Pelvic floor muscle training for erectile function in men undergoing radical prostatectomy: a systematic review of randomized controlled trials.

We aimed to evaluate the effectiveness of pelvic floor muscle training (PFMT), with or without adjunctive biofeedback or electrical stimulation, in improving erectile function (EF) in men who have undergone radical prostatectomy (RP) for prostate cancer, by examining randomized controlled trials (RCTs). PubMed, Scopus and Web of Science databases were systematically searched. Eligible studies were RCTs examining PFMT for post-RP erectile dysfunction (ED) according to predefined inclusion and exclusion criteria. The protocol was registered in PROSPERO (CRD420251162740). Twelve RCTs were included in the final analysis. PFMT-related effects on EF were inconsistent: four RCTs reported statistically significant EF benefits, one multimodal survivorship trial showed a favorable surgery-subgroup sexual-domain signal, and seven found no significant between-group EF difference. Across trials with extractable mean IIEF/IIEF-5 endpoint data, between-group differences ranged from - 0.97 to + 2.18 points, with a maximum change-score advantage of + 4.3 points. Selected favorable findings included higher 12-month potency rate after biofeedback-assisted PFMT (47.1% vs. 12.5%) and higher 15-month IIEF-EF scores after supervised PFMT initiated at 12 months for persistent ED (11.1 ± 8.8 vs. 9.3 ± 7.1; p = 0.025). Evidence quality was limited by substantial clinical and methodological heterogeneity and risk-of-bias concerns. PFMT may improve EF through enhancing the structural support for erections and the hemodynamic erectile response after RP. Men who prefer a holistic approach may benefit from PFMT as part of a multimodal rehabilitation program. Further research to clarify the role of PFMT in EF recovery after RP is needed.