Pelvic floor muscle exercises  are used as first line treatment in patients with   urinary incontinence post prostatectomy. Conscious training of pelvic muscles under biofeedback control makes for effective control of pelvic floor muscles, precise application  of  muscular force  and reduced impact of antagonist muscles, primarily  the muscles  of the abdomen. We have compared  the outcomes of training to perform pelvic floor exercises under biofeedback control, their efficacy for continence  recovery in patients with urinary incontinence  after laparoscopic and robotic prostatectomy for prostatic cancer.

Pelvic floor muscle training was  employed in 64 patients with urinary incontinence. 48 patients (75.0%) underwent  laparoscopic and 16 (25.0) robot-assisted prostatectomy. The age of patients was 64.6 ±5.3 years ( range 54-78) . The  ICIQ-UI  score totaled 14±2 (8-20). The duration of urinary incontinence was 3.6±0.9 (1-15) months. All patients were trained to do pelvic floor muscle exercises to learn the skill of isolated PFM contractions.

As a result of training 55 patients (85.9%) have acquired  the skill of isolated contractions  and could perform the exercises on their own. The remaining  9 patients (14.1%) had to rely on regular biofeedback-assisted support. The distribution of  patients  who have  acquired the skill of isolated contractions and those failed to  learn  the skill showed no  significant disparities after laparoscopic and robotic prostatectomy (p=0.303)  .      
  Initially the ICIQ-UI scale score after laparoscopic prostatectomy was   15 (8-20)  and after robotic prostatectomy 13 (18-14) (р=0,002) . The age of patients in groups with laparoscopic and robotic prostatectomy showed no significant differences (p=0.79). The duration of urinary incontinence  post   laparoscopic  prostatectomy  was 2.5 (1.1-15.8) months and after  robotic -1.4 (0.6-7.2) months (p=0.036). 
By the 6th month  of observation  In the patient group  with perceived skill of isolated PFM contractions  2 patients (3.6%) were found to have recovered continence,  28 patients (50.9%) showed signs of improvement and no changes were noted  in 25 (45.5%). In patients who failed to develop the skill of isolated PFM contraction the values were 1 (11.1%), 2 ( 22.2%) and 6 (66.7%)   respectively (р=0.223).

The ICIQ-UI scale score and the duration of incontinence in patients was significantly less after robotic prostatectomy  compared with  their laparoscopic counterparts.  With biofeedback  the majority of patients with urinary incontinence who have undergone  radical  prostatectomy were able to acquire the skill of isolated PFM contractions. The frequency of skill acquisition was not contingent on performance of laparoscopic or robotic prostatectomy. Dynamics of urinary continence recovery in groups with different surgical modes  showed no important differences.

In our observation robotic-assisted prostatectomy  yielded the best functional results. The sequellae  of laparoscopic and robotic prostatectomy  did not impact on developing   a  new PFM contraction  skill with minimal involvement of anterior abdominal wall muscles. The time periods  of recovery of urinary continence  by the 6th month of observation with biofeedback-mediated pelvic muscle training did not vary  after laparoscopic and robotic prostatectomy.