ExMI vs. Biofeedback PFMT for Post-Prostatectomy Incontinence

This is a prospective, randomized controlled trial conducted at the outpatient urology clinic of Tanta University Hospital evaluating the effect of extracorporeal magnetic stimulation (ExMI) added to pelvic floor muscle training (PFMT) versus biofeedback-assisted PFMT alone on recovery of urinary continence following Holmium Laser Enucleation of the Prostate (HoLEP) or Bipolar Enucleation of the Prostate (BipoLEP) for benign prostatic hyperplasia.

A total of 100 male patients aged 50 years or older who develop postoperative stress-predominant urinary incontinence after catheter removal will be randomized in a 1:1 ratio to Group 1 (electromagnetic pelvic floor stimulation, n=50) or Group 2 (biofeedback-assisted pelvic floor muscle training, n=50).

All participants will receive supervised PFMT consisting of three daily sessions (10 slow contractions of 5-10 seconds and 10 rapid contractions per session) for 12 weeks postoperatively. Group 1 will additionally receive extracorporeal magnetic stimulation using a magnetic chair device, twice weekly for 20-30 minutes per session over 6-8 weeks, at an intensity adjusted to patient tolerance, aiming to induce repetitive pelvic floor muscle contraction and pudendal nerve stimulation.

Continence status will be assessed after catheter removal and at follow-up visits at 2 weeks, 1 month, 3 months, and 6 months postoperatively, using pad count, 24-hour pad weight testing, the ICIQ-UI SF questionnaire, and quality-of-life scoring. Continence will be defined as no pad use, or use of one security pad with no significant leakage.

The primary outcome is time to recovery of urinary continence. Secondary outcomes include reduction in pad usage, improvement in 24-hour pad test results, improvement in ICIQ-UI SF score, quality-of-life improvement, and treatment-related adverse events.

Inclusion criteria

• Male patients aged ≥50 years
• Diagnosed with symptomatic benign prostatic hyperplasia (BPH) requiring surgical intervention
• Scheduled for Holmium Laser Enucleation of the Prostate (HoLEP) or Bipolar Enucleation of the Prostate (BipoLEP)
• Development of postoperative stress-predominant urinary incontinence after catheter removal
• Presence of postoperative urinary leakage requiring at least one safety pad/day
• Ability to understand and perform pelvic floor muscle training instructions
• Ability and willingness to attend extracorporeal magnetic stimulation sessions and follow-up visits

Exclusion criteria

• Preoperative urinary incontinence or neurogenic bladder dysfunction
• Previous prostate surgery or prior anti-incontinence surgery
• Urethral stricture disease or bladder neck contracture
• Active urinary tract infection at the time of enrollment
• Severe cognitive impairment preventing compliance with PFMT instructions
• Neurological disorders affecting lower urinary tract function, including Parkinson disease, multiple sclerosis, spinal cord injury, or cerebrovascular stroke with residual deficits
• Implanted electronic or metallic devices contraindicating magnetic stimulation, including cardiac pacemaker, implantable cardioverter-defibrillator, neurostimulators, or cochlear implants
• Uncontrolled diabetes mellitus with severe neuropathy
• Receiving concurrent therapies for urinary incontinence during the study period
• Persistent postoperative complications requiring reintervention (e.g., severe hematuria, clot retention)
• Inability or refusal to complete follow-up evaluations