傳統上，接受攝護腺根除性手術後產生應力性尿失禁的患者，在接受復健的過程中，都是聚焦在骨盆底肌肉的強度訓練。然而，骨盆底的失能（pelvic floor dysfunction, PFD）的狀況可大致上分為過度反應以及低反應度的狀況，並非所有人都是一樣的狀況。因此，此篇文章將患者分成此兩大類，再針對這樣的患者給予個人化的物理治療，並分析其在應力性尿失禁以及骨盆疼痛的預後。

這是一篇回溯性的病例研究，總共囊括了136位接受攝護腺根除性手術後產生應力性尿失禁的患者並給予其骨盆腔的物理治療。這些患者會被分類為過度反應、低反應度或是混合形的狀況；再根據這樣的分類去給予患者不同的個人化物理療法。再去分析其對於應力性尿失禁以及骨盆腔疼痛的進步，主要是以每天使用護墊的數目以及疼痛評估表來做評估。

在分類之後，總共有25位患者有低反應度的骨盆底失能，會接受骨盆底的肌肉加強訓練；13位患者有過度反應的骨盆底失能，會接受骨盆底的放鬆訓練；98位患者合併有兩者混合的骨盆底失能，這樣的患者會提供患者先做放鬆訓練之後再加強骨盆底肌肉的強度。經過統計分析之後發現，在這樣的個人化治療下，不管是應力性尿失禁的改善（每天使用護墊的減少）或是骨盆腔的疼痛都有顯著的改善。另外就算患者是過度反應的骨盆底失能，在經過放鬆訓練後也能增加骨盆底肌肉的強度。

總括而論，在接受攝護腺根除性手術後產生應力性尿失禁的患者往往不是只有單純骨盆底肌肉低反應度的失能，可以看到絕大多數的患者都有混合性的問題。因此，針對不同患者族群給予量身定做的物理療法會有更好的效果（比起單純一味地做格爾運動）。

Background: The rehabilitation of post-prostatectomy urinary incontinence has traditionally focused on pelvic floor strengthening exercise. The goal of this study was to determine whether an individualized pelvic physical therapy (PT) program aimed at normalizing both underactive and overactive pelvic floor dysfunction (PFD) can result in improvement in post-prostatectomy stress urinary incontinence (SUI) and pelvic pain.

Methods: A retrospective chart review of 136 patients with post-prostatectomy SUI and treated with pelvic PT. Patients were identified as having either underactive, overactive, or mixed-type PFD and treated accordingly with a tailored program to normalize pelvic floor function. Outcomes including decrease in SUI as measured in pad usage per day and pain rated on the numeric pain rating scale.

Results: Twenty five patients were found to have underactive PFD and were treated with strengthening. Thirteen patients had overactive PFD and were treated with relaxation training. Ninety eight patients had mixed-type PFD and were treated with a combination of relaxation training followed by strengthening. Patients demonstrated statistically significant decrease in pad usage per day (p < 0.001), decreased pelvic pain (p < 0.001), and increased pelvic floor strength (p = 0.049), even in patients who received predominantly pelvic floor relaxation training to normalize pelvic floor overactivity.

Conclusions: A majority of post-prostatectomy men with SUI have pelvic floor overactivity in addition to pelvic floor underactivity. An individualized pelvic PT program aimed at normalizing pelvic floor function (as opposed to a pure Kegel strengthening program) can be helpful in reducing SUI and pelvic pain.