This randomized controlled trial investigates the effects of hypopressive exercises on urinary incontinence and erectile dysfunction in men following radical prostatectomy. Participants will be randomly assigned to one of two groups: a control group receiving home-based pelvic floor muscle exercises and an experimental group receiving both pelvic floor muscle exercises and supervised hypopressive exercises twice per week. The study aims to determine whether the addition of hypopressive techniques, which target coordinated activation of the pelvic floor and abdominal muscles without increasing intra-abdominal pressure, offers greater improvements in urinary and sexual function. Primary outcomes include pelvic floor muscle strength and endurance, while secondary outcomes include urinary incontinence severity, erectile function, and quality of life.
Male individuals diagnosed with prostate cancer who have undergone radical prostatectomy
Experiencing both urinary incontinence and erectile dysfunction
Age > 55 years
A score of 24 or higher on the Mini-Mental State Examination (MMSE)
History of urinary incontinence before surgery
Congenital abnormalities of the urinary system
Presence of neurological disorders
History of transurethral resection of the prostate (TURP)
Parallel
Pelvic Floor Muscle Training (PFMT)
BehavioralParticipants in the control group will receive an individualized home-based pelvic floor muscle exercise program. Exercises will be performed once daily for 8 weeks, focusing on voluntary pelvic floor contractions in various positions (supine, sitting, standing). Participants will receive initial training and written instructions from a physiotherapist, and will be contacted weekly to monitor adherence.
Hypopressive Exercises
BehavioralParticipants in the experimental group will attend supervised hypopressive exercise sessions twice per week for 8 weeks. These sessions involve specific postural sequences combined with breathing and apnea techniques aimed at reducing intra-abdominal pressure while activating pelvic floor and abdominal muscles. Sessions will be led by a physiotherapist and adapted based on individual performance and posture tolerance.
Change in urinary incontinence severity measured by 1-hour Pad Test
The 1-hour Pad Test, standardized by the International Continence Society (ICS), will be used to objectively assess urinary leakage. A weight gain of \>1g indicates a positive test. Severity will be classified as mild (\<2g), moderate (2-10g), severe (10-50g), or very severe (\>50g). The difference in pad weight pre- and post-intervention will be recorded.
Change in pelvic floor muscle strength measured by Modified Oxford Scale
Pelvic floor muscle strength will be assessed by manual digital palpation in a side-lying position with knees flexed at 45 degrees. Strength will be scored using the Modified Oxford Scale, which ranges from 0 (no contraction) to 5 (strong contraction). Higher scores indicate better pelvic floor muscle strength.
Change in pelvic floor muscle endurance measured in seconds
Pelvic floor muscle endurance will be assessed by instructing participants to sustain a maximal voluntary pelvic floor muscle contraction for as long as possible in a side-lying position with knees flexed at 45 degrees. The duration (in seconds) for which the contraction is maintained without loss of force will be recorded. Longer durations indicate greater endurance.
Change in erectile function measured by IIEF-5
Erectile function will be assessed using the 5-item version of the International Index of Erectile Function (IIEF-5). Total scores range from 5 to 25, with lower scores indicating more severe erectile dysfunction. The change in total score from baseline to post-intervention will be analyzed.
Change in urinary incontinence severity and impact measured by ICIQ-SF
The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) will be used to assess perceived severity and quality of life impact of urinary incontinence. The total score is based on responses to questions 3, 4, and 5 (range: 0-21). Higher scores indicate more severe incontinence.
Change in quality of life measured by King's Health Questionnaire
The King's Health Questionnaire will be used to assess health-related quality of life in individuals with urinary incontinence. The questionnaire includes multiple subdomains, with scores ranging from 0 (best health status) to 100 (worst). A decrease in score indicates improvement.
Change in urinary frequency and incontinence episodes measured by 3-day bladder diary
A 3-day bladder diary will be used to document frequency of urination, incontinence episodes, and fluid intake. Data from weekdays and weekends will be averaged to calculate daily means. Change in urination and leakage frequency from baseline to Week 8 will be analyzed.
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