Conservative treatment for urinary incontinence in men after prostate surgery (MAPS)

Many men experience some urinary incontinence (UI) after prostate surgery, but it usually improves with time. The chance of UI is higher after radical surgery for cancer, but endoscopic surgery for benign prostatic enlargement is so common that this too is an important cause of incontinence. This study aims to find out if physical treatment based on pelvic floor muscle training can help men regain continence. Current evidence suggests that it can, but is not conclusive. There are no obvious risks but the training is time-consuming and resource-intensive. Over a two-year period, around 17,000 men having prostate surgery in about 26 UK hospitals will be asked to reply to a questionnaire three weeks later. Those who indicate that they have UI will be asked to join the study. Eight hundred men (400 after radical and 400 after endoscopic surgery) who agree will be randomly allocated to having physiotherapist or continence-nurse led treatment or to a control group. The treatment aims to teach men to contract their pelvic floor muscles. Sometimes, a monitor will be used so men recognise good muscle contractions (called biofeedback); men who have urgency will also be taught how to lengthen the time between voids (bladder training). Men in the control group will receive usual care through their GPs and additional lifestyle advice. The men will be followed up for one year by postal questionnaires. We will find out not only if men's incontinence has improved but also if their quality of life has changed. In addition, we shall assess whether any benefits justify the additional costs to the men and to the NHS.