ONCOLOGY NURSING FORUM – VOL 34, NO 1, 200747Key Points . . .➤ Practicing pelvic fl oor muscle exercise (PFME) in a group set-ting likely increases patients’ motivation to maintain PFME on a daily basis as compared to practicing PFME individually.➤ Patients who practice PFME in a group setting are likely to ex-perience fewer incontinent symptoms and use fewer pads over time than patients who practice PFME individually after bio-feedback PFME training because of increased muscle strength. ➤ The proposed intervention that combines PFME with a sup-port group signifi cantly improved disease-specifi c quality of life among patients, perhaps because of enhanced urinary con-tinence and social support.Urinary incontinence, defined by the International Continence Society as any involuntary leakage of urine (Abrams et al., 2002), is estimated to occur in 25%–70% of patients who have undergone radical prostatec-tomy (Grise & Thurman, 2001). Although most patients regain urinary continence at least partially a year after surgery, many continue to experience incontinence (Little, Kuban, Levy, Zagars, & Pollack, 2003). Urinary incontinence reduces pa-tients’ ability to attend family and social gatherings and makes patients feel burdened, shamed, or even depressed (Broome, 2003). The symptom clearly constitutes a signifi cant source of reduced quality of life (QOL) for patients with prostate cancer (Miller et al., 2005).BackgroundPhysiologyMen’s continence is guarded by internal and external sphincters. When the prostate is resected surgically, the conti-nence mechanism has to rely solely on the external sphincter. An external sphincter weakened by surgery leads to sphinc-ter insuffi ciency and stress incontinence—urinary leakage during stressful events such as coughing or heavy lifting. Furthermore, patients with prostate cancer tend to compen-sate with more frequent bladder contractions to overcome the obstruction caused by malignant prostatic enlargement. After the prostate is removed surgically, bladder contractions may persist and result in urge incontinence—the frequent urge or Effects of Combined Pelvic Floor Muscle Exercise and a Support Group on Urinary Incontinence and Quality of Life of Postprostatectomy PatientsAmy Y. Zhang, PhD, Gerald J. Strauss, PhD, and Laura A. Siminoff, PhDPurpose/Objectives: To examine the effect of combined pelvic fl oor muscle exercise (PFME) and a support group on postprostatectomy urinary incontinence and quality of life. Design: Pilot study of a randomized, controlled clinical trial.Setting: Two metropolitan hospitals in northeastern Ohio.Sample: 29 men with postprostatectomy urinary incontinence.Methods: The participants learned PFME through bi ofeedback and were randomized to the control group (n = 15) or the support group (n = 14). The control group practiced PFME at home, whereas the sup-port group attended six biweekly group meetings facilitated by a health psychologist. Assessment of urinary incontinence and quality of life was conducted at baseline and three months.Main Research Variables: Urinary incontinence and disease-specifi c quality of life.Findings: Eighty-six percent of the support group participants versus 46% of the control group participants practiced PFME four to seven days per week. The support group had a lower rating of urinary incontinence based on a 0- to 10-point visual analog rating scale than the control group (—X = 3.2 versus 4.7), and fewer support group participants used pads (50%) than control group participants (85%) at three months. The support group also scored signifi cantly lower on the severity of incon-tinence problems than the control group at three months, especially in relationship with spouse and social outing, despite no group difference in these areas at baseline.Conclusions: The study provided promising evidence regardi ng the effect of the proposed intervention on adherence to PFME, urinary incontinence, and quality of life. Implications for Nursing: Reports regarding nursing practice are lacking with respect to PFME. This study suggests that practicing PFME in a group with patients with incontinence who have undergone prosta-tectomy can be a useful nursing intervention.Amy Y. Zhang, PhD, is an assistant professor of nursing in the Frances Payne Bolton School of Nursing at Case Western Reserve University, Gerald J. Strauss, PhD, is a licensed health psychologist at Louis Stokes Cleveland Department of Veterans Affairs Medical Center, and Laura A. Siminoff, PhD, is a professor of bioethics, oncology, and family medicine in the School of Medicine at Case Western Reserve University, all in Cleveland, OH. This study was supported by an American Cancer Society pilot research grant and the Frances Payne Bolton School of Nursing at Case Western Reserve University. (Submit-ted December 2005. Accepted for publication April 20, 2006.)Digital Object Identifi er: 10.1188/07.ONF.47-53This material is protected by U.S. copyright law. Unauthorized reproduction is prohibited. To purchase quantity reprints,please e-mail [email protected] or to requestpermission to reproduce multiple copies, please e-mail [email protected] NURSING FORUM – VOL 34, NO 1, 200748pressure to urinate (Moore & Gray, 2004). Some studies have reported that the extent of nerve preservation or damage to external sphincters in men who have undergone prostatectomy had no signifi cant effect on urinary incontinence, suggesting that the external sphincter muscles can be strengthened to compensate for the loss of internal sphincter control (Harris, 1997).Performance of Pelvic Floor Muscle ExerciseEvidence is increasing that pelvic fl oor muscle exercise (PFME) can strengthen the external sphincter and improve urinary continence in men (Hunter, Moore, Cody, & Glazen-er, 2005; Van Kampen et al., 2000). Despite the International Nursing Summit calling for further research (Moore & Gray, 2004), evidence regarding nursing practice of PFME still is lacking. One published nursing study could not confi rm the effects of PFME, in part because of methodologic rea-sons (Moore, Griffi ths, & Hughton, 1999), which indicates the need to promote nursing research and the practice of PFME.PFME outcomes appear to be affected by patients’ compli-ance and appropriate comprehension of the technique (Hunter et al., 2005; Palmer, 2004). A nursing pilot study reported that men who received a small refrigerator magnet