A novel multifaceted physical therapy approach for stress incontinence secondary to prostatectomy: Randomized controlled trial.

METHOD: 40 men with stress urinary incontinence (SUI) secondary to radical prostatectomy were randomly assigned to two groups (control = 20, treatment = 20). The treatment group received a novel multifaceted approach (including interferential therapy, a combination of exercise therapy approaches, and manual therapy) and the control group received sham electrotherapy. Both groups received 12 sessions of treatment in one month. Outcome measures include SF12 form to assess the quality of life and bladder diary to assess incontinence parameters including urination amount, fluid intake, urinary frequency, and incontinence frequency. RESULT: treatment group shows significant improvement in comparison with the control group in quality of life (control group from 29.6 ± 4.5 to 31.0 ± 4.9 and the treatment group from 30.6 ± 4.4 to 42.2 ± 2.4, P = 0.003), urinary frequency (control group from 10.1 ± 2.0 to 9.2 ± 1.8 and treatment group from 9.7 ± 1.91 to 7.1 ± 1.1, P = 0.038), and incontinence frequency (control group from 7.0 ± 2.2 to 6.4 ± 2.0 and treatment group from 7.8 ± 2.4 to 1.2 ± 1.1, P = 0.003). Also, urination amount (control group from 1621.50 ± 403.7 to 1507.2 ± 402.3 and treatment group from 1638.3 ± 356.1 to 1360.55 ± 360.9, P = 0.503) and fluid intake (control group from 2024.0 ± 595.5 to 1865.2 ± 596.5 and treatment group from 2184.4 ± 484.5 to 1724.2 ± 596.6, P = 0.987) showed no significant difference between the two groups after the treatment sessions. CONCLUSION: the multifaceted approach presented here, consists of electrotherapy (interferential therapy), exercise therapy, and manual therapy that can improve incontinence and quality of life in patients with stress incontinence secondary to prostatectomy. To determine the long-term efficacy of this approach, studies with long-term evaluation are required.

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.

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 signifi cantly improve urinary continence or erectile function at 3 months after RP.

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

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.

Terapias alternativas para la recuperación temprana de la continencia urinaria posterior a la prostatectomía: una revisión sistemática / Terapias alternativas para recuperação precoce da continência urinária pós-prostatectomia: revisão sistemática / Alternative therapies for early recovery of post-prostatectomy urinary continence: systematic review

Objetivo: Realizar una revisión sistemática de la evidencia sobre la eficacia de entrenamiento de los músculos del suelo pélvico (EMSP) en el tratamiento de la incontinencia urinaria posterior a la prostatectomía. Métodos: Una revisión sistemática realizada em Ovid MEDLINE, EMBASE y LILACS en Portugués, Inglés y Español, límite de tiempo: 2005-2015. Resultados: 9 estudios examinaron la eficacia de los asociados o no con la biorretroalimentación y la estimulación eléctrica TMAP. Conclusión: El EMSP con o sin biorretroalimentación y la estimulación eléctrica pueden contribuir a la pronta recuperación de la continencia. Los pacientes con dificultad inicial de la identificación de los músculos del suelo pélvico pueden beneficiarse de sesiones de electroestimulación de biofeedback. Una mayor integración de la enfermera es posible en la atención relacionada con el pronto retorno de la continencia en pacientes post-prostatectomía mediante el establecimiento de los ejercicios de fortalecimiento del suelo pélvico y terapia conductual

Objetivo: Conduzir uma revisão sistemática a cerca das evidências da efetividade do Treinamento dos Músculos do Assoalho Pélvico (TMAP) no tratamento da incontinência urinária pós-prostatectomia. Método: Revisão sistemática realizada nas bases de dados MEDLINE/OVID, EMBASE e LILACS nos idiomas português, inglês e espanhol, limite temporal: 2005-2015. Resultados: 9 estudos analisaram a efetividade do TMAP associado ou não ao biofeedback e eletroestimulação. Conclusão: TMAP associados ou não ao biofeedback e eletroestimulação podem contribuir na recuperação precoce da continência. Pacientes com dificuldade inicial de identificação dos músculos do assoalho pélvico podem se beneficiar de sessões de eletroestimulação e biofeedback. É possível uma maior inserção do enfermeiro nos cuidados relacionados ao retorno precoce da continência em pacientes pós-prostatectomizados através da instituição dos exercícios de fortalecimento do assoalho pélvico e terapia comportamental

Aim: To conduct a systematic review of the evidence of the effectiveness of Pelvic Floor Muscle Training (PFMT) in the treatment of post-prostatectomy urinary incontinence. Method: Systematic review conducted in Ovid MEDLINE, EMBASE and LILACS in Portuguese, English and Spanish, with the time limit: 2005-2015. Results: 9 studies analyzed the effectiveness of PFMT associated or not with biofeedback (BFB) and electrical stimulation (ES). Conclusion: PFMT with or without the biofeedback and electrical stimulation may contribute to the early recovery of continence. Patients with initial difficulty of identifying the pelvic floor muscles can benefit from ES followed BFB sessions of structured PFMT. A greater participation of nurses in the care related to the early return of continence in post-prostatectomy patients is possible through the implementation of pelvic floor muscle exercises and behavioral therapy

Fisioterapia en la incontinencia urinaria severa y disfunción eréctil posprostatectomía: estudio de un caso / Physiotherapy in severe urinary incontinence and erectile dysfunction after prostatectomy: a case study

Antecedentes y objetivo: La prostatectomía radical se ha convertido en el gold standard para tratar el cáncer de próstata. Se han desarrollado nuevas técnicas quirúrgicas para intentar maximizar los resultados en la resección del tumor y minimizar las secuelas, naciendo así la prostatectomía radical robótica. Aunque parece mostrar unos mejores resultados, el porcentaje de pacientes con secuelas como la incontinencia urinaria y la disfunción eréctil sigue siendo importante. Se ha probado que la fisioterapia puede contribuir a la resolución de estas secuelas acortando los tiempos de curación en la prostatectomía abierta y en la laparoscópica. El objetivo de este trabajo es conocer los efectos del tratamiento de fisioterapia en las secuelas de la prostatectomía radical robótica. Descripción del caso: Paciente de 63 años intervenido de prostatectomía radical robótica por adenocarcinoma de próstata, Gleason 6 (3+3), bilateral. Al inicio del tratamiento el paciente presenta incontinencia muy severa, con una pérdida de 332g en el Pad test 1h y una disfunción severa con una puntuación de 5 en el cuestionario International Index of Erectile Function(IIEF-15). Intervención: Aplicación de un programa de fisioterapia que consiste en toma de conciencia, biofeedback barométrico y electroestimulación intracavitaria, de la musculatura suelo pélvico, realizado 3 días/semana con una duración de 1h durante 32 semanas. Resultados y discusión: El paciente alcanza la función eréctil a los 6 meses, con una puntuación de 26 en el IIEF-15 y la continencia a los 8 meses, con 0g de pérdida en el Pad test 1h

Background and objective: Radical prostatectomy has become the reference method for treating prostate cancer. New surgical techniques have been developed to try to maximize results in tumour resection and minimize sequelae, resulting in radical robotic prostatectomy. Although there appear to be better outcomes, there are still a significant percentage of patients with sequelae, such as urinary incontinence and erectile dysfunction. It has been shown that physiotherapy can contribute to the resolution of these sequelae by shortening healing times in open and laparoscopic prostatectomy. The aim of this study is to determine the effects of physiotherapy treatment on the sequelae of radical robotic prostatectomy. Case report: A 63-year-old patient underwent robotic radical prostatectomy for prostate adenocarcinoma, Gleason 6 (3+3), bilateral. At the beginning of the treatment, the patient had very severe incontinence, with a loss of 332g in the 1-h pad test, and a severe dysfunction with a score of 5 in the International Index of Erectile Function questionnaire (IIEF-15). Intervention: Application of a physiotherapy program consisting of awareness, barometric biofeedback, and intracavitary electrostimulation of the pelvic floor musculature, performed 3 days/week, 1h for 32 weeks. Results and discussion: The patient achieved erectile function at 6 months, with a score of 26 in the IIEF-15, and continence at 8 months, with 0g of loss in the 1-h pad test

Patient-reported quality of life recovery curves after robotic prostatectomy are similar across body mass index categories.

PURPOSE: To assess the impact of body mass index (BMI) on postoperative recovery curve of urinary and sexual function after robotic-assisted laparoscopic prostatectomy (RALP). We hypothesized that overweight and obese men have different recovery curves than normal weight men. MATERIALS AND METHODS: We reviewed preoperative and postoperative surveys from 691 men who underwent RALP from 2004-2014 in an integrated healthcare delivery system. Survey instruments included: sexual health inventory for men (SHIM), urinary behavior, leakage, and incontinence impact questionnaire (IIQ). A repeated measures analysis with autoregressive covariance structure was employed with linear splines with 2 knots for the time factor. We fit unadjusted and adjusted models and stratified by BMI (under/normal weight, overweight, and obese). Adjusted models included age, race/ethnicity, smoking status, diabetes, operation length, prostate-specific antigen, pathologic stage, nerve-sparing status, and surgery year. RESULTS: Mean age was 59 years. Most men were overweight (43%) and obese (42%). There were no significant differences in mean baseline SHIM, urinary behavior, leakage, and IIQ scores by BMI category. All groups had initial steep declines in urinary and sexual function in the first 3 months after RALP. There were no significant differences in postoperative urinary and sexual function score curves by BMI category. CONCLUSIONS: The pattern of urinary and sexual function recovery was similar across all BMI categories. Overweight and obese men may be counseled that urinary and sexual function recovery curves after surgery is similar to that of normal weight men.

Resultados en la calidad de vida y la severidad de la incontinencia urinaria tras rehabilitación en varones prostatectomizados por neoplasia de próstata / Results of rehabilitation on quality of life and urinary incontinence severity after radical prostatectomy

Introducción. La incontinencia urinaria en varones tras prostatectomía radical puede suponer un problema importante de calidad de vida. El tratamiento rehabilitador disminuye las pérdidas urinarias y el empleo de protectores, mejorando así la calidad de vida de estos pacientes. Material y métodos. Se evaluó una cohorte de 84 varones tras cirugía radical de próstata. Todos los pacientes presentaban incontinencia urinaria secundaria a la cirugía y 71 pacientes completaron el tratamiento rehabilitador. La media de edad de los pacientes fue de 64 años. El tiempo medio de sondaje vesical postoperatorio fue de 23,4 días. Se analizaron los resultados obtenidos en las escalas de Sandvik e ICIQ y la cantidad de protectores empleados antes y después del tratamiento. Los pacientes realizaron una media de 12,7 sesiones de rehabilitación. Resultados. Se analizaron las diferencias obtenidas en ambas escalas y en el empleo de protectores y su correlación mediante el test de Wilcoxon y el coeficiente de Spearman. Se observó una mejoría estadísticamente significativa en los resultados obtenidos en las escalas de valoración antes y después del tratamiento rehabilitador (p < 0,0005); los porcentajes de cambio en los resultados obtenidos en dichas escalas se correlacionaron de forma estadísticamente significativa con la disminución en el empleo de protectores al finalizar el tratamiento. Conclusión. El tratamiento rehabilitador es útil para mejorar la calidad de vida y disminuir la severidad de la incontinencia urinaria en pacientes sometidos a cirugía radical de próstata (AU)

Introduction. Male urinary incontinence after radical prostatectomy can substantially impair quality of life. Rehabilitation is used to reduce urinary leakage and the use of pads and diapers, and consequently to improve quality of life. Material and methods. A total of 84 patients were evaluated after radical prostatectomy. All of them had postoperative urinary incontinence and 71 completed rehabilitation treatment. The mean age was 64 years. The mean length of bladder catheterization after surgery was 23.4 days. The results of the Sandvik and International Consultation on Incontinence Questionnaire scales and pad use were analyzed before and after rehabilitation treatment. The mean length of rehabilitation treatment was 12.7 days. Results. The Wilcoxon and Spearman tests showed a significant pos-treatment improvement in both scales (p < .0005). This improvement was significantly correlated with a decrease in pad use at the end of the treatment. Conclusion. Rehabilitation treatment is useful to improve quality of life and decrease the severity of urinary incontinence in men after radical prostatectomy (AU)

Recovery of Urinary Continence After Radical Prostatectomy Using Early vs Late Pelvic Floor Electrical Stimulation and Biofeedback-associated Treatment.

OBJECTIVE: To compare the early vs late use of pelvic floor electrical stimulation (FES) plus biofeedback (BF) in terms of time to recovery and rate of continence after radical prostatectomy (RP). MATERIALS AND METHODS: Between April 2007 and April 2012, a total of 120 patients who underwent RP were prospectively included in the study. In group 1 (60 cases), we included patients who presented a urinary leakage weight ≥50 g for 24 hours, 14 days after catheter removal. In group 2 (60 cases), we included patients who continued to present a urinary leakage weight ≥50 g for 24 hours, 12 months after surgery. In both groups, patients were prospectively submitted to the same program of BF+FES. RESULTS: Mean leakage weight became significantly lower (P <.002) in group 1 than in group 2 starting from visit 1 (2 weeks) through visit 7 (24 weeks). However, a significant difference (P <.05) between the 2 groups in terms of percentage of continent patients was achieved only at 2 weeks (group 1 = 20%; group 2 = 0%) and 4 weeks (group 1 = 66.7%; group 2 = 46.7%). The objective continence rate 6 months after the beginning of treatment was 96.7% in group 1 and 91.7% in group 2. CONCLUSION: In our experience, the treatment with BF and FES has a significant positive effect on the recovery of urinary continence independently to the time in which it is used (early vs delayed). This protocol might represent a noninvasive method for all patients undergoing RP, also in a 12-month interval from surgery.

Predictors of short-term recovery of urinary continence after radical prostatectomy.

PURPOSE: To evaluate treatment variables for early urinary continence status 6 weeks following radical prostatectomy. METHODS: In this retrospective analysis, 4,028 consecutive patients underwent open radical retropubic (RRP) or robot-assisted transperitoneal prostatectomy (RARP) at a single academic institution (07/2003-07/2013). After discharge, patients were offered 3-week treatment in a rehabilitation facility. Patients who opted for rehabilitation (n = 2,998, 74.4%) represent our study cohort. Exclusion criteria were acute urinary retention after catheter removal (n = 55, 1.4%), incomplete datasets (n = 50, 1.2%) or refusal of rehabilitation (n = 925, 23.0%). Results of urinary continence were evaluated from final rehabilitation reports. Twenty-two clinical and oncological variables were statistically analysed in uni- and multivariable analyses to determine whether they were associated with early urinary continence status six weeks after radical prostatectomy. Odds ratios and 95% CI as well as p values were calculated. A p level of 0.05 was considered as significant. RESULTS: Six weeks after surgery, 1,962 (65.4%) patients were continent (≤1 pad/day) and 1,036 (34.6%) patients were considered incontinent. Age, clinical stage, PSA, ASA score, prior TURP, seminal vesicle invasion, Gleason score, nerve-sparing status, intraoperative blood loss, catheterisation time, OR time, surgical caseload >1,000 and the surgeon were associated with continence status on univariable analysis (p < 0.05). On multivariable analysis, nerve-sparing procedure (NS), clinical stage, individual surgeon, patient age, surgical procedure (RARP vs. RRP) and duration of catheterisation were independent predictors (p < 0.05) of incontinence status. CONCLUSIONS: Strategies that can ensure NS procedures and early catheter removal should be applied to enable early recovery of urinary continence.

Efectividad de la intervención con biofeedback en el tratamiento conservador de la incontinencia urinaria posprostatectomía. Una revisión sistemática / Effectiveness of biofeedback intervention for the conservative management of post-prostatectomy urinary incontinence. A systematic review

Objetivo. Determinar la efectividad de las intervenciones con biofeedback en el tratamiento de la incontinencia urinaria posprostatectomía. Materiales y métodos. Se realizó una revisión sistemática en las bases de datos de CENTRAL, Pubmed/MEDLINE, EMBASE y CINAHL. El riesgo de sesgo en los estudios incluidos fue evaluado mediante la escala PEDro (Scale for Rating Quality of Randomized Controlled Trials). Selección de los estudios. Fueron incluidos ensayos controlados aleatorios, con pacientes adultos, con diagnóstico de incontinencia urinaria posprostatectomía que incorporaran el uso de biofeedback dentro del tratamiento conservador. Resultados. Ocho estudios cumplieron los criterios de inclusión. Las intervenciones con biofeedback incluyeron el uso de instrucciones verbales y escritas, electromiografía y sonda rectal. Conclusiones. Existe evidencia limitada a favor de la efectividad del biofeedback en el tratamiento de la incontinencia urinaria posprostatectomía (AU)

Objective. To determine the effectiveness of biofeedback for the treatment of post-prostatectomy urinary incontinence. Materials and methods. A systematic review was conducted in the CENTRAL, Pubmed/MEDLINE, EMBASE and CINAHL data bases. Risk of bias in the studies included was assessed with the PEDro scale (Rating Quality of Randomized Controlled Trials). Study selection. Randomized controlled trials with adult patients diagnosed of post-prostatectomy urinary incontinence involving biofeedback for the conservative management were included. Results. Eight studies met the inclusion criteria. Biofeedback interventions included verbal and written instructions, electromyography and anal catheter. Conclusions. There is limited evidence supporting the effectiveness of biofeedback on the treatment of post-prostatectomy urinary incontinence (AU)

Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, randomized, controlled trial.

Erectile dysfunction (ED) and urinary incontinence are common complications following radical prostatectomy (RP). Although pelvic-floor biofeedback training (PFBT) may improve urinary continence following RP, its effects on the recovery of potency are unknown. Fifty-two patients selected for RP were prospectively randomized for a treatment group (n=26) receiving PFBT once a week for 3 months and home exercises or a control group (n=26), in which patients received verbal instructions to contract the pelvic floor. Erectile function (EF) was evaluated with the International Index of Erectile Function-5 (IIEF-5) before surgery and 1, 3, 6 and 12 months postoperatively. Patients were considered potent when they had a total IIEF-5 score>20. Continence status was assessed and defined as the use of no pads. Groups were comparable in terms of age, body mass index, diabetes, pathological tumor stage and neurovascular bundle preservation. A significant reduction in IIEF-5 scores was observed after surgery in both groups. In the treatment group, 8 (47.1%) patients recovered potency 12 months postoperatively, as opposed to 2 (12.5%) in the control group (P=0.032). The absolute risk reduction was 34.6% (95% confidence interval (CI): 3.8-64%) and the number needed to treat was 3 (95% CI: 1.5-17.2). A strong association between recovery of potency and urinary continence was observed, with continent patients having a 5.4 higher chance of being potent (P=0.04). Early PFBT appears to have a significant impact on the recovery of EF after RP. Urinary continence status was a good indicator of EF recovery, with continent patients having a higher chance of being potent.

Vacuum erection devices revisited: its emerging role in the treatment of erectile dysfunction and early penile rehabilitation following prostate cancer therapy.

INTRODUCTION: Vacuum erection devices (VEDs) are becoming first-line therapies for the treatment of erectile dysfunction and preservation (rehabilitation) of erectile function following treatment for prostate cancer. Currently, there is limited efficacy of the use of phosphodiesterase type 5 inhibitors in elderly patients, or patients with moderate to severe diabetes, hypertension, and coronary artery disease. AIM: The article aims to study the role of VED in patients following prostate cancer therapy. RESULTS: Alternative therapies such as VED have emerged as one of the primary options for patients refractory to oral therapy. VED has also been successfully used in combination treatment with oral therapy and penile injections. More recently, there has been interest in the use of VED in early intervention protocols to encourage corporeal rehabilitation and prevention of postradical prostatectomy veno-occlusive dysfunction. This is evident by the preservation of penile length and girth that is seen with early use of the VED following radical prostatectomy. There are ongoing studies to help preserve penile length and girth with early use of VED following prostate brachytherapy and external beam radiation for prostate cancer. Recently, there has also been interest in the use of VED to help maintain penile length following surgical correction of Peyronie's disease and to increase penile size prior to implantation of the penile prosthesis. CONCLUSION: VEDs can be one of the options for penile rehabilitation after prostate cancer therapy.

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.

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.

Entrenamiento en técnicas de relajaciónen pacientes sometidos a cirugía urológica / No disponible

La mayoría de los pacientes sometidos a cirugía de próstata y vejiga en el posoperatorio son portadores de sonda vesical, que en algunasocasiones, produce espasmos vesicales. Éstos producen cierto grado de dolor y muchas veces la analgesia o los lavados manuales soninefectivos. Además tenemos que sumar el estrés que produce la hospitalización y el nuevo estado de salud. Dada la visión holística delos profesionales de enfermería, hemos entrenado y enseñado a nuestros pacientes técnicas sencillas de relajación y se ha conseguido disminuirel dolor percibido por el paciente (AU)

Most of patients under prostate and bladder surgery at post-intervention are carrying vesicle catheter, which sometimes produces vesicalspasms. Those produce certain grade of pain and frequently, anaesthesic products or manual washouts are ineffective.Furthermore, we have to add stress produced by hospitalization and new health status. Given the holistic vision of nursing staff, we havetrained and taught our patients some relaxation techniques, and reduction on self-related pain was achieved (AU)

Effects of combined pelvic floor muscle exercise and a support group on urinary incontinence and quality of life of postprostatectomy patients.

PURPOSE/OBJECTIVES: To examine the effect of combined pelvic floor muscle exercise (PFME) and a support group on postprostatectomy urinary incontinence and quality of life. DESIGN: Pilot study of a randomized, controlled clinical trial. SETTING: Two metropolitan hospitals in northeastern Ohio. SAMPLE: 29 men with postprostatectomy urinary incontinence. METHODS: The participants learned PFME through biofeedback and were randomized to the control group (n = 15) or the support group (n = 14). The control group practiced PFME at home, whereas the support group attended six biweekly group meetings facilitated by a health psychologist. Assessment of urinary incontinence and quality of life was conducted at baseline and three months. MAIN RESEARCH VARIABLES: Urinary incontinence and disease-specific quality of life. FINDINGS: Eighty-six percent of the support group participants versus 46% of the control group participants practiced PFME four to seven days per week. The support group had a lower rating of urinary incontinence based on a 0- to 10-point visual analog rating scale than the control group (X = 3.2 versus 4.7), and fewer support group participants used pads (50%) than control group participants (85%) at three months. The support group also scored significantly lower on the severity of incontinence problems than the control group at three months, especially in relationship with spouse and social outing, despite no group difference in these areas at baseline. CONCLUSIONS: The study provided promising evidence regarding the effect of the proposed intervention on adherence to PFME, urinary incontinence, and quality of life. IMPLICATIONS FOR NURSING: Reports regarding nursing practice are lacking with respect to PFME. This study suggests that practicing PFME in a group with patients with incontinence who have undergone prostatectomy can be a useful nursing intervention.

Noninvasive therapies for treating post-prostatectomy urinary incontinence.

Incorporation of a noninvasive program for both body and mind can lead to successful outcomes in men suffering from post-prostatectomy urinary incontinence. Key factors in the initial assessment and a detailed description of effective, unique treatment interventions for men with post-prostatectomy urinary incontinence are described.