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Benedetto G, Simone B, Gaia L, Mirko J, Ottavia B, Marco T. The added value of devices to pelvic floor muscle training in radical post-prostatectomy stress urinary incontinence: A systematic review with metanalysis. PLoS One 2023; 18:e0289636. [PMID: 37768987 PMCID: PMC10538711 DOI: 10.1371/journal.pone.0289636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/23/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE To investigate the role of pelvic floor devices (e.g., biofeedback, electrical stimulation, magnetic stimulation, or their combination) as adjunctive treatments in pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) after radical prostatectomy. MATERIALS AND METHODS A systematic review with meta-analysis. We searched for randomised controlled trials (RCTs) and prospective non-randomised studies investigating the effectiveness of pelvic floor devices as an adjunctive treatment for SUI symptoms assessed with weight pad-test or standardised questionnaires. To assess the risk of bias (RoB) and overall certainty of evidence, the RoB 2.0 or the ROBINS-I, and the GRADE approach were used. RESULTS Eleven RCTs met our eligibility criteria. One was at a 'low' RoB, one had 'some concerns', while nine were at a 'high' RoB. Two meta-analyses were conducted to analyse the pooled results of six RCTs included. Specifically, two RCTs reported at week 4 with a 1h pad test a mean difference of 0.64 (95% CI = [-13.09, 14.36]), and four RCTs reported at week 12 with a 24h pad test a mean difference of -47.75 (95% CI = [-104.18, 8.69]). The heterogeneity was high in both analyses (I2 = 80.0%; I2 = 80.6%). The overall level of certainty was very low. CONCLUSIONS In line with our results, we cannot conclude whether pelvic floor devices add any value as adjunctive treatment in the management of SUI after radical prostatectomy. Future studies require more comprehensive and standardised approaches to understand whether these devices are effective.
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Affiliation(s)
- Giardulli Benedetto
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Battista Simone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Leuzzi Gaia
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Job Mirko
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Buccarella Ottavia
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Testa Marco
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
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Do Y, Lim Y, Lee S, Lee H. The Correlation between Transperineal Shear-Wave Elastography and Transabdominal Ultrasound When Assessing Pelvic Floor Function in Nulliparous Women. Diagnostics (Basel) 2023; 13:3002. [PMID: 37761369 PMCID: PMC10527825 DOI: 10.3390/diagnostics13183002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Pelvic floor muscles (PFMs) play a crucial role in maintaining pelvic organ support and continence. However, pelvic floor dysfunction (PFD), often resulting from insufficient PFM control, poses a substantial global health challenge for women. This study aims to explore the relationship between levator ani muscle elasticity when assessed through transperineal shear-wave elastography (SWE) and bladder base displacement, quantified using transabdominal ultrasonography (TAUS), as a means to comprehensively evaluate PFM function. A total of 42 nulliparous women participated in this study. Participants received instructions on proper PFM contractions using Kegel exercises. Levator ani muscle elasticity was assessed both at rest and during contractions using transperineal SWE, while bladder base displacement was simultaneously measured through TAUS. Repeated measures demonstrated strong intraclass correlation coefficients of 0.906 at rest and 0.687 during contractions for levator ani muscle elasticity. The mean elasticity values were 24.7 ± 4.5 kPa at rest and 62.1 ± 10.4 kPa during contractions. Additionally, the mean bladder base displacement was 7.2 ± 2.5 mm, and the normalized bladder base displacement via body mass index was 0.3 ± 0.1 mm. Significantly, a moderate correlation was identified between the PFM function, represented by the difference in levator ani elasticity during contractions and resting, and bladder base displacement (r = 0.486, p = 0.001). These findings underscore the potential utility of transperineal SWE as a reliable and noninvasive method to assess levator ani muscle elasticity and, consequently, PFM function. In conclusion, this study sheds light on the interplay between PFM elasticity and bladder base displacement, offering insights into PFM function assessments. The observed correlation suggests the clinical relevance of SWE in providing valuable information for treatment planning in PFD. These findings contribute to a deeper understanding of PFM dynamics, ultimately aiding in the effective management of PFD among women.
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Affiliation(s)
- Yerim Do
- Graduate School, Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Republic of Korea; (Y.D.); (Y.L.)
| | - Youngeun Lim
- Graduate School, Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Republic of Korea; (Y.D.); (Y.L.)
| | - Soohyun Lee
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Republic of Korea;
| | - Haneul Lee
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Republic of Korea;
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Wang L, Li Y, Qi Z, Wang W. Barriers and facilitators of the implementation of the application of pelvic floor muscle training in patients with prostate cancer: a scoping review. Front Public Health 2023; 11:1191508. [PMID: 37771836 PMCID: PMC10523151 DOI: 10.3389/fpubh.2023.1191508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/14/2023] [Indexed: 09/30/2023] Open
Abstract
Background Patients with prostate cancer (PCa) benefit significantly from pelvic floor exercises, but recent results indicate that these exercises have not been fully promoted in clinical settings. This scoping review aimed to identify the facilitators of and barriers to pelvic floor muscle training (PFMT) in PCa survivors. Methods A scoping review was conducted in November 2022. Relevant studies were identified from CINAHL, Embase, PubMed, PsycINFO, and Web of Science databases from their inception to 20 November 2022. Data were analyzed and extracted by two formally trained researchers. Results A total of 53 studies were included, most of which were randomized controlled trials. The Tailored Implementation for Chronic Diseases (TICD) model framework was used to identify the contents of seven barriers and promotion areas, as well as a series of sub-domains. The most common barriers to implementing pelvic floor muscle training (PFMT) included the following: the lack of a common scheme in guidelines and the measurement of common standardized outcomes, inadequate self-monitoring or feedback from healthcare professionals to improve PFMT compliance, poor patient compliance, and a lack of implementation equipment and financial support. Good treatment effects and easy operation were the facilitators of PFMT. Conclusion The implementation of PFMT faces several challenges and opportunities that should be understood thoroughly before implementation. In terms of guidelines and clinical practice, more work is needed, and the possibility of PFMT implementation in various hospitals and community health centers or clinics should be considered.
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Affiliation(s)
| | | | | | - Wei Wang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Zhang Y, Hou S, Qi Z, Wu S, Zhu K, Wang W. Non-pharmacological and nonsurgical interventions in male urinary incontinence: A scoping review. J Clin Nurs 2023; 32:6196-6211. [PMID: 37161602 DOI: 10.1111/jocn.16749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/10/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
AIMS To describe and synthesize non-pharmacological and nonsurgical interventions for male urinary incontinence from the existing literature. METHODS A scoping review was conducted following the methodology suggested by Arksey and O'Malley: (1) identification of the research questions; (2) identification of relevant studies using a three-step search recommended by JBI: an initial search within PubMed and CINAHL, a comprehensive literature search within PubMed, CINAHL, EMBASE, PsycINFO, Cochrane Library, and literature search of references lists; (3) study selection; (4) data extraction and charting; (5) collation, summarization, and reporting of the results. The PRISMA-ScR Checklist was used to report. RESULTS A total of 4602 studies were identified, of which 87 studies were included. Approximately 78% were randomized controlled trials. More than 88% of the participants were men with prostate cancer. Exercising pelvic floor muscles 30 times per day for 12 weeks was the most frequently reported. Parameters of electrical stimulation were typically set up to 50 Hz and 300 μs for frequency and width of pulse, respectively, and lasted for 15 min. Pure pelvic floor muscle training, Pilates, Yoga, whole body vibration, diaphragm/abdominal muscle training, micturition interruption exercise, acupuncture, and auriculotherapy showed positive effects on reducing urinary incontinence. CONCLUSION The findings suggested implementing pelvic floor muscle training alone before or after surgery can both prompt the recovery of continence in men after prostate cancer surgery. The decision to use biofeedback or electrical stimulation to enhance the therapeutic effect of pelvic floor muscle training should be approached with caution. More rigorous designed studies are needed to validate the effectiveness of Traditional Chinese Medicine techniques and diverse novel methods. RELEVANCE TO CLINICAL PRACTICE Physicians and nurses need to be up to date on the latest evidence-based non-pharmacological and nonsurgical interventions in male urinary incontinence and select appropriate interventions based on available medical resources and patient preferences.
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Affiliation(s)
- Ying Zhang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
- Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
| | - Sijia Hou
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
- Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
| | - Ziyi Qi
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
- Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
| | - Siyuan Wu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
- Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
| | - Keping Zhu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
| | - Wei Wang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
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Giraudo D, Lamberti G, Ciardi G. Pelvic Floor Muscle Training for Urinary Incontinence After Radical Prostatectomy: A Narrative Review. Urologia 2023; 90:445-453. [PMID: 37002838 DOI: 10.1177/03915603231166729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Rehabilitative treatment of urinary incontinence after prostatectomy has showed, on the basis of recent published evidence, encouraging results. At first, clinician applied evaluation and treatment approach suggested based on the studies and rationale of female stress urinary incontinence, but although long term literature suggested no evidence of benefits. Recent studies that have shown the real control mechanisms in male continence through the use of trans-perineal ultrasound, demonstrated that it is not appropriate to transfer the rehabilitation techniques applied in female stress incontinence to male incontinence after prostatectomy. Even that pathophysiology of urinary incontinence after prostatectomy is not fully understood, it's in part attributable to a urethral or bladder source. In particular, however, urethral sphincter dysfunction is predominant, secondary to surgical damage and to the partly organic and partly functional dysfunction of the external urethral sphincter; complementary action of all the muscles capable of contributing to the maintenance of urethral resistance is therefore important. As for rehabilitative approach to post-prostatectomy incontinence, the primary objective is to quantify the residual capacity of the muscular function that must replace the sphincter function, often compromised by surgery. Than a multimodal approach, comprising exercise and instrumental therapies, is needed. The present paper's aim was to overview current urinary dysfunction knowledge for male with radical prostatectomy, and to describe practical issue of evaluation and conservative treatment.
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Affiliation(s)
- Donatella Giraudo
- Department of Urology, San Raffaele Turro Hospital, Milano, Lombardia, Italy
| | - Gianfranco Lamberti
- Department of Rehabilitative Medicine, AUSL Piacenza, Piacenza, Emilia-Romagna, Italy
- Physiotherapy Degree Course, University of Parma, Parma, Italy
| | - Gianluca Ciardi
- Department of Rehabilitative Medicine, AUSL Piacenza, Piacenza, Emilia-Romagna, Italy
- Physiotherapy Degree Course, University of Parma, Parma, Italy
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Johnson EE, Mamoulakis C, Stoniute A, Omar MI, Sinha S. Conservative interventions for managing urinary incontinence after prostate surgery. Cochrane Database Syst Rev 2023; 4:CD014799. [PMID: 37070660 PMCID: PMC10112049 DOI: 10.1002/14651858.cd014799.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND Men may need to undergo prostate surgery to treat prostate cancer or benign prostatic hyperplasia. After these surgeries, men may experience urinary incontinence (UI). Conservative treatments such as pelvic floor muscle training (PFMT), electrical stimulation and lifestyle changes can be undertaken to help manage the symptoms of UI. OBJECTIVES To assess the effects of conservative interventions for managing urinary incontinence after prostate surgery. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP and handsearched journals and conference proceedings (searched 22 April 2022). We also searched the reference lists of relevant articles. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs of adult men (aged 18 or over) with UI following prostate surgery for treating prostate cancer or LUTS/BPO. We excluded cross-over and cluster-RCTs. We investigated the following key comparisons: PFMT plus biofeedback versus no treatment; sham treatment or verbal/written instructions; combinations of conservative treatments versus no treatment, sham treatment or verbal/written instructions; and electrical or magnetic stimulation versus no treatment, sham treatment or verbal/written instructions. DATA COLLECTION AND ANALYSIS We extracted data using a pre-piloted form and assessed risk of bias using the Cochrane risk of bias tool. We used the GRADE approach to assess the certainty of outcomes and comparisons included in the summary of findings tables. We used an adapted version of GRADE to assess certainty in results where there was no single effect measurement available. MAIN RESULTS We identified 25 studies including a total of 3079 participants. Twenty-three studies assessed men who had previously undergone radical prostatectomy or radical retropubic prostatectomy, while only one study assessed men who had undergone transurethral resection of the prostate. One study did not report on previous surgery. Most studies were at high risk of bias for at least one domain. The certainty of evidence assessed using GRADE was mixed. PFMT plus biofeedback versus no treatment, sham treatment or verbal/written instructions Four studies reported on this comparison. PFMT plus biofeedback may result in greater subjective cure of incontinence from 6 to 12 months (1 study; n = 102; low-certainty evidence). However, men undertaking PFMT and biofeedback may be less likely to be objectively cured at from 6 to 12 months (2 studies; n = 269; low-certainty evidence). It is uncertain whether undertaking PFMT and biofeedback has an effect on surface or skin-related adverse events (1 study; n = 205; very low-certainty evidence) or muscle-related adverse events (1 study; n = 205; very low-certainty evidence). Condition-specific quality of life, participant adherence to the intervention and general quality of life were not reported by any study for this comparison. Combinations of conservative treatments versus no treatment, sham treatment or verbal/written instructions Eleven studies assessed this comparison. Combinations of conservative treatments may lead to little difference in the number of men being subjectively cured or improved of incontinence between 6 and 12 months (RR 0.97, 95% CI 0.79 to 1.19; 2 studies; n = 788; low-certainty evidence; in absolute terms: no treatment or sham arm: 307 per 1000 and intervention arm: 297 per 1000). Combinations of conservative treatments probably lead to little difference in condition-specific quality of life (MD -0.28, 95% CI -0.86 to 0.29; 2 studies; n = 788; moderate-certainty evidence) and probably little difference in general quality of life between 6 and 12 months (MD -0.01, 95% CI -0.04 to 0.02; 2 studies; n = 742; moderate-certainty evidence). There is little difference between combinations of conservative treatments and control in terms of objective cure or improvement of incontinence between 6 and 12 months (MD 0.18, 95% CI -0.24 to 0.60; 2 studies; n = 565; high-certainty evidence). However, it is uncertain whether participant adherence to the intervention between 6 and 12 months is increased for those undertaking combinations of conservative treatments (RR 2.08, 95% CI 0.78 to 5.56; 2 studies; n = 763; very low-certainty evidence; in absolute terms: no intervention or sham arm: 172 per 1000 and intervention arm: 358 per 1000). There is probably no difference between combinations and control in terms of the number of men experiencing surface or skin-related adverse events (2 studies; n = 853; moderate-certainty evidence), but it is uncertain whether combinations of treatments lead to more men experiencing muscle-related adverse events (RR 2.92, 95% CI 0.31 to 27.41; 2 studies; n = 136; very low-certainty evidence; in absolute terms: 0 per 1000 for both arms). Electrical or magnetic stimulation versus no treatment, sham treatment or verbal/written instructions We did not identify any studies for this comparison that reported on our key outcomes of interest. AUTHORS' CONCLUSIONS Despite a total of 25 trials, the value of conservative interventions for urinary incontinence following prostate surgery alone, or in combination, remains uncertain. Existing trials are typically small with methodological flaws. These issues are compounded by a lack of standardisation of the PFMT technique and marked variations in protocol concerning combinations of conservative treatments. Adverse events following conservative treatment are often poorly documented and incompletely described. Hence, there is a need for large, high-quality, adequately powered, randomised control trials with robust methodology to address this subject.
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Affiliation(s)
- Eugenie E Johnson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Akvile Stoniute
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
| | - Muhammad Imran Omar
- Guidelines Office, European Association of Urology, Arnhem, Netherlands
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
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Mazur-Bialy A, Tim S, Kołomańska-Bogucka D, Burzyński B, Jurys T, Pławiak N. Physiotherapy as an Effective Method to Support the Treatment of Male Urinary Incontinence: A Systematic Review. J Clin Med 2023; 12:jcm12072536. [PMID: 37048619 PMCID: PMC10095040 DOI: 10.3390/jcm12072536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/05/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Urinary incontinence (UI) is a serious health issue that affects both women and men. The risk of UI increases in men with age and after treatment for prostate cancer and affects up to 32% of men. Furthermore, UI may affect up to 69% of men after prostatectomy. Considering such a high incidence, it is critical to search for effective methods to mitigate this issue. Hence, the present review aims to provide an overview of physiotherapeutic methods and evaluate their effectiveness in treating UI in men. This systematic review was performed using articles included in PubMed, Embase, WoS, and PEDro databases. A total of 6965 relevant articles were found. However, after a risk of bias assessment, 39 studies met the inclusion criteria and were included in the review. The research showed that the available physiotherapeutic methods for treating men with UI, including those after prostatectomy, involve pelvic floor muscle training (PFMT) alone or in combination with biofeedback (BF) and/or electrostimulation (ES), vibrations, and traditional activity. In conclusion, PFMT is the gold standard of UI therapy, but it may be complemented by other techniques to provide a personalized treatment plan for patients. The effectiveness of the physiotherapeutic methods varies from study to study, and large methodological differences make it difficult to accurately compare individual results and draw unequivocal conclusions.
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Affiliation(s)
- Agnieszka Mazur-Bialy
- Department of Biomechanics and Kinesiology, Faculty of Health Science, Jagiellonian University Medical College, Skawińska 8, 31-066 Krakow, Poland
- Correspondence: ; Tel.: +48-012-421-9351
| | - Sabina Tim
- Department of Biomechanics and Kinesiology, Faculty of Health Science, Jagiellonian University Medical College, Skawińska 8, 31-066 Krakow, Poland
| | - Daria Kołomańska-Bogucka
- Department of Biomechanics and Kinesiology, Faculty of Health Science, Jagiellonian University Medical College, Skawińska 8, 31-066 Krakow, Poland
| | - Bartłomiej Burzyński
- Department of Rehabilitation, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Tomasz Jurys
- Department of Rehabilitation, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Natalia Pławiak
- University Hospital in Krakow, Jakubowskiego 2, 30-688 Krakow, Poland
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Mowafy ZME, Fouad FAE, Shehata SR, Abd El Salam AH, Ali KM. Effect of progressive resistance training on post prostatectomy stress urinary incontinence: A randomized controlled study. FIZJOTERAPIA POLSKA 2022; 22:48-55. [DOI: 10.56984/8zg1a6it9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Purpose. The aim of this study was to investigate the effectiveness of progressive resistance training on post prostatectomy stress urinary incontinence. Materials and Methods. Sixty male patients who complaint from post prostatectomy stress urinary incontinence were participated in this study, their ages were ranged from 40 to 75 years and they were randomly assigned into two equal groups. Group (A) (Study group): This group included 30 patients who had post prostatectomy stress urinary incontinence and they received progressive resistance training in addition to interferential current stimulation and routine medical treatment three sessions per week for 12 weeks. Group (B) (Control group): This group included 30 patients who had post prostatectomy stress urinary incontinence and they received interferential current stimulation and routine medical treatment three sessions per week for 12 weeks. Pre- and post-treatment assessment using DANTIC UD 5000/5500 Urodynamic investigation system & Severity index scale were done for all patients. Results. The obtained results of the present study indicated significant difference of all measured variables when comparing between pre and post- treatment values of the groups (A and B) and revealed significant difference when comparing between post- treatment values of the groups (A and B) in favor of group (A). Conclusion. Progressive resistance training had an effect on reducing post prostatectomy stress urinary incontinence and there was significant difference when comparing between post-treatment values of the groups (A and B) in favor of group (A).
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Affiliation(s)
| | | | | | - Aml Hamdy Abd El Salam
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Khadra Mohamed Ali
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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A systematic review of treatment options for post-prostatectomy incontinence. World J Urol 2022; 40:2617-2626. [PMID: 36107210 PMCID: PMC9617828 DOI: 10.1007/s00345-022-04146-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/30/2022] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Urinary incontinence remains common in men after prostatectomy. Current guidance suggests early corrective surgery to those that are still incontinent after trying Pelvic Floor Muscle Therapy, however, other treatments are now available. This review aims to evaluate all currently available treatment options for men with post-prostatectomy incontinence (PPI). METHODS A search of MEDLINE and CENTRAL databases on 2/2/2021 produced 879 articles. Any study evaluating incontinence before and after a treatment protocol was eligible for inclusion. After screening, 17 randomized control trials were included, and pre-defined data points were collected. Due to heterogeneity, pooled analysis was not possible, and a descriptive synthesis was produced in accordance with PRISMA guidelines. Cochrane Risk of Bias (RoB) tool was used to evaluate all studies. The search protocol and methods for this study was registered on the PROSPERO database before the search began, ID:(CRD42021229749). RESULTS 3/17(18%) of studies focussed on pharmacotherapy, 2/17(12%) on vibration therapies, 8/17(47%) on pelvic floor muscle therapy (PFMT), 3/17(18%) on electrical stimulation (ES), and 1/17 (6%) on extracorporeal magnetic innervation (ExMI) as their main intervention. The use of Duloxetine, Solifenacin, PFMT, ES, and ExMI all show effective reduction in incontinence in men suffering from PPI. No study in this review evaluated surgical managements for PPI. CONCLUSION A large number of treatments are available for PPI using an array of different methods. For this reason, a variety of treatments could be considered before early invasive procedures, to prevent unnecessary surgery and its associated negative complications.
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Salciccia S, Sciarra A, Moriconi M, Maggi M, Viscuso P, Rosati D, Frisenda M, Di Pierro GB, Canale V, Bevilacqua G, Nesi G, Del Giudice F, Gentilucci A, Cattarino S, Mariotti G. How to Predict Outcomes from a Biofeedback and Pelvic Floor Muscle Electric Stimulation Program in Patients with Urinary Incontinence after Radical Prostatectomy. J Clin Med 2021; 11:jcm11010127. [PMID: 35011866 PMCID: PMC8745214 DOI: 10.3390/jcm11010127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/11/2021] [Accepted: 12/23/2021] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The objective of this study was to analyze the pre-operative and intra-operative variables that can condition urinary incontinence (UI) after radical prostatectomy (RP), as well as continence rate recovery during a pelvic floor rehabilitation program. MATERIALS AND METHODS A total of 72 cases with UI after RP were prospectively examined. All cases were homogeneously treated by the same surgeon, using the same RP technique. A combination of biofeedback (BF) and pelvic floor electric stimulation (PFES) performed by the same clinician and using the same protocol was used. Clinical, pathologic and surgical variables were analyzed in terms of 24 h pad test results (pad weight and pad-free status). RESULTS Prostate volume (PV) strongly varied from 24 to 127 cc (mean ± SD 46.39 ± 18.65 cc), and the baseline pad weight varied from 10 to 1500 cc (mean ± SD 354.29 ± 404.15 cc). PV strongly and positively correlated with the baseline pad weight (r = 0.4215; p = 0.0269) and inversely with the three-month pad weight (r = - 0.4763; p = 0.0213) and pad-free status (r =- 0.3010; p = 0.0429). The risk of a residual pad weight >10 g after the rehabilitative program significantly increased according to PV (p = 0.001) and the baseline pad weight (p = 0.002 and < 0.0001). In particular, PV > 40 cc and a baseline pad weight >400 g significantly (p = 0.010 and p < 0.0001, respectively) and independently predicted a 5.7 and a 35.4 times increase in the risk of a residual pad weight at the three-month follow-up, respectively. CONCLUSION This is the first prospective trial whose primary objective is to verify the possible predictors, such as PV, that are able to condition the response to a pelvic floor rehabilitation program for UI after RP.
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Affiliation(s)
- Stefano Salciccia
- Department of Maternal-Infant and Urologic Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Viale del Policlinico 151, 00161 Rome, Italy; (S.S.); (M.M.); (M.M.); (P.V.); (D.R.); (M.F.); (G.B.D.P.); (V.C.); (G.B.); (F.D.G.); (A.G.); (S.C.); (G.M.)
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urologic Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Viale del Policlinico 151, 00161 Rome, Italy; (S.S.); (M.M.); (M.M.); (P.V.); (D.R.); (M.F.); (G.B.D.P.); (V.C.); (G.B.); (F.D.G.); (A.G.); (S.C.); (G.M.)
- Correspondence:
| | - Martina Moriconi
- Department of Maternal-Infant and Urologic Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Viale del Policlinico 151, 00161 Rome, Italy; (S.S.); (M.M.); (M.M.); (P.V.); (D.R.); (M.F.); (G.B.D.P.); (V.C.); (G.B.); (F.D.G.); (A.G.); (S.C.); (G.M.)
| | - Martina Maggi
- Department of Maternal-Infant and Urologic Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Viale del Policlinico 151, 00161 Rome, Italy; (S.S.); (M.M.); (M.M.); (P.V.); (D.R.); (M.F.); (G.B.D.P.); (V.C.); (G.B.); (F.D.G.); (A.G.); (S.C.); (G.M.)
| | - Pietro Viscuso
- Department of Maternal-Infant and Urologic Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Viale del Policlinico 151, 00161 Rome, Italy; (S.S.); (M.M.); (M.M.); (P.V.); (D.R.); (M.F.); (G.B.D.P.); (V.C.); (G.B.); (F.D.G.); (A.G.); (S.C.); (G.M.)
| | - Davide Rosati
- Department of Maternal-Infant and Urologic Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Viale del Policlinico 151, 00161 Rome, Italy; (S.S.); (M.M.); (M.M.); (P.V.); (D.R.); (M.F.); (G.B.D.P.); (V.C.); (G.B.); (F.D.G.); (A.G.); (S.C.); (G.M.)
| | - Marco Frisenda
- Department of Maternal-Infant and Urologic Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Viale del Policlinico 151, 00161 Rome, Italy; (S.S.); (M.M.); (M.M.); (P.V.); (D.R.); (M.F.); (G.B.D.P.); (V.C.); (G.B.); (F.D.G.); (A.G.); (S.C.); (G.M.)
| | - Giovanni Battista Di Pierro
- Department of Maternal-Infant and Urologic Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Viale del Policlinico 151, 00161 Rome, Italy; (S.S.); (M.M.); (M.M.); (P.V.); (D.R.); (M.F.); (G.B.D.P.); (V.C.); (G.B.); (F.D.G.); (A.G.); (S.C.); (G.M.)
| | - Vittorio Canale
- Department of Maternal-Infant and Urologic Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Viale del Policlinico 151, 00161 Rome, Italy; (S.S.); (M.M.); (M.M.); (P.V.); (D.R.); (M.F.); (G.B.D.P.); (V.C.); (G.B.); (F.D.G.); (A.G.); (S.C.); (G.M.)
| | - Giulio Bevilacqua
- Department of Maternal-Infant and Urologic Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Viale del Policlinico 151, 00161 Rome, Italy; (S.S.); (M.M.); (M.M.); (P.V.); (D.R.); (M.F.); (G.B.D.P.); (V.C.); (G.B.); (F.D.G.); (A.G.); (S.C.); (G.M.)
| | - Gianluca Nesi
- Department of Urology, Sant’Andrea Hospital, 00141 Rome, Italy;
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urologic Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Viale del Policlinico 151, 00161 Rome, Italy; (S.S.); (M.M.); (M.M.); (P.V.); (D.R.); (M.F.); (G.B.D.P.); (V.C.); (G.B.); (F.D.G.); (A.G.); (S.C.); (G.M.)
| | - Alessandro Gentilucci
- Department of Maternal-Infant and Urologic Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Viale del Policlinico 151, 00161 Rome, Italy; (S.S.); (M.M.); (M.M.); (P.V.); (D.R.); (M.F.); (G.B.D.P.); (V.C.); (G.B.); (F.D.G.); (A.G.); (S.C.); (G.M.)
| | - Susanna Cattarino
- Department of Maternal-Infant and Urologic Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Viale del Policlinico 151, 00161 Rome, Italy; (S.S.); (M.M.); (M.M.); (P.V.); (D.R.); (M.F.); (G.B.D.P.); (V.C.); (G.B.); (F.D.G.); (A.G.); (S.C.); (G.M.)
| | - Gianna Mariotti
- Department of Maternal-Infant and Urologic Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Viale del Policlinico 151, 00161 Rome, Italy; (S.S.); (M.M.); (M.M.); (P.V.); (D.R.); (M.F.); (G.B.D.P.); (V.C.); (G.B.); (F.D.G.); (A.G.); (S.C.); (G.M.)
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11
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Sciarra A, Viscuso P, Arditi A, Mariotti G, De Berardinis E, Di Pierro GB, Canale V, Gentilucci A, Maria Busetto G, Maggi M, Eisenberg ML, Vilson F, Chung BI, Ferro M, Salciccia S, Del Giudice F. A biofeedback-guided programme or pelvic floor muscle electric stimulation can improve early recovery of urinary continence after radical prostatectomy: A meta-analysis and systematic review. Int J Clin Pract 2021; 75:e14208. [PMID: 33811418 DOI: 10.1111/ijcp.14208] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/15/2021] [Accepted: 03/31/2021] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Urinary incontinence (UI) after radical prostatectomy (RP) is an early side effect after catheter removal. This systematic review and meta-analysis were conducted to compare different forms of non-invasive treatments for post-RP UI and to analyse whether the addition of biofeedback (BF) and/or pelvic floor muscle electric stimulation (PFES) to PF muscle exercise (PFME) alone can improve results in terms of continence recovery rate. MATERIALS AND METHODS A literature search was performed following the PRISMA guidelines. We performed a cumulative meta-analysis to explore the trend in the effect sizes across subgroups during a 12-months follow-up. RESULTS Twenty-six articles were selected. At baseline after RP and catheter removal, mean pad weight varied extremely. At 1- and 3-months intervals, mean difference in pad weight recovery from baseline was significantly higher using guided programs (BF, PFES or both) than using PFME alone (3-months: PFME 111.09 g (95%CI 77.59-144.59), BF 213.81 g (95%CI -80.51-508-13), PFES 306.88 g (95%CI 158.11-455.66), BF + PFES 266.31 g (95%CI 22.69-302.93); P < .01), while at 6- and 12-months differences were similar (P > .04). At 1- and 3-months intervals, event rate (ER) of continence recovery was significantly higher using guided programs than using PFME alone (3-months: PFME 0.40 (95%CI 0.30-0.49), BF 0.49 (95%CI 0.31-0.67), PFES 0.57 (95%CI 0.46-0.69), BF + PFES 0.75 (95%CI 0.60-0.91); P < .01), while at 6- and 12-months ERs were similar. CONCLUSIONS Regarding non-invasive treatment of UI secondary to RP, the addition of guided programs using BF or/and PFES demonstrated to improve continence recovery rate, particularly in the first 3-month interval, when compared with the use of PFME alone.
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Affiliation(s)
- Alessandro Sciarra
- Department of Maternal-Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Pietro Viscuso
- Department of Maternal-Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Alessandro Arditi
- Department of Maternal-Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Gianna Mariotti
- Department of Maternal-Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Ettore De Berardinis
- Department of Maternal-Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Giovanni Battista Di Pierro
- Department of Maternal-Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Vittorio Canale
- Department of Maternal-Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Alessandro Gentilucci
- Department of Maternal-Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Gian Maria Busetto
- Department of Maternal-Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Martina Maggi
- Department of Maternal-Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Michael L Eisenberg
- Department of Urology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Fernandino Vilson
- Department of Maternal-Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Benjamin I Chung
- Department of Urology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO), Milan, Italy
| | - Stefano Salciccia
- Department of Maternal-Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urologic Sciences, 'Sapienza' University of Rome, Policlinico Umberto I Hospital, Rome, Italy
- Department of Urology, School of Medicine, Stanford University, Stanford, CA, USA
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12
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Kim YU, Lee DG, Ko YH. Pelvic floor muscle exercise with biofeedback helps regain urinary continence after robot-assisted radical prostatectomy. Yeungnam Univ J Med 2020; 38:39-46. [PMID: 32668526 PMCID: PMC7787894 DOI: 10.12701/yujm.2020.00276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background To determine the benefit of pelvic floor muscle exercise (PFME) with visual biofeedback on promoting patient recovery from incontinence, we investigated variables associated with the early restoration of continence for patients who robot-assisted radical prostatectomy (RARP). Methods Of the 83 patients enrolled, 41 consecutive patients completed PFME (the exercise group), and the other 42 consecutive patients just before the PFME program commenced (the control group). The primary outcome was whether PFME engagement was associated with zero pad continence restoration within 3 months of surgery. Results Continence restoration percentages (defined as zero pads used per day) at 1, 3, and 6 months after surgery were 49.4%, 77.1%, and 94.0%, respectively. The exercise group achieved significantly higher recovery rates at 1 month (p=0.037), 3 months (p<0.001), and 6 months (p=0.023). Cox regression analysis demonstrated that a lower Gleason score (<8; hazard ratio [HR], 2.167), lower prostate specific antigen (<20 ng/dL; HR, 2.909), and engagement in PFME (HR, 3.731) were independent predictors of early recovery from postprostatectomy incontinence. Stratification by age showed that those younger than 65 years did not benefit significantly from exercise (log-rank test, p=0.08), but that their elderly counterparts, aged 65–70 years (p=0.007) and >70 years old (p=0.002) benefited significantly. Conclusion This study suggests that postoperative engagement in PFME with biofeedback speeds up the recovery of continence in elderly patients (≥65 years old) that undergo RARP.
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Affiliation(s)
- Yeong Uk Kim
- Department of Urology, Yeungnam Hospital of Medicine, Daegu, Korea
| | - Dong Gyu Lee
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
| | - Young Hwii Ko
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
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13
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Soto González M, Da Cuña Carrera I, Gutiérrez Nieto M, López García S, Ojea Calvo A, Lantarón Caeiro EM. Early 3-month treatment with comprehensive physical therapy program restores continence in urinary incontinence patients after radical prostatectomy: A randomized controlled trial. Neurourol Urodyn 2020; 39:1529-1537. [PMID: 32442334 DOI: 10.1002/nau.24389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 11/12/2022]
Abstract
AIMS The objective of this study is to ascertain whether an early three-month treatment with electrotherapy and biofeedback restores continence in urinary incontinence patients after radical prostatectomy (RP). METHODS Design: The study performed a randomized, controlled trial of parallel and open groups. Configuration: Secondary care, urology department of a university hospital complex. PARTICIPANTS Patients sent for RP due to prostate cancer (n = 60), 47 patients finally completed the study. INTERVENTIONS The treatment group (TG) received physiotherapy consisting of electrotherapy and biofeedback, 3 days a week for 3 months, while the control group (CG) received no specific treatment. Both groups received a guide to perform pelvic floor exercises at home. The measurement instruments used were the 1- and 24-hour pad tests and the International Consultation on Incontinence Questionnaire Short-Form. The recording method used was a micturition (urinary) diary. RESULTS The results of the 1-hour pad test (PT) show statistically significant differences between groups at 3 months (P = .001) and 6 months (P = .001), in favor of those in the TG. Sixty-four percent of patients in the TG recovered continence as against 9.1% in the CG after 3 months in the 1-hour PT, in line with the objective of this study. CONCLUSIONS An early physiotherapy program helps RP patients with urinary incontinence recover continence after 3 months. Moreover, they lead a better quality life.
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Affiliation(s)
- Mercedes Soto González
- Department of Functional Biology and Health Sciences, Faculty of Physiotherapy, University of Vigo, Vigo, Spain
| | - Iria Da Cuña Carrera
- Department of Functional Biology and Health Sciences, Faculty of Physiotherapy, University of Vigo, Vigo, Spain
| | - Manuel Gutiérrez Nieto
- Department of Functional Biology and Health Sciences, Faculty of Physiotherapy, University of Vigo, Vigo, Spain
| | | | | | - Eva M Lantarón Caeiro
- Department of Functional Biology and Health Sciences, Faculty of Physiotherapy, University of Vigo, Vigo, Spain
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14
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Heydenreich M, Puta C, Gabriel HHW, Dietze A, Wright P, Zermann DH. Does trunk muscle training with an oscillating rod improve urinary incontinence after radical prostatectomy? A prospective randomized controlled trial. Clin Rehabil 2020; 34:320-333. [PMID: 31858823 PMCID: PMC7029439 DOI: 10.1177/0269215519893096] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 11/07/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the effect of a new therapeutic approach, using an oscillating rod to strength the pelvic floor and deep abdominal musculature and to speed up recovery of continence after radical prostatectomy. DESIGN Prospective randomized controlled clinical trial. SETTING Inpatient uro-oncology rehabilitation clinic. SUBJECTS Ninety-three (intervention group (IG)) and ninety-one patients (control group (CG)) with urinary incontinence after prostatectomy were examined. INTERVENTION All patients were randomly allocated to either standard pelvic floor muscle exercises and oscillating rod therapy (IG) or standard pelvic floor muscle exercises and relaxation therapy (CG). MAIN OUTCOME MEASURES Urinary incontinence (1- and 24-hour pad test) was assessed, and health-related quality of life (HRQL; Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire) was measured for all patients before and after three weeks of treatment. RESULTS One hundred and eighty-four patients (mean (SD) age: 64.1 (6.94) years) completed the study. The IG showed a significant reduction in urinary incontinence (1-hour pad test: P = 0.008, 24-hour pad test: P = 0.012) and a significant improvement of HRQL (P = 0.017) compared with CG. Continence was significantly improved in both groups (1-hour pad test: 22.6-8.5 g (IG) vs. 23.0-18.1 g (CG)/24-hour pad test: 242.9-126.7 g (IG) vs. 237.6-180.9 g (CG)). CONCLUSION The study demonstrated that a combination of conventional continence exercises and the new oscillation rod training increased abdominal and pelvic floor musculature and speeded up recovery of continence after radical prostatectomy.
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Affiliation(s)
- Marc Heydenreich
- Division of Sports and Training Science, Vogtland-Klinik Bad Elster, Bad Elster, Germany
- Department of Urology & Urooncology, Vogtland-Klinik Bad Elster, Bad Elster, Germany
| | - Christian Puta
- Department of Sports Medicine and Health Promotion, Friedrich Schiller University Jena, Jena, Germany
- Center for Interdisciplinary Prevention of Diseases related to Professional Activities, Friedrich Schiller University Jena, Jena, Germany
| | - Holger HW Gabriel
- Department of Sports Medicine and Health Promotion, Friedrich Schiller University Jena, Jena, Germany
| | - Andre Dietze
- Division of Sports and Training Science, Vogtland-Klinik Bad Elster, Bad Elster, Germany
- Department of Urology & Urooncology, Vogtland-Klinik Bad Elster, Bad Elster, Germany
| | - Peter Wright
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
| | - Dirk-Henrik Zermann
- Division of Sports and Training Science, Vogtland-Klinik Bad Elster, Bad Elster, Germany
- Department of Urology & Urooncology, Vogtland-Klinik Bad Elster, Bad Elster, Germany
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15
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Hall LM, Neumann P, Hodges PW. Do features of randomized controlled trials of pelvic floor muscle training for postprostatectomy urinary incontinence differentiate successful from unsuccessful patient outcomes? A systematic review with a series of meta-analyses. Neurourol Urodyn 2020; 39:533-546. [PMID: 31977112 DOI: 10.1002/nau.24291] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/13/2020] [Indexed: 01/08/2023]
Abstract
AIMS Efficacy of pelvic floor muscle training (PFMT) for postprostatectomy incontinence (PPI) differs between randomized clinical trials (RCT). This might be explained by variation in content/delivery of PFMT (eg, biofeedback, muscles targeted, and time of commencement of training). This review investigated whether outcome of meta-analysis differs based on presence or not of specific RCT features. METHODS PubMed, CINAHL, EMBASE, Physiotherapy Evidence Database (PEDro), and Cochrane were searched for RCTs that investigated efficacy of PFMT on PPI. PFMT details and outcomes were extracted. Methodological quality and comprehensiveness of PFMT reporting was assessed using the PEDro scale and Consensus on Reporting Template, respectively. Effect size and 95% confidence intervals were calculated for incontinence rate at 3 months. To identify features that influenced efficacy, separate meta-analyses were performed for studies with and without specific features. RESULTS Twenty-two trials were included, and 15 were used for meta-analysis of 3-month outcomes. Overall, meta-analysis showed reduced incontinence with PFMT (risk ratio [RR] = 0.85; I2 = 55%; P = .005). Meta-analyses showed better outcomes for PFMT than control groups when the study included preoperative PFMT (RR = 0.76; I2 = 30%; P = .006), biofeedback (RR = 0.73; I2 = 58%; P = .006), instruction to contract around the urethra (RR = 0.9; I2 = 43%; P = .009), a control group without PFMT instruction (RR = 0.85; I2 = 69%; P = .05), inclusion of all men irrespective of continence status (RR = 0.84; I2 = 30%; P = .003) and continence defined as no leakage (RR = 0.85; I2 = 48%; P = .05). CONCLUSIONS Preoperative PFMT, biofeedback, urethral instructions, no PFMT instruction for controls, inclusion of all men, and continence defined as no leakage are features associated with successful patient outcomes. Future studies should consider these features in design of interventions and pooling data for meta-analysis.
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Affiliation(s)
- Leanne M Hall
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Patricia Neumann
- Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Paul W Hodges
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
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16
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de Lira GHS, Fornari A, Cardoso LF, Aranchipe M, Kretiska C, Rhoden EL. Effects of perioperative pelvic floor muscle training on early recovery of urinary continence and erectile function in men undergoing radical prostatectomy: a randomized clinical trial. Int Braz J Urol 2020; 45:1196-1203. [PMID: 31808408 PMCID: PMC6909867 DOI: 10.1590/s1677-5538.ibju.2019.0238] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/02/2019] [Indexed: 11/24/2022] Open
Abstract
Aims: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction (ED), which negatively impact quality of life (QoL). This study aimed to evaluate the effects of a perioperative pelvic floor muscle training (PFMT) program versus usual care on early recovery of urinary continence and erectile function after RP. Materials and Methods: Of 59 eligible men, 31 were randomly allocated into 2 groups: Group 1 (Control, N=15) received usual post-RP care; and Group 2 (Physical therapy, N=16) received two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were used to evaluate UI and ED, respectively. Results: Demographic characteristics were similar in both groups. Three months after RP, the UI rate was 72.7% and 70.0% in Groups 1 and 2, respectively (P >0.05). The severity and frequency of UI and its impact on QoL were evaluated by the ICIQ-Short Form, with scores of 6.9±6.26 in Group 1 and 7.0±5.12 in Group 2 (P >0.05). The IIEF-5 scores were similar in Groups 1 and 2 (5.73±7.43 vs. 6.70±6.68, respectively) (P >0.05). Conclusion: Our pre-RP protocol of two physical therapist-assisted sessions of PFMT plus instructions did not significantly improve urinary continence or erectile function at 3 months after RP.
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Affiliation(s)
| | - Alexandre Fornari
- Unidade de Disfunção Miccional, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | - Luiz Felipe Cardoso
- Unidade de Disfunção Miccional, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | - Magda Aranchipe
- Unidade de Disfunção Miccional, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | - Carmem Kretiska
- Unidade de Disfunção Miccional, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
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Sodré DSM, Sodré PRS, Brasil C, Teles A, Dória M, Café LE, Lordelo P. New concept for treating urinary incontinence after radical prostatectomy with radiofrequency: phase 1 clinical trial. Lasers Med Sci 2019; 34:1865-1871. [PMID: 30989457 DOI: 10.1007/s10103-019-02784-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/02/2019] [Indexed: 02/05/2023]
Abstract
To describe the clinical response and side effects of radiofrequency treatment in patients with urinary incontinence after radical prostatectomy. This is a phase 1 clinical trial with 10 men up to 65 years of age who had urinary incontinence after radical prostatectomy, post void residual volume < 50 ml verified by ultrasonography, pad test ≥ 1 g, and PSA < 0.2 ng/ml. pad test and self-administered questionnaires were used to assess clinical response. Scales were used to measure treatment satisfaction and improvement in symptoms. Participants underwent five sessions of 2 min of non-ablative endoanal radiofrequency (41 °C). The evaluated co-primary endpoints were urinary incontinence volume and urinary symptoms, analyzed by the Wilcoxon nonparametric test; residual volume, and self-reports to assess safety. The participants' mean age was 57.5 ± 4.9. The initial pad test score was 6.5 g (1.7-50.0) with a final score of 2.0 g (0.0-9.0) (p < 0.01). Ultrasonography showed no alteration of residual volume. A decrease of urinary loss was found in nine patients, three of them showed a complete resolution of urinary loss. A decrease in irritative micturition symptoms was found as well, but no improvement in the quality of life was shown. Regarding treatment satisfaction, two patients were neutral, six satisfied, and two very satisfied. Limitations included pain while the endoanal electrode was inserted. Four patients indicated pain during treatment, but overall results were positive. The reduction of urinary loss and irritative micturition symptoms increased patients' satisfaction scores, without improving their perception of quality of life.
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Affiliation(s)
- Danielle Santana Macêdo Sodré
- Bahiana School of Medicine and Public Health, Av. Dom Joao VI, 275, Brotas, Salvador, Bahia, 40290-000, Brazil
- Center for Care of Pelvic Floor, Salvador, Bahia, Brazil
| | - Plínio Roberto Souza Sodré
- Center for Care of Pelvic Floor, Salvador, Bahia, Brazil
- University of State of Bahia (UNEB), Salvador, Brazil
| | - Cristina Brasil
- Bahiana School of Medicine and Public Health, Av. Dom Joao VI, 275, Brotas, Salvador, Bahia, 40290-000, Brazil
- Center for Care of Pelvic Floor, Salvador, Bahia, Brazil
| | - Alcina Teles
- Center for Care of Pelvic Floor, Salvador, Bahia, Brazil
| | - Matheus Dória
- Bahiana School of Medicine and Public Health, Av. Dom Joao VI, 275, Brotas, Salvador, Bahia, 40290-000, Brazil
- Center for Care of Pelvic Floor, Salvador, Bahia, Brazil
| | - Luiz Eduardo Café
- Bahiana School of Medicine and Public Health, Av. Dom Joao VI, 275, Brotas, Salvador, Bahia, 40290-000, Brazil
| | - Patrícia Lordelo
- Bahiana School of Medicine and Public Health, Av. Dom Joao VI, 275, Brotas, Salvador, Bahia, 40290-000, Brazil.
- Center for Care of Pelvic Floor, Salvador, Bahia, Brazil.
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Murphy A, Teplitsky S, Das AK, Leong JY, Margules A, Lallas CD. Medical evaluation and management of male and female voiding dysfunction: a review. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2019; 57:220-232. [PMID: 30990789 DOI: 10.2478/rjim-2019-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Indexed: 06/09/2023]
Abstract
A significant workforce shortage of urologists available to serve the US population has been projected to occur over the next decade. Accordingly, much of the management of urologic patients will need to be assumed by other specialties and practitioners. Since primary care physicians are often first evaluate common urologic complaints, it makes sense that these physicians are in an excellent position to intervene in the management of these patients when appropriate. One of the most common complaints in urology is voiding dysfunction. The incidence of voiding dysfunction increases with age, with conservative estimates showing that over 50% of elderly patients suffer. Despite this high prevalence and its negative impact on quality of life, however, few seek or receive treatment, as many do not readily disclose these impactful yet personal symptoms. We sought to summarize the typical presentation, evaluation, assessment and therapeutic options for both male and female patients presenting with voiding dysfunction.
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MESH Headings
- Cystitis, Interstitial/diagnosis
- Cystitis, Interstitial/etiology
- Cystitis, Interstitial/therapy
- Female
- Humans
- Male
- Prostatism/diagnosis
- Prostatism/etiology
- Prostatism/therapy
- Urinary Bladder, Overactive/diagnosis
- Urinary Bladder, Overactive/etiology
- Urinary Bladder, Overactive/therapy
- Urinary Bladder, Underactive/diagnosis
- Urinary Bladder, Underactive/etiology
- Urinary Bladder, Underactive/therapy
- Urinary Incontinence, Stress/diagnosis
- Urinary Incontinence, Stress/etiology
- Urinary Incontinence, Stress/therapy
- Urination Disorders/diagnosis
- Urination Disorders/etiology
- Urination Disorders/therapy
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Affiliation(s)
- Alana Murphy
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Seth Teplitsky
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Akhil K Das
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Joon Yau Leong
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Andrew Margules
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Costas D Lallas
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Laurienzo CE, Magnabosco WJ, Jabur F, Faria EF, Gameiro MO, Sarri AJ, Kawano PR, Yamamoto HA, Reis LO, Amaro JL. Pelvic floor muscle training and electrical stimulation as rehabilitation after radical prostatectomy: a randomized controlled trial. J Phys Ther Sci 2018; 30:825-831. [PMID: 29950773 PMCID: PMC6016310 DOI: 10.1589/jpts.30.825] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 03/15/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To investigate the effect of electrical stimulation and pelvic floor muscle
training on muscle strength, urinary incontinence and erectile function in men with
prostate cancer treated by radical prostatectomy. [Subjects and Methods] One hundred
twenty-three males were randomized into 3 groups 1 month after RP: (G1, n=40) control;
(G2, n=41) guideline: patients were instructed to perform three types of home exercises to
strengthen the pelvic floor and (G3, n=42) electrical stimulation: patients in this group
were also instructed to perform exercises as group G2, and also received anal
electro-stimulation therapy, twice a week for 7 weeks. The primary outcome assessment was
based on the measurement of the recovery of pelvic floor muscle strength between groups.
Secondary outcomes were: 1 hour Pad Test, ICIQ-SF, IIEF-5 and IPSS. Data were obtained
preoperatively and at 1, 3 and 6 months after surgery. [Results] There was no significant
difference in the demographic data among groups. Greater urinary leakage and pelvic floor
muscle weakness in the first month compared to pre treatment improved after 3 and 6 months
postoperative, without difference among groups. [Conclusion] The muscle strength recovery
occurs independently of the therapy employed. Pelvic floor exercises or electrical
stimulation also did not have an impact on the recovery of urinary continence and erectile
function in our study.
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Affiliation(s)
- Carla Elaine Laurienzo
- Department of Physiotherapy, Barretos Cancer Hospital: Rua Antenor Duarte Villela, 1331 SP, 14784-400, Brazil
| | | | - Fernanda Jabur
- Department of Physiotherapy, Barretos Cancer Hospital: Rua Antenor Duarte Villela, 1331 SP, 14784-400, Brazil
| | | | | | - Almir Jose Sarri
- Department of Physiotherapy, Barretos Cancer Hospital: Rua Antenor Duarte Villela, 1331 SP, 14784-400, Brazil
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Hall LM, Aljuraifani R, Hodges PW. Design of programs to train pelvic floor muscles in men with urinary dysfunction: Systematic review. Neurourol Urodyn 2018; 37:2053-2087. [PMID: 29687914 DOI: 10.1002/nau.23593] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/23/2018] [Indexed: 01/01/2023]
Abstract
AIMS Pelvic floor muscle training (PFMT) is a first line conservative treatment for men with urinary dysfunction, but reports of its efficacy are variable. This study aimed to systematically review the content of PFMT programs used for urinary dysfunction in men. METHODS Electronic databases (PubMed, CINAHL, EMBASE, Cochrane, PEDro) were searched for studies that used PFMT in the treatment of adult men with urinary dysfunction. Details of PFMT treatment sessions and home exercise protocols were extracted. Criteria specific to PFMT were developed, based on the Consensus on Exercise Reporting Template, and applied to all studies to measure the comprehensiveness of the PFMT description in the manuscript. RESULTS Results from the 108 included studies indicate substantial heterogeneity in both the content of PFMT and the quality of reporting of the components of the exercise regimes. There was notable disparity in the muscles targeted by the interventions (and few focused on urethral control despite the use in management of urinary conditions) and the intensity of the programs (eg, 18-240 contractions per day). Most studies were missing key details of description of the PFMT programs (eg, the position in which the pelvic floor muscle [PFM] contraction was taught and how it was assessed, methods used to ensure exercise adherence). CONCLUSIONS Variation in content of PFMT programs is likely to contribute to variation in the reported efficacy for management of urinary dysfunction in men, and unclear description of the details of the evaluated programs makes it difficult to identify the effective/ineffective components. PROSPERO registration number CRD42017071038.
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Affiliation(s)
- Leanne M Hall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rafeef Aljuraifani
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Wu D, Rosedale R. The use of Mechanical Diagnosis and Therapy (MDT) in patients with lower urinary tract symptoms (LUTS): case series. Physiother Theory Pract 2018; 35:383-391. [PMID: 29482406 DOI: 10.1080/09593985.2018.1443359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Lower urinary tract symptoms (LUTS) are highly prevalent among men over the age of 40. Even though associations between lumbar spine conditions and LUTS have been documented in the literature, no studies have detailed a specific lumbar assessment and classification process, and the related treatment effects in patients with LUTS. In this case series, we present three male patients with LUTS as primary complaints, who were evaluated and treated with Mechanical Diagnosis and Therapy (MDT) for the lumbar spine. The duration of their symptoms was between 4 months and 7 years. Urogenital pathologies were ruled out for all patients. The Chronic Prostatitis Symptom Index was used as a functional outcome measure. All patients were classified as having lumbar derangements. Treatment of derangements with directional preference exercises resulted in the improvement of their LUTS, with clinically significant improvements (56.0%-77.4%) in functional outcome measures over an average of six sessions. Preliminary indications suggest that these LUTS cases may possibly have had a lumbar spine origin and "mechanical" nature. Therefore, they may be within the scope of MDT assessments and interventions. With careful monitoring of symptoms, MDT may serve as a screening tool and conservative treatment option.
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Affiliation(s)
- Di Wu
- a Physiothérapie Polyclinique Cabrini , Montreal , Quebec , Canada
| | - Richard Rosedale
- b Occupational Health and Safety , London Health Sciences Centre , London , Ontario , Canada
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Perez FSB, Rosa NC, da Rocha AF, Peixoto LRT, Miosso CJ. Effects of Biofeedback in Preventing Urinary Incontinence and Erectile Dysfunction after Radical Prostatectomy. Front Oncol 2018. [PMID: 29535970 PMCID: PMC5834912 DOI: 10.3389/fonc.2018.00020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this study, we present a biofeedback method for the strengthening of perineal muscles during the preoperative procedures for radical prostatectomy, and we evaluate this technique as a prevention measure against complications such as urinary incontinence (UI) and erectile dysfunction (ED), which affect prostatectomy patients after surgery. In the experimental protocol, the patients performed specific exercises with the help of a device that provided the patient with visual biofeedback, based on a plot of the anal pressure. For the experimental protocol, we selected 20 male patients, with an average age of 64.0 years, and submitted them to ten therapeutic sessions each. A control group consisting of 32 men with an average age of 66.3 years, who were treated with the same surgical procedure but not with the preoperative procedures, also took part in the experiment. To evaluate UI and ED after the surgery in both control and experimental groups, we used two validated questionnaires-to assess UI, we used the King's Health Questionnaire (KHQ) and, for ED, we used the International Index of Erectile Function (IIEF-5) Questionnaire. We compared the variables associated with UI and ED after the surgery for the control and experimental groups. The occurrence of UI after radical prostatectomy in the control group (100% of the patients) was higher than that for the experimental group (5% of the patients), with p < 0.0001. Likewise, the occurrence of erectile dysfunction after prostatectomy in the control group (48.6% of the patients) was higher than that for the experimental group (5% of the patients), with p < 0.0001. The number of nocturia events also decreased as a consequence of the intervention (p < 0.0001), as did the number of disposable underwear units for urinary incontinence (p < 0.0001). Furthermore, we compared, only for the experimental group, the anal pressure before the biofeedback intervention and after the surgery, and we verified that the anal pressure after surgery was significantly higher (p < 0.0001). The results strongly suggest that the preoperative biofeedback procedure was effective in decreasing urinary incontinence and erectile dysfunction after radical prostatectomy. As future work, we intend to extend this analysis for larger samples and considering a broader age range.
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Affiliation(s)
- Fabiana S B Perez
- Medical Sciences Graduate Program, University of Brasilia, Brasilia, Brazil.,Department of Physiotherapy, Alfredo Nasser College, Aparecida de Goiania, Brazil
| | - Nathalia C Rosa
- Department of Physiotherapy, Alfredo Nasser College, Aparecida de Goiania, Brazil
| | - Adson F da Rocha
- Medical Sciences Graduate Program, University of Brasilia, Brasilia, Brazil.,Biomedical Engineering Graduate Program, University of Brasilia, Brasilia, Brazil
| | - Luciana R T Peixoto
- Biomedical Engineering Graduate Program, University of Brasilia, Brasilia, Brazil
| | - Cristiano J Miosso
- Biomedical Engineering Graduate Program, University of Brasilia, Brasilia, Brazil
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Intervention for patient reported urinary symptoms in prostate cancer survivors: Systematic review. J Cancer Surviv 2017; 11:643-654. [DOI: 10.1007/s11764-017-0637-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
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Santos NADS, Saintrain MVDL, Regadas RP, da Silveira RA, de Menezes FJC. Assessment of Physical Therapy Strategies for Recovery of Urinary Continence after Prostatectomy. Asian Pac J Cancer Prev 2017; 18:81-86. [PMID: 28240013 PMCID: PMC5563123 DOI: 10.22034/apjcp.2017.18.1.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction: Urinary incontinence is a complication of radical prostatectomy. Pelvic floor exercises can facilitate recovery of continence after surgery; however, there is not sufficient evidence that physical therapy with biofeedback training is effective, particularly with respect to providing a faster recovery. Objective: To analyze the application of physical therapy techniques in the recovery of urinary incontinence after prostatectomy. Methodology: A randomized clinical trial was conducted from April to October 2015 with patients undergoing radical prostatectomy up to three months after surgery at the Santa Casa de Misericordia in Northeastern Brazil. The physical therapy intervention consisted of up to eight individual sessions. Patients were randomized into the intervention group, which performed exercises and received biofeedback training, and the control group, which performed exercises alone. Participants were assessed before, during and after treatment. The initial assessment included a structured instrument addressing sociodemographic and urological data. Frequencies were calculated for all variables and comparisons were checked by the Mann-Whitney test and for correlation significance. Results: The study included 13 patients aged 54-74 years, the majority undergoing retropubic surgery with mild urinary incontinence [11 (84.6%)]. There was a significant difference in the outcome of the pad test before (p=0.070) and after (p=0.015) treatment between the groups, but the reduction of urinary loss and the time to recovery of continence were equivalent for both groups. Conclusion: Both interventions provided improvement in the degree of incontinence within two months of treatment.
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Zaidan P, Silva EBD. Pelvic floor muscle exercises with or without electric stimulation and post-prostectomy urinary incontinence: a systematic review. FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/1980-5918.029.003.ao21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Abstract Introduction: Urinary incontinence (UI) after prostatectomy is difficult to treat and causes profound adverse impacts on the individual's quality of life. The main clinical treatments available for post-prostatectomy UI consist of behavioral techniques and physical therapy techniques, such as exercises, electrical stimulation and biofeedback for pelvic floor muscles (PFMs). Objective: To investigate the effectiveness of PFM exercises with or without electrical stimulation for reducing post-prostatectomy UI. Methods: We included only randomized controlled trials (RCTs) which used PFM exercises with or without electrical stimulation. The search was conducted in August of 2013 in the databases of the U.S. National Library of Medicine (MEDLINE), Scientific Electronic Library Online (SciELO), Physiotherapy Evidence Database (PEDro) and Virtual Health Library (VHL). We searched for RCTs published between 1999 and 2013. As keywords for our search, we used the following descriptors from the Health Sciences Descriptors (DeCS): urinary incontinence, pelvic diaphragm, prostatectomy, pelvic floor exercises, electrostimulation and electrical stimulation. We also used the following descriptors from the Medical Subject Headings (MeSH): electrical stimulation, pelvic floor, urinary incontinence, prostatectomy, physiotherapy and exercise therapy. Results: Of the 59 RCTs found, 26 were excluded as duplicates, and 28 were excluded for not displaying a minimum score of 5.0 on the PEDro Scale, which left us with five RCTs. Conclusion: PFM exercises can be effective for treating UI after radical prostatectomy, especially if begun soon after surgery. Associating electrical stimulation with PFM exercises did not show additional benefit for treating urinary incontinence. However, the selected studies presented some methodological weaknesses that may have compromised their internal validity.
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Hsu LF, Liao YM, Lai FC, Tsai PS. Beneficial effects of biofeedback-assisted pelvic floor muscle training in patients with urinary incontinence after radical prostatectomy: A systematic review and metaanalysis. Int J Nurs Stud 2016; 60:99-111. [PMID: 27297372 DOI: 10.1016/j.ijnurstu.2016.03.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 03/16/2016] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This systematic review and metaanalysis compared the effects of biofeedback-assisted pelvic floor muscle training with those of pelvic floor muscle training alone in patients with urinary incontinence after radical prostetactomy. DESIGN A review and metaanalysis study design. DATA SOURCES The metaanalysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and MetaAnalyses guidelines. A systematic search of PubMed/Medline OVID, the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, BioMed Central, Web of Science, Chinese Electronic Periodical Services, Chinese Journal and Thesis Database, and China National Knowledge Infrastructure was performed for retrieving records. REVIEW METHODS For determining the effects of training type on urinary incontinence, randomized controlled trials on biofeedback-assisted pelvic floor muscle training with or without electrical stimulation were compared with those on pelvic floor muscle training with or without electrical stimulation, respectively, in the metaanalysis. The Cochrane Collaboration tool in the Cochrane Handbook for Systematic Review of Interventions 5.1.0 was used to assess the methodological quality of the included trials. Subjective and objective measurement of urinary incontinence improvement and the quality of life were the primary and secondary outcome measures, respectively. Data were analyzed using Comprehensive Meta-Analysis software 2.0. In addition, subgroup analyses and metaregression were performed to explore the possible sources of heterogeneity. RESULTS Thirteen randomized controlled trials involving 1108 patients with prostatectomy incontinence were included. The immediate-, intermediate-, and long-term effects of objectively measured biofeedback-assisted pelvic floor muscle training on urinary incontinence were significant (mean effect size=-0.316, -0.335, and -0.294; 95% CI: -0.589 to -0.043, -0.552 to -0.118 and -0.535 to -0.053; p=0.023, 0.002, and 0.017, respectively) when compared with those of pelvic floor muscle training alone. However, when urinary incontinence was measured subjectively, only the intermediate and long-term effects of biofeedback were found (p=0.034 and 0.005, respectively). Small-to-moderate immediate- and intermediate-term effects on the quality of life were observed when biofeedback-assisted pelvic floor muscle training was compared with pelvic floor muscle training alone. No publication bias was observed among studies. CONCLUSIONS Biofeedback can be an adjunct treatment to pelvic floor muscle training for reducing urinary incontinence in patients who have undergone radical prostatectomy.
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Affiliation(s)
- Lan-Fang Hsu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Yuan-Mei Liao
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Fu-Chih Lai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Sleep Science Center, Taipei Medical University Hospital, Taipei, Taiwan.
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Stafford RE, Coughlin G, Lutton NJ, Hodges PW. Validity of Estimation of Pelvic Floor Muscle Activity from Transperineal Ultrasound Imaging in Men. PLoS One 2015; 10:e0144342. [PMID: 26642347 PMCID: PMC4671687 DOI: 10.1371/journal.pone.0144342] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 11/17/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the relationship between displacement of pelvic floor landmarks observed with transperineal ultrasound imaging and electromyography of the muscles hypothesised to cause the displacements. MATERIALS AND METHODS Three healthy men participated in this study, which included ultrasound imaging of the mid-urethra, urethra-vesical junction, ano-rectal junction and bulb of the penis. Fine-wire electromyography electrodes were inserted into the puborectalis and bulbocavernosus muscles and a transurethral catheter electrode recorded striated urethral sphincter electromyography. A nasogastric sensor recorded intra-abdominal pressure. Tasks included submaximal and maximal voluntary contractions, and Valsalva. The relationship between each of the parameters measured from ultrasound images and electromyography or intra-abdominal pressure amplitudes was described with nonlinear regression. RESULTS Strong, non-linear relationships were calculated for each predicted landmark/muscle pair for submaximal contractions (R2-0.87-0.95). The relationships between mid-urethral displacement and striated urethral sphincter electromyography, and bulb of the penis displacement and bulbocavernosus electromyography were strong during maximal contractions (R2-0.74-0.88). Increased intra-abdominal pressure prevented shortening of puborectalis, which resulted in weak relationships between electromyography and anorectal and urethravesical junction displacement during all tasks. CONCLUSIONS Displacement of landmarks in transperineal ultrasound imaging provides meaningful measures of activation of individual pelvic floor muscles in men during voluntary contractions. This method may aid assessment of muscle function or feedback for training.
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Affiliation(s)
- Ryan E. Stafford
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Geoff Coughlin
- Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Nicholas J Lutton
- Department of Colorectal Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - Paul W. Hodges
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
- * E-mail:
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Mariotti G, Salciccia S, Innocenzi M, Gentilucci A, Fasulo A, Gentile V, Sciarra A. Recovery of Urinary Continence After Radical Prostatectomy Using Early vs Late Pelvic Floor Electrical Stimulation and Biofeedback-associated Treatment. Urology 2015; 86:115-20. [DOI: 10.1016/j.urology.2015.02.064] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 02/11/2015] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
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Stafford RE, Ashton-Miller JA, Constantinou C, Coughlin G, Lutton NJ, Hodges PW. Pattern of activation of pelvic floor muscles in men differs with verbal instructions. Neurourol Urodyn 2015; 35:457-63. [PMID: 25727781 DOI: 10.1002/nau.22745] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/14/2015] [Indexed: 11/08/2022]
Abstract
AIMS To investigate the effect of instruction on activation of pelvic floor muscles (PFM) in men as quantified by transperineal ultrasound imaging (US) and to validate these measures with invasive EMG recordings. METHODS Displacement of pelvic floor landmarks on transperineal US, intra-abdominal pressure (IAP) recorded with a nasogastric transducer, and surface EMG of the abdominal muscles and anal sphincter were recorded in 15 healthy men during sub-maximal PFM contractions in response to different verbal instructions: "tighten around the anus," "elevate the bladder," "shorten the penis," and "stop the flow of urine." In three men, fine-wire EMG recordings were made from puborectalis and bulbocavernosus, and trans-urethral EMG recordings from the striated urethral sphincter (SUS). Displacement data were validated by analysis of relationship with invasive EMG. Displacement, IAP, and abdominal/anal EMG were compared between instructions. RESULTS Displacement of pelvic landmarks correlated with the EMG of the muscles predicted anatomically to affect their locations. Greatest dorsal displacement of the mid-urethra and SUS activity was achieved with the instruction "shorten the penis." Instruction to "elevate the bladder" induced the greatest increase in abdominal EMG and IAP. "Tighten around the anus" induced greatest anal sphincter activity. CONCLUSIONS The pattern of urethral movement measured from transperineal US is influenced by the instructions used to teach activation of the pelvic floor muscles in men. Efficacy of PFM training may depend on the instructions used to train activation. Instructions that optimize activation of muscles with a potential to increase urethral pressure without increasing abdominal EMG/IAP are likely ideal. Neurourol. Urodynam. 35:457-463, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Ryan E Stafford
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - James A Ashton-Miller
- Departments of Mechanical and Biomedical Engineering, Institute of Gerontology, The University of Michigan, Ann Arbor, Michigan
| | - Chris Constantinou
- Department of Urology, School of Medicine, Stanford University, Palo Alto, California
| | - Geoff Coughlin
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Nicholas J Lutton
- Department of Colorectal Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - Paul W Hodges
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
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Anderson CA, Omar MI, Campbell SE, Hunter KF, Cody JD, Glazener CMA. Conservative management for postprostatectomy urinary incontinence. Cochrane Database Syst Rev 2015; 1:CD001843. [PMID: 25602133 PMCID: PMC7025637 DOI: 10.1002/14651858.cd001843.pub5] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Urinary incontinence is common after radical prostatectomy and can also occur in some circumstances after transurethral resection of the prostate (TURP). Conservative management includes pelvic floor muscle training with or without biofeedback, electrical stimulation, extra-corporeal magnetic innervation (ExMI), compression devices (penile clamps), lifestyle changes, or a combination of methods. OBJECTIVES To determine the effectiveness of conservative management for urinary incontinence up to 12 months after transurethral, suprapubic, laparoscopic, radical retropubic or perineal prostatectomy, including any single conservative therapy or any combination of conservative therapies. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register (5 February 2014), CENTRAL (2014, Issue 1), EMBASE (January 2010 to Week 3 2014), CINAHL (January 1982 to 18 January 2014), ClinicalTrials.gov and World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (both searched 29 January 2014), and the reference lists of relevant articles. SELECTION CRITERIA Randomised or quasi-randomised controlled trials evaluating conservative interventions for urinary continence in men after prostatectomy. DATA COLLECTION AND ANALYSIS Two or more review authors assessed the methodological quality of the trials and abstracted data. We tried to contact several authors of included studies to obtain extra information. MAIN RESULTS Fifty trials met the inclusion criteria, 45 in men after radical prostatectomy, four trials after TURP and one trial after either operation. The trials included 4717 men of whom 2736 had an active conservative intervention. There was considerable variation in the interventions, populations and outcome measures. Data were not available for many of the pre-stated outcomes. Men's symptoms improved over time irrespective of management.There was no evidence from eight trials that pelvic floor muscle training with or without biofeedback was better than control for men who had urinary incontinence up to 12 months after radical prostatectomy; the quality of the evidence was judged to be moderate (for example 57% with urinary incontinence in the intervention group versus 62% in the control group, risk ratio (RR) for incontinence after 12 months 0.85, 95% confidence interval (CI) 0.60 to 1.22). One large multi-centre trial of one-to-one therapy showed no difference in any urinary or quality of life outcome measures and had narrow CIs. It seems unlikely that men benefit from one-to-one PFMT therapy after TURP. Individual small trials provided data to suggest that electrical stimulation, external magnetic innervation, or combinations of treatments might be beneficial but the evidence was limited. Amongst trials of conservative treatment for all men after radical prostatectomy, aimed at both treatment and prevention, there was moderate evidence of an overall benefit from pelvic floor muscle training versus control management in terms of reduction of urinary incontinence (for example 10% with urinary incontinence after one year in the intervention groups versus 32% in the control groups, RR for urinary incontinence 0.32, 95% CI 0.20 to 0.51). However, this finding was not supported by other data from pad tests. The findings should be treated with caution because the risk of bias assessment showed methodological limitations. Men in one trial were more satisfied with one type of external compression device, which had the lowest urine loss, compared to two others or no treatment. The effect of other conservative interventions such as lifestyle changes remained undetermined as no trials involving these interventions were identified. AUTHORS' CONCLUSIONS The value of the various approaches to conservative management of postprostatectomy incontinence after radical prostatectomy remains uncertain. The evidence is conflicting and therefore rigorous, adequately powered randomised controlled trials (RCTs) which abide by the principles and recommendations of the CONSORT statement are still needed to obtain a definitive answer. The trials should be robustly designed to answer specific well constructed research questions and include outcomes which are important from the patient's perspective in decision making and are also relevant to the healthcare professionals. Long-term incontinence may be managed by an external penile clamp, but there are safety problems.
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Affiliation(s)
| | - Muhammad Imran Omar
- University of AberdeenAcademic Urology UnitAberdeenUKAB25 2ZD
- London School of Hygiene and Tropical MedicineLondonUK
| | - Susan E Campbell
- University of East AngliaSchool of Health SciencesEdith Cavell BuildingNorwich Research ParkNorwichUKNR4 7TJ
| | - Kathleen F Hunter
- University of AlbertaFaculty of Nursing3rd Floor Clinical Sciences BuildingEdmontonABCanadaT6G 2G3
| | - June D Cody
- University of AberdeenCochrane Incontinence Review Group2nd Floor, Health Sciences BuildingHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Cathryn MA Glazener
- University of AberdeenHealth Services Research Unit3rd Floor, Health Sciences BuildingForesterhillAberdeenScotlandUKAB25 2ZD
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Arroyo Fernández R, García-Hermoso A, Solera-Martínez M, Martín Correa MT, Ferri Morales A, Martínez-Vizcaíno V. Improvement of Continence Rate with Pelvic Floor Muscle Training Post-Prostatectomy: A Meta-Analysis of Randomized Controlled Trials. Urol Int 2014; 94:125-32. [DOI: 10.1159/000368618] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objective: The aim of this meta-analysis was to evaluate the evidence of the effect of pelvic floor muscle training on urinary incontinence after radical prostatectomy. Methods: A bibliographic search was conducted in four databases. Studies were grouped according to the intervention program (muscle training versus control and individual home-based versus physiotherapist-guided muscle training). Results: Eight studies were selected for meta-analysis after satisfying the selection criteria. The data show that pelvic floor muscle training improves continence rate in the short (RR = 2.16; p < 0.001), medium (RR = 1.45; p = 0.001) and long term (RR = 1.23; p = 0.019) after surgery. The number of randomized controlled trials and the heterogeneity in the study population and type of pelvic floor muscle training were the main limitations. Conclusion: Programs including at least three sets of 10 repetitions of muscle training daily appear to improve continence rate after radical prostatectomy. Our meta-analysis shows that muscle training programs for urinary incontinence provide similar results to those of physiotherapist-guided programs, therefore being more cost- effective.
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Burgio KL. Update on behavioral and physical therapies for incontinence and overactive bladder: the role of pelvic floor muscle training. Curr Urol Rep 2014; 14:457-64. [PMID: 23913199 DOI: 10.1007/s11934-013-0358-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Behavioral and physical therapies have been used for many years to treat incontinence and overactive bladder (OAB). This paper focuses on programs that include pelvic floor muscle training (PFMT) as a component in treatment for women or men. PFMT was long used almost exclusively for treatment of stress incontinence. When it became evident that voluntary pelvic floor muscle contraction can be used to control bladder function, PFMT was also integrated into the treatment of urge incontinence and OAB as part of a broader behavioral urge suppression strategy. PFMT has evolved over decades, both as a behavioral therapy and a physical therapy, combining principles from behavioral science, nursing, and muscle physiology into a widely recommended conservative treatment. The collective literature indicates that PFMT is effective for incontinence, as well as urgency, frequency, and nocturia. It can be combined with all other treatment modalities and holds potential for prevention of bladder symptoms.
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Efficacy of physiotherapy for urinary incontinence following prostate cancer surgery. BIOMED RESEARCH INTERNATIONAL 2014; 2014:785263. [PMID: 24868546 PMCID: PMC4017841 DOI: 10.1155/2014/785263] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/04/2014] [Indexed: 11/25/2022]
Abstract
The study enrolled 81 with urinary incontinence following radical prostate-only prostatectomy for prostatic carcinoma. The patients were divided into two groups. The patients in Group I were additionally subdivided into two subgroups with respect to the physiotherapeutic method used. The patients of subgroup IA received a rehabilitation program consisting of three parts. The patients of subgroup IB rehabilitation program consist of two parts. Group II, a control group, had reported for therapy for persistent urinary incontinence following radical prostatectomy but had not entered therapy for personal reasons. For estimating the level of incontinence, a 1-hour and 24-hour urinary pad tests, the miction diary, and incontinence questionnaire were used, and for recording the measurements of pelvic floor muscles tension, the sEMG (surface electromyography) was applied. The therapy duration depended on the level of incontinence and it continued for not longer than 12 months. Superior continence outcomes were obtained in Group I versus Group II and the difference was statistically significant. The odds ratio for regaining continence was greater in the rehabilitated Group I and smaller in the group II without the rehabilitation. A comparison of continence outcomes revealed a statistically significant difference between Subgroups IA versus IB. The physiotherapeutic procedures applied on patients with urine incontinence after prostatectomy, for most of them, proved to be an effective way of acting, which is supported by the obtained results.
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Kim JC, Cho KJ. Current trends in the management of post-prostatectomy incontinence. Korean J Urol 2012; 53:511-8. [PMID: 22949993 PMCID: PMC3427833 DOI: 10.4111/kju.2012.53.8.511] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 06/14/2012] [Indexed: 01/13/2023] Open
Abstract
One of the annoying complications of radical prostatectomy is urinary incontinence. Post-prostatectomy incontinence (PPI) causes a significant impact on the patient's health-related quality of life. Although PPI is stress urinary incontinence caused by intrinsic sphincter deficiency in most cases, bladder dysfunction and vesicourethral anastomotic stenosis can induce urine leakage also. Exact clinical assessments, such as a voiding diary, incontinence questionnaire, pad test, urodynamic study, and urethrocystoscopy, are necessary to determine adequate treatment. The initial management of PPI is conservative treatment including lifestyle interventions, pelvic floor muscle training with or without biofeedback, and bladder training. An early start of conservative treatment is recommended during the first year. If the conservative treatment fails, surgical treatment is recommended. Surgical treatment of stress urinary incontinence after radical prostatectomy can be divided into minimally invasive and invasive treatments. Minimally invasive treatment includes injection of urethral bulking agents, male suburethral sling, and adjustable continence balloons. Invasive treatment includes artificial urinary sphincter implantation, which is still the gold standard and the most effective treatment of PPI. However, the demand for minimally invasive treatment is increasing, and many urologists consider male suburethral slings to be an acceptable treatment for PPI. The male sling is usually recommended for patients with persistent mild or moderate incontinence. It is necessary to improve our understanding of the pathophysiologic mechanisms of PPI and to compare different procedures for the development of new and potentially better treatment options.
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Affiliation(s)
- Joon Chul Kim
- Department of Urology, The Catholic University of Korea School of Medicine, Seoul, Korea
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Stafford RE, Ashton-Miller JA, Constantinou CE, Hodges PW. Novel insight into the dynamics of male pelvic floor contractions through transperineal ultrasound imaging. J Urol 2012; 188:1224-30. [PMID: 22902016 DOI: 10.1016/j.juro.2012.06.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE Transperineal ultrasound imaging enables the minimally invasive assessment of pelvic floor muscle function. Although commonly used in women, the approach has rarely been reported in men. This approach has advantages because the midsagittal view visualizes a bony landmark and the entire urethral length. This allows investigation of the displacement of multiple points along the urethra and the unique mechanical actions of multiple muscles that could influence continence. We used a new transperineal ultrasound technique to compare the relative displacement of urethrovesical junction, anorectal junction and distal urethra during voluntary pelvic floor muscle contractions in continent men. MATERIALS AND METHODS We performed measurement and comparison of urethral displacement at specific urethral regions in 10 continent men (age range 28 to 41 years). Measures made on 2-dimensional midsagittal plane ultrasound images included the displacements of specific points along the urethra. Anatomical considerations suggest that these are caused by contraction of the levator ani, striated urethral sphincter and bulbocavernosus muscles. Pearson's correlation coefficient was used to investigate the relationship between displacements of pairs of points. RESULTS Data show individual variation in displacement of the distal urethra (striated urethral sphincter contraction) and urethrovesical junction (levator ani contraction). A strong inverse linear relationship (0.723) between displacements of these points indicates 2 alternative strategies of urethral movement. CONCLUSIONS Transperineal ultrasound imaging allows the simultaneous investigation of multiple pelvic floor muscles by measuring urethral displacement. The data provide evidence of different but coordinated strategies of urethral displacement in men.
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Affiliation(s)
- Ryan E Stafford
- Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, the University of Queensland, Brisbane, Australia
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Recovery of Overall Exercise Ability, Quality of Life, and Continence After 12-Week Combined Exercise Intervention in Elderly Patients Who Underwent Radical Prostatectomy: A Randomized Controlled Study. Urology 2012; 80:299-305. [DOI: 10.1016/j.urology.2011.12.060] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 12/06/2011] [Accepted: 12/09/2011] [Indexed: 11/18/2022]
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Tienforti D, Sacco E, Marangi F, D'Addessi A, Racioppi M, Gulino G, Pinto F, Totaro A, D'Agostino D, Bassi P. Efficacy of an assisted low-intensity programme of perioperative pelvic floor muscle training in improving the recovery of continence after radical prostatectomy: a randomized controlled trial. BJU Int 2012; 110:1004-10. [DOI: 10.1111/j.1464-410x.2012.10948.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Campbell SE, Glazener CM, Hunter KF, Cody JD, Moore KN. Conservative management for postprostatectomy urinary incontinence. Cochrane Database Syst Rev 2012; 1:CD001843. [PMID: 22258946 DOI: 10.1002/14651858.cd001843.pub4] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Urinary incontinence is common after both radical prostatectomy and transurethral resection of the prostate (TURP). Conservative management includes pelvic floor muscle training with or without biofeedback, electrical stimulation, extra-corporeal magnetic innervation (ExMI), compression devices (penile clamps), lifestyle changes, or a combination of methods. OBJECTIVES To assess the effects of conservative management for urinary incontinence after prostatectomy. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register (searched 24 August 2011), EMBASE (January 1980 to Week 48 2009), CINAHL (January 1982 to 20 November 2009), the reference lists of relevant articles, handsearched conference proceedings and contacted investigators to locate studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials evaluating conservative interventions for urinary continence in men after prostatectomy. DATA COLLECTION AND ANALYSIS Two or more review authors assessed the methodological quality of trials and abstracted data. We tried to contact several authors of included studies to obtain extra information. MAIN RESULTS Thirty-seven trials met the inclusion criteria, 33 amongst men after radical prostatectomy, three trials after transurethral resection of the prostate (TURP) and one trial after either operation. The trials included 3399 men, of whom 1937 had an active conservative intervention. There was considerable variation in the interventions, populations and outcome measures. Data were not available for many of the pre-stated outcomes. Men's symptoms improved over time irrespective of management. Adverse effects did not occur or were not reported.There was no evidence from eight trials that pelvic floor muscle training with or without biofeedback was better than control for men who had urinary incontinence after radical prostatectomy (e.g. 57% with urinary incontinence versus 62% in the control group, risk ratio (RR) for incontinence after 12 months 0.85, 95% confidence interval (CI) 0.60 to 1.22) as the confidence intervals were wide, reflecting uncertainty. However, one large multicentre trial of one-to-one therapy showed no difference in any urinary or quality of life outcome measures and had narrower confidence intervals. There was also no evidence of benefit for erectile dysfunction (56% with no erection in the pelvic floor muscle training group versus 55% in the control group after one year, RR 1.01, 95% CI 0.84 to 1.20). Individual small trials provided data to suggest that electrical stimulation, external magnetic innervation or combinations of treatments might be beneficial but the evidence was limited. One large trial demonstrated that there was no benefit for incontinence or erectile dysfunction from a one-to-one pelvic floor muscle training based intervention to men who were incontinent after transurethral resection of the prostate (TURP) (e.g. 65% with urinary incontinence versus 62% in the control group, RR after 12 months 1.05, 95% CI 0.91 to 1.23).In eight trials of conservative treatment of all men after radical prostatectomy aimed at both treatment and prevention, there was an overall benefit from pelvic floor muscle training versus control management in terms of reduction of UI (e.g. 10% with urinary incontinence after one year versus 32% in the control groups, RR for urinary incontinence 0.32, 95% CI 0.20 to 0.51). However, this finding was not supported by other data from pad tests. The findings should be treated with caution, as most trials were of poor to moderate quality and confidence intervals were wide. Men in one trial were more satisfied with one type of external compression device, which had the lowest urine loss, compared to two others or no treatment. The effect of other conservative interventions such as lifestyle changes remains undetermined as no trials involving these interventions were identified. AUTHORS' CONCLUSIONS The value of the various approaches to conservative management of postprostatectomy incontinence after radical prostatectomy remains uncertain. It seems unlikely that men benefit from one-to-one pelvic floor muscle training therapy after transurethral resection of the prostate (TURP). Long-term incontinence may be managed by external penile clamp, but there are safety problems.
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Affiliation(s)
- Susan E Campbell
- School of Nursing Sciences, Faculty of Medicine and Health Sciences,University of East Anglia, Norwich, UK
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Clinical exercise interventions in prostate cancer patients--a systematic review of randomized controlled trials. Support Care Cancer 2011; 20:221-33. [PMID: 21989678 DOI: 10.1007/s00520-011-1271-0] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 09/06/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Urinary incontinence, erectile dysfunction, fatigue as well as fears and depression rank among the most common complaints in patients with prostate cancer, resulting in a reduced participation in daily life and social isolation. Consequently, the quality of life of prostate cancer patients is strongly affected in a negative way. Numerous studies focusing on physical exercise interventions in prostate cancers patients demonstrate positive physiological and psychological effects. Our objective was to evaluate the evidence of randomized controlled studies which examined exercise during medical treatment and in the aftercare of a prostate cancer disease. METHODS Twenty-five randomized controlled trials regarding physical activities in patients with prostate cancer were obtained by systematic literature research (Medpilot). Twenty-one studies examined clinical exercise interventions during the phase of medical treatment (irradiation, pre- and/or post-op, androgen deprivation therapy) and four studies during the aftercare. In order to evaluate the evidence of the included studies, the evaluation system of the Oxford Centre for Evidence-Based Medicine was used. Within this systematic review, we differentiated between "supervised clinical exercise" and "non-supervised clinical exercise." RESULTS AND DISCUSSION Current data suggest that incontinence, fitness, fatigue, body constitution, and also quality of life can be improved by clinical exercise in patients during and after prostate cancer. Studies were mostly ranked evidence level "2b." Only four studies, all conducted during medical treatment, reached the level "1b." It seems to be that "supervised exercise" is more effective than "non-supervised exercise." For future research, further randomized controlled trials with high methodological quality need to be conducted in order to establish evidence-based recommendations particularly for prostate cancer patients.
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Glazener C, Boachie C, Buckley B, Cochran C, Dorey G, Grant A, Hagen S, Kilonzo M, McDonald A, McPherson G, Moore K, Norrie J, Ramsay C, Vale L, N'Dow J. Urinary incontinence in men after formal one-to-one pelvic-floor muscle training following radical prostatectomy or transurethral resection of the prostate (MAPS): two parallel randomised controlled trials. Lancet 2011; 378:328-37. [PMID: 21741700 DOI: 10.1016/s0140-6736(11)60751-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Urinary incontinence is common immediately after prostate surgery. Men are often advised to do pelvic-floor exercises, but evidence to support this is inconclusive. Our aim was to establish if formal one-to-one pelvic floor muscle training reduces incontinence. METHODS We undertook two randomised trials in men in the UK who were incontinent 6 weeks after radical prostatectomy (trial 1) or transurethral resection of the prostate (TURP; trial 2) to compare four sessions with a therapist over 3 months with standard care and lifestyle advice only. Randomisation was by remote computer allocation. Our primary endpoints, collected via postal questionnaires, were participants' reports of urinary incontinence and incremental cost per quality-adjusted life year (QALY) after 12 months. Group assignment was masked from outcome assessors, but this masking was not possible for participants or caregivers. We used intention-to-treat analyses to compare the primary outcome at 12 months. This study is registered, number ISRCTN87696430. FINDINGS In the intervention group in trial 1, the rate of urinary incontinence at 12 months (148 [76%] of 196) was not significantly different from the control group (151 [77%] of 195; absolute risk difference [RD] -1·9%, 95% CI -10 to 6). In trial 2, the difference in the rate of urinary incontinence at 12 months (126 [65%] of 194) from the control group was not significant (125 [62%] of 203; RD 3·4%, 95% CI -6 to 13). Adjusting for minimisation factors or doing treatment-received analyses did not change these results in either trial. No adverse effects were reported. In both trials, the intervention resulted in higher mean costs per patient (£180 and £209 respectively) but we did not identify evidence of an economically important difference in QALYs (0·002 [95% CI -0·027 to 0·023] and -0·00003 [-0·026 to 0·026]). INTERPRETATION In settings where information about pelvic-floor exercise is widely available, one-to-one conservative physical therapy for men who are incontinent after prostate surgery is unlikely to be effective or cost effective. The high rates of persisting incontinence after 12 months suggest a substantial unrecognised and unmet need for management in these men. FUNDING National Institute of Health Research, Health Technology Assessment (NIHR HTA) Programme.
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Affiliation(s)
- Cathryn Glazener
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK.
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Yamanishi T, Mizuno T, Watanabe M, Honda M, Yoshida KI. Randomized, placebo controlled study of electrical stimulation with pelvic floor muscle training for severe urinary incontinence after radical prostatectomy. J Urol 2010; 184:2007-12. [PMID: 20850831 DOI: 10.1016/j.juro.2010.06.103] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE We evaluated electrical stimulation combined with pelvic floor muscle training for urinary incontinence after radical prostatectomy in a randomized controlled study. MATERIALS AND METHODS A total of 56 men with severe urinary incontinence (more than 200 gm daily), mean ± SD age 66.6 ± 6.2 years, were randomized to an active treatment group (26) or a sham group (30). All patients performed pelvic floor muscle training preoperatively and continued throughout the study. For active stimulation 50 Hz square waves of 300 μs pulse duration and a 5 seconds on, 5 seconds off duty cycle were applied for 15 minutes twice daily with an anal electrode. Sham stimulation was limited to 3 mA with a 2 seconds on, 13 seconds off duty cycle. RESULTS In the active group 8 (36%), 14 (63%), 18 (81%) and 19 (86%) patients were continent (22) vs 1 (4%), 4 (16%), 11 (44%) and 17 (86%) in the sham group (25) (leakage less than 8 gm daily) after 1, 3, 6 and 12 months, respectively. There was a significant difference in the number of continent patients between the groups at 1, 3 and 6 months (p = 0.0161, p = 0.0021 and p = 0.0156, respectively). The time to achieve continence was significantly shorter in the active group (2.71 ± 2.6 months) than in the sham group (6.82 ± 3.9 months, p = 0.0006). Changes in the amount of leakage, the International Consultation on Incontinence Questionnaire-Short Form score and the King's Health Questionnaire score were significantly larger in the active group at 1 month but there was no difference at 12 months. CONCLUSIONS Electrical stimulation resulted in earlier recovery of continence in patients with urinary incontinence after radical prostatectomy.
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Ribeiro LHS, Prota C, Gomes CM, de Bessa J, Boldarine MP, Dall'Oglio MF, Bruschini H, Srougi M. Long-Term Effect of Early Postoperative Pelvic Floor Biofeedback on Continence in Men Undergoing Radical Prostatectomy: A Prospective, Randomized, Controlled Trial. J Urol 2010; 184:1034-9. [DOI: 10.1016/j.juro.2010.05.040] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Indexed: 11/26/2022]
Affiliation(s)
| | - Cristina Prota
- Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Cristiano M. Gomes
- Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - José de Bessa
- Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Marcos F. Dall'Oglio
- Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Homero Bruschini
- Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Miguel Srougi
- Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil
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Nyarangi-Dix JN, Schultz-Lampel D, Hohenfellner U, Huber J, Hatiboglu G, Djakovic N, Haferkamp A, Hohenfellner M. [Conservative management of postoperative urinary incontinence in men]. Urologe A 2010; 49:498-503. [PMID: 20376652 DOI: 10.1007/s00120-010-2264-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Urinary incontinence in men most commonly occurs after radical prostatectomy. Of these patients, 3-23% remain incontinent a year after prostatectomy. Data on conservative therapy for postoperative incontinence is contradictory. Nonetheless, conservative treatment strategies must generally be attempted before any operative technique. Early pelvic floor muscle training with or without biofeedback therapy and duloxetine seem to have a positive effect on continence. Further randomised controlled studies are necessary to accurately assess other conservative therapeutic options such as extracorporeal magnetic innervation and electrical stimulation therapy.
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Affiliation(s)
- J N Nyarangi-Dix
- Urologische Universitätsklinik, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
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Dubbelman Y, Groen J, Wildhagen M, Rikken B, Bosch R. The recovery of urinary continence after radical retropubic prostatectomy: a randomized trial comparing the effect of physiotherapist-guided pelvic floor muscle exercises with guidance by an instruction folder only. BJU Int 2010; 106:515-22. [DOI: 10.1111/j.1464-410x.2010.09159.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Hodgkinson B, Tuckett A, Hegney D, Paterson J, Kralik D. Effectiveness of educational interventions to raise men's awareness of bladder and bowel health. ACTA ACUST UNITED AC 2010; 8:1202-1241. [PMID: 27820391 DOI: 10.11124/01938924-201008300-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
EXECUTIVE SUMMARY Urinary incontinence (UI) has been defined as a condition in which the involuntary loss of urine is a social or hygienic problem and is objectively demonstrable. Urinary incontinence is a common health problem that carries with it significant medical, psychosocial and economic burdens. Fecal incontinence has been defined as the involuntary or inappropriate passing of liquid or solid stool and can also include the incontinence of flatus. Studies suggest that twice as many men suffer from fecal incontinence compared to urinary incontinence whilst more than three times as many women suffer from urinary incontinence compared to fecal incontinence. The general consensus in the literature is that barriers exist for seeking help for those with incontinence. REVIEW QUESTION: 'How effective are educational interventions at raising men's awareness of bladder and bowel health?' TYPES OF PARTICIPANTS Adult and adolescent males (age 12 years and over). TYPES OF INTERVENTIONS Any intervention, program or action that provided information, or attempted to raise awareness of men's bladder and bowel health. TYPES OF OUTCOME MEASURES The primary outcomes of interest included any measure defined by included studies such as: TYPES OF STUDIES: As this review attempted to evaluate the effectiveness of an intervention or interventions, reviewers considered studies using concurrent controls. SEARCH STRATEGY The search strategy was designed to identify both published and unpublished material and was restricted to English language publications with a publication date of 10 years prior to the search with the exception of a review of seminal papers before this time. ASSESSMENT OF METHODOLOGICAL QUALITY The quality of included studies was assessed by two reviewers using the Joanna Briggs Institute Checklists for experimental and observational studies. DATA EXTRACTION For each included paper the type of information that was extracted and tabulated in a database followed the JBI Data Extraction Form for Experimental and Observational Studies. DATA SYNTHESIS Where possible relative risk (RR), odds ratios (OR), Mean differences and associated 95% confidence intervals (95% CI) were calculated from individual studies. For homogeneous studies quantitative results were combined into a meta-analysis for evaluation of the overall effect of an intervention. Where heterogeneity existed between studies the results were presented in a narrative summary. REVIEW RESULTS The review identified 12 RCT and 2 controlled trials. Ten studies evaluated the effectiveness of interventions on the incidence of urinary incontinence symptoms in men after prostatectomy Only two trials examined interventions to manage post-micturition dribble, one evaluated the effectiveness of lifestyle and behavioural modifications to manage lower urinary tract symptoms and one evaluated the use of a consensus guideline for the management of continence by primary health care teams in an urban general practice.No controlled trials evaluated interventions to improve men's knowledge or management of bowel health, or to improve men's attendance at promotional events.Few of the RCT described the method of randomisation and no trials reported using blinding either to assessment or to treatment.Two studies did not provide the measures of dispersion (no standard deviation), one study provided graphical data only and one presented no data whatsoever.Pelvic floor muscle exercises with or without additional interventions are effective at reducing the incidence of urinary incontinence in men >65 years who have had a prostatectomy.Education on lifestyle and behavioural modifications may be more effective in reducing lower urinary tract symptoms than doing nothing.Pelvic floor muscle exercisesmay be effective in treating post-micturition dribble in men with or without erectile dysfunction.Providing verbal feedback to participants to support pelvic floor muscle exercises technique appears to be as effective as biofeedback for improvement of urinary incontinence symptoms in this group.No evidence for the effectiveness of education interventions on faecal incontinence orNo evidence for the effectiveness of education interventions to improve men's attendance at promotional events. DISCUSSION The results of this review have highlighted that with the exception of pelvic floor muscle exercises (PME) after prostatectomy, few controlled trials have examined the effectiveness of any interventions at raising awareness of bladder and bowel health in males aged 12 years and over.The majority of trials that evaluated interventions to manage bladder and bowel health presented data for both male and female in a combined form making it impossible to estimate the effect of the intervention(s) on male participants only. In some cases, where the male data were presented separately, the population was too small to provide adequate power, and therefore most comparisons between treatment groups were found to have statistically insignificant differences in effectiveness. CONCLUSIONS There is little quantitative evidence for the effectiveness of interventions to improve men's awareness of bladder and bowel health. Therefore few recommendations can be made. Pelvic floor muscle exercises with or without additional interventions such as biofeedback could be used to reduce the incidence of urinary incontinence in men who have had a prostatectomy.Education on lifestyle and behavioural modifications may be more effective in reducing lower urinary tract symptoms than doing nothing.Pelvic floor muscle exercises may be effective in treating post-micturition dribble in men with or without erectile dysfunction.With the exception of instruction of pelvic floor muscle exercises for men after prostatectomy, little quantitative research has been performed that establishes the effectiveness of interventions on men's awareness of bladder and bowel health. While numerous interventions have been trialed on mixed gender populations, and these trials suggest that the interventions would be effective, their effectiveness on the male component cannot be definitively established. Therefore, well designed controlled trials using male sample populations only are needed to confirm these suppositions.
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Affiliation(s)
- Brent Hodgkinson
- 1 Senior Business Improvement Officer (Best Practice), Blue Care Queensland and Core Team Member Australian Centre for Evidence Based Community Care a Joanna Briggs Institute Collaborating Center. Contact: (07) 3720 5306 2 The University of Queensland, Senior Lecturer, The University of Queensland/Blue Care Research and Practice Development Centre, Contact: (07) 3720 5405 3 Professor and Director of Research, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore 4 Flinders University, Professor of Nursing (Aged Care). Contact: (08) 8201 3266 5 Royal District Nursing Service (RDNS) of South Australia Inc., Director, Associate Professor, RDNs Research Unit. Contact: (08) 8201 3266
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Early Recovery of Urinary Continence After Radical Prostatectomy Using Early Pelvic Floor Electrical Stimulation and Biofeedback Associated Treatment. J Urol 2009; 181:1788-93. [DOI: 10.1016/j.juro.2008.11.104] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Indexed: 11/27/2022]
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Bauer RM, Bastian PJ, Gozzi C, Stief CG. Postprostatectomy incontinence: all about diagnosis and management. Eur Urol 2008; 55:322-33. [PMID: 18963418 DOI: 10.1016/j.eururo.2008.10.029] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Accepted: 10/14/2008] [Indexed: 10/21/2022]
Abstract
CONTEXT The ever-increasing number of radical prostatectomies entails an increasing number of patients suffering from postprostatectomy stress incontinence despite improved surgical techniques. We provide an overview of the current diagnosis and treatment of postprostatectomy stress incontinence. OBJECTIVE To review previous and recent literature on this subject and to assess the current standards of diagnosis and management of postprostatectomy incontinence. EVIDENCE ACQUISITION The PubMed database was searched, and all articles published since 2000 were evaluated. EVIDENCE SYNTHESIS This review presents the current recommended diagnostic tools and available noninvasive and invasive treatment options. CONCLUSIONS The European Association of Urology (EAU) recommends a two-stage assessment for diagnosis of postprostatectomy incontinence. Noninvasive therapy, pelvic floor-muscle training and biofeedback, is recommended in early postoperative and mild incontinence. Pharmacological treatment with duloxetine is especially effective in combination with physiotherapy, where it synergistically improves the continence rate. For surgical treatment, the insertion of an artificial urinary sphincter, AS-800, is still the gold standard. In recent years, several minimal invasive treatment options have been introduced with different rates of success, but they have not yet surpassed the results of the artificial sphincter.
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Affiliation(s)
- Ricarda M Bauer
- Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Munich, Germany.
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Moore KN, Valiquette L, Chetner MP, Byrniak S, Herbison GP. Return to continence after radical retropubic prostatectomy: a randomized trial of verbal and written instructions versus therapist-directed pelvic floor muscle therapy. Urology 2008; 72:1280-6. [PMID: 18384853 DOI: 10.1016/j.urology.2007.12.034] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 11/24/2007] [Accepted: 12/05/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To test the effectiveness of weekly postoperative pelvic floor muscle training (PFMT) versus supportive telephone contact by a urology nurse for men at 4 weeks after radical prostatectomy. METHODS This was a randomized controlled trial in three Canadian centers. At 4 weeks after surgery, standardized verbal and written instruction about PFMT was provided to all subjects. Randomization occurred after initial instruction. Continence was defined as 8 g or less of urine loss on a 24-hour pad test. Primary outcome was grams of urine loss on pad test; secondary outcomes were International Prostate Symptom Score (IPSS), Incontinence Impact Questionnaire (IIQ-7) score, cost, and perception of urine loss as a problem. Data were obtained at baseline (preoperatively) and at weeks 4, 8, 12, 16, and 28 and 1 year after surgery. RESULTS A total of 216 men were enrolled; 11 were dry or withdrew at 4 weeks. Ninety-nine were randomized to the control group and 106 to the treatment group. There were no group differences at baseline for prostate-specific antigen level (mean [standard deviation] 8.4 [10.4] ng/mL; 7.6 [4.6] ng/mL), Gleason score (6.3 [0.86]), IPSS, IIQ-7 score, pad test, or voiding diary. At 8 weeks 23% of the control group and 20% of the treatment group were continent; at 12 weeks, 28% and 32%; 16 weeks, 40% and 44%; 28 weeks, 50% and 47%; and at 52 weeks, 64% and 60%, respectively. There were no significant differences between groups at any time point for the outcome variables. CONCLUSIONS Verbal instruction and written information with telephone support seemed to be as effective as intensive PFMT. Less-intense therapy may be more cost-effective.
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Affiliation(s)
- Katherine N Moore
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
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Lebret T, Cour F, Benchetrit J, Grise P, Bernstein J, Delaporte V, Chartier-Kastler E, Botto H, Costa P. Treatment of Postprostatectomy Stress Urinary Incontinence Using a Minimally Invasive Adjustable Continence Balloon Device, ProACT: Results of a Preliminary, Multicenter, Pilot Study. Urology 2008; 71:256-60. [DOI: 10.1016/j.urology.2007.08.062] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Revised: 06/19/2007] [Accepted: 08/31/2007] [Indexed: 11/28/2022]
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MacDonald R, Fink HA, Huckabay C, Monga M, Wilt TJ. Pelvic floor muscle training to improve urinary incontinence after radical prostatectomy: a systematic review of effectiveness. BJU Int 2007; 100:76-81. [PMID: 17433028 DOI: 10.1111/j.1464-410x.2007.06913.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of pelvic floor muscle training (PFMT) for treating urinary incontinence (UI) after radical prostatectomy (RP) by reviewing evidence from randomized trials. METHODS Randomized trials published in English were included if they involved men with UI after RP and compared PFMT with a control group. Data were abstracted onto a standardized form using a prospectively developed protocol. RESULTS Eleven trials randomizing 1028 men (mean age 64 years) met the inclusion criteria; the duration of the trials was 3-12 months. One trial of 300 men found that those assigned to PFMT achieved continence more quickly (after 1, 3 and 6 months) than men not assigned to PFMT. Men receiving biofeedback-enhanced PFMT were more likely to achieve continence or have no continual leakage than those with no training within 1-2 months after RP (relative benefit increase 1.54; 95% confidence interval 1.01-2.34; four trials reporting). The relative benefit increase (1.19, 0.82-1.72; five studies) was no longer significant after 3-4 months. Biofeedback-enhanced PFMT was comparable to written/verbal PFMT instruction. Extracorporeal magnetic innervation (ExMI) and electrical stimulation (ES) were found to be initially (within 1-2 months) more effective than PFMT in one trial, but there were no significant differences between groups at > or = 3 months. CONCLUSION Based on available evidence, PFMT with or without biofeedback enhancement hastens the return to continence more than no PFMT in men with UI after RP. Additional trials are needed to confirm whether ExMI and ES are effective conservative treatment options.
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Affiliation(s)
- Roderick MacDonald
- Minneapolis Veterans Affairs Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417, USA
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