor muscle training with Knack maneuver for post-prostatectomy urinary incontinence: a randomized controlled trial

Purpose The aim of this study is to investigate the additional effects of the Knack maneuver and comprehensive lifestyle recommendations to pelvic floor muscle training (PFMT) in individuals with post-prostatectomy urinary incontinence (PP-UI). Methods Seventy-one individuals with symptom of PP-UI were included. Individuals were randomly assigned to study groups (Group I: PFMT + Knack + Comprehensive Lifestyle Recommendations, Group II: PFMT + Knack, Group III: PFMT alone). Assessments were performed at the baseline and at the end of the 8th week. The primary outcome was the subjective severity and impact of UI. Secondary outcomes were objective severity of UI, health-related quality of life (QoL) and patient global impression of severity and improvement. Descriptive and outcome measures were compared between study groups using the Kruskal-Wallis test. The Games-Howell post hoc test was also used to indicate which groups differ. Results A total of 66 patients were included in the final analysis. Per protocol analysis in all three groups showed significant improvements in all primary and secondary outcomes in eight weeks. The group of patients who had the PFMT + Knack + Comprehensive Lifestyle Recommendations had the greatest improvement in all outcome measures (p < 0.001). In addition, while PFMT + Knack showed superiority in terms of subjective UI severity and effect of UI on daily life, compared to PFMT alone (p < 0.001), there was no inter-group differences for objective UI severity and other subdomains of QoL (p > 0.05). Conclusion Adding comprehensive lifestyle recommendations and/or Knack maneuver to traditional PFMT is more effective in the management of post-prostatectomy UI in the short term. Further long-term follow-up studies should be planned to investigate compliance and response to these combined interventions. Clinical Trial Registration Number ClinicalTrials.gov NCT04804839. Date of registration: 03/17/2021.