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1.
Int Braz J Urol ; 45(6): 1196-1203, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808408

RESUMO

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.


Assuntos
Disfunção Erétil/reabilitação , Exercícios de Alongamento Muscular/métodos , Diafragma da Pelve/fisiopatologia , Assistência Perioperatória/métodos , Prostatectomia/reabilitação , Incontinência Urinária/reabilitação , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Gradação de Tumores , Estadiamento de Neoplasias , Neurorretroalimentação , Estudos Prospectivos , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia
2.
Actas urol. esp ; 43(10): 526-535, dic. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185258

RESUMO

Contexto y objetivo: La incontinencia urinaria es el efecto secundario con mayor impacto en la calidad de vida después de la prostatectomía radical. El objetivo de nuestro artículo es revisar la evidencia científica actual sobre las variaciones quirúrgicas descritas para preservar la continencia urinaria después de la prostatectomía radical. Adquisición de la evidencia: Se realizó una revisión sistemática de la literatura en PubMed, Cochrane y ScienceDirect según los criterios PRISMA (Preferred reporting items for systematic reviews and meta-analyses), utilizando los términos: urinary continence, urinary incontinence, urinary leakage, radical prostatectomy, open radical prostatectomy, laparoscopic prostatectomy, robot assisted laparoscopic prostatectomy, robotic prostatectomy y los criterios de selección PICO. Se identificaron 1.603 referencias de las que se seleccionaron 27 publicaciones que cumplieron los criterios de inclusión, 6 fueron ensayos clínicos aleatorizados y 4 metaanálisis. Síntesis de la evidencia: Las técnicas más empleadas para alcanzar una continencia urinaria precoz son la preservación del cuello vesical, de las bandeletas neurovasculares y la reconstrucción del rabdoesfínter, siendo esta la técnica con mayor evidencia, ya que existen 3 ensayos clínicos aleatorizados. Pese que algunas variaciones técnicas han conseguido mejorías en los resultados funcionales, la ausencia de consenso en la definición de incontinencia urinaria y la manera de evaluarla no permiten elaborar recomendaciones técnicas basadas en evidencia científica de calidad. Conclusiones: La reconstrucción del rabdoesfínter es la única técnica que ha demostrado mejoría en la recuperación precoz de la continencia urinaria tras la prostatectomía radical. La evidencia científica actual es heterogénea y limitada, por lo que son necesarios estudios aleatorizados bien diseñados para evaluar las modificaciones técnicas


Background and objective: Urinary incontinence is the adverse effect with more impact on patients’ quality of life after undergoing radical prostatectomy. The objective of this study is to review the present evidence that describes the variations on surgical techniques which aim to preserve urinary continence after radical prostatectomy. Evidence acquisition: We searched the literature on PubMed, Cochrane, and ScienceDirect according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement, using the PICO review protocol. The search terms were urinary continence, urinary incontinence, urinary leakage, radical prostatectomy, open radical prostatectomy, laparoscopic prostatectomy, robot-assisted laparoscopic prostatectomy, robotic prostatectomy. We identified 1,603 registers, and 27 articles were reviewed for meeting the inclusion criteria. Six of them are randomized clinical trials and 4 of them, meta-analysis. Evidence synthesis: The surgical techniques more frequently used to achieve early urinary continence are bladder neck and neurovascular bundles preservation, as well as the reconstruction of the rhabdosphincter. The latter has been presented in three randomized clinical trials. Even though some approaches have obtained improved functional outcomes, the lack of consensus on the definition of urinary incontinence and its measurement methods have not advocated for the creation of technical recommendations based on scientific evidence. Conclusions: The reconstruction of the rhabdosphincter is the only technique that has shown improved functional results through randomized trials. The current evidence is limited and heterogenous, and more studies with consistent criteria are needed in order to establish a standard surgical technique


Assuntos
Humanos , Masculino , Prostatectomia/métodos , Prostatectomia/reabilitação , Incontinência Urinária/reabilitação , Qualidade de Vida , Medicina Baseada em Evidências , Incontinência Urinária/complicações , Robótica , Uretra/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos
4.
Rehabilitación (Madr., Ed. impr.) ; 53(1): 8-12, ene.-mar. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185406

RESUMO

Objetivo: Identificar las situaciones que puedan hacer variar en algún sentido los resultados de las herramientas Pad test 1 y 24horas e ICIQ-SF. Participantes: Cinco fisioterapeutas que realizaron las entrevistas y tratamiento a 81 pacientes intervenidos de prostatectomía radical. Método: Se realizó un estudio cualitativo fenomenológico descriptivo, mediante técnica de grupo focal de 5 personas (4 mujeres y un hombre) responsables del tratamiento y valoración de pacientes con incontinencia urinaria tras prostatectomía. Se transcribieron las grabaciones realizadas y se utilizó el programa Atlas.ti7 para codificar las variables. Resultados: Se identificaron importantes factores a tener en cuenta en el uso de los instrumentos de medida para el diagnóstico y valoración de la incontinencia urinaria en todas las herramientas utilizadas. Conclusiones: Existen situaciones que pueden modificar la objetividad de las distintas pruebas para la valoración de la incontinencia urinaria. Así se ha detectado, entre otras, una menor ingesta de líquidos, una menor actividad, utilización de pinza manual o de orinales para evitar las pérdidas, así como la interferencia con el uso de determinados fármacos


Objective: To identify situations that may alter the results of the 1-hour and 24-hour Pad test and the short-form International Consultation in Incontinence Questionnaire (SF-ICIQ). Participants: Five physiotherapists, who conducted the interviews and treatment of 81 patients undergoing radical prostatectomy. Method: A qualitative descriptive phenomenological study was carried out, using a focus group technique with five people (4 women and 1 man) responsible for the treatment and assessment of patients with urinary incontinence after prostatectomy. Recordings were transcribed and the Atlas.ti7 programme was used to carry out the coding of the variables. Results: Important factors were identified in the use of measuring instruments for the diagnosis and assessment of urinary incontinence in all the tools used. Conclusions: Some situations can modify the objectivity of the various tests for the assessment of urinary incontinence. Some of the factors identified were lower fluid intake, less activity, use of manual clamp or urinals to avoid leakage, as well as the interference of certain drugs


Assuntos
Humanos , Masculino , Incontinência Urinária/diagnóstico , Prostatectomia/reabilitação , Psicometria/instrumentação , Neoplasias da Próstata/reabilitação , Urodinâmica/fisiologia , Incontinência Urinária/reabilitação , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Pesquisa Qualitativa , Grupos Focais
5.
Prog Urol ; 29(1): 29-35, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30337057

RESUMO

OBJECTIVE: There is controversy around prostate cancer (PCa) screening through the use of PSA, due to the risk of overtreatment. The current trend observed in various European and American studies is a decrease in the number of radical prostatectomy (RP) in low-risk PCa and an increase for intermediate or locally advanced diseases. The objective of this study was to observe the migration of the pathological stages from radical prostatectomy (RP) over 10 years in France through 2 French centers. METHODS: It was a multicentric retrospective study, where all the RP realized in 2 French tertiary centers, in a laparoscopic or retropubic approach for each of the years 2005, 2010 and 2015 were included. Preoperative data (age, PSA, clinical stage, number of positive biopsies, Gleason biopsy score) and postoperative data (pTNM, pathological Gleason score (pGS)) were analyzed and compared. RESULTS: In all, 1282 RP were realized (503 in 2005, 403 in 2010, 376 in 2015). Respectively between 2005, 2010, 2015 the average number of positive biopsy increased significantly from 2.30 vs. 2.88 vs. 5.3 (P=0.0001). The distribution of D'Amico's risk evolves with time: low-risk: 49.9 vs. 44.4 vs. 15.7% (P=0.0001); intermediate risk: 40.95 vs. 43.92 vs. 64.1% (P=0.0001) and high-risk: 9.15 vs. 11.66 vs. 20.2% (P=0.0001) between 2005, 2010 and 2015 respectively. pGS evolved to higher score with SG<7: 22.8 vs. 29.9 vs. 7.1% et SG≥7: 77.2 vs. 70.1 vs. 92.9% (P=0.001). Also, pTNM increased to non-organ-confined disease: pT2: 66.9 vs. 51.9 vs. 48.7%; pT3: 33.1 vs. 48.1 vs. 51.3% (P=0.0001). CONCLUSION: This study showed a change in the management of PCa since new recommendations from medical authorities about PSA screening and evolving of conservative treatment. Number of RP increase for higher risk PCa. This change corresponds to better patient selection for RP: decrease for low-risk and increase for high-risk organ-confined disease. LEVEL OF EVIDENCE: 3.


Assuntos
Prostatectomia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Idoso , Progressão da Doença , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Período Pós-Operatório , Antígeno Prostático Específico/sangue , Prostatectomia/métodos , Prostatectomia/reabilitação , Prostatectomia/estatística & dados numéricos , Neoplasias da Próstata/sangue , Neoplasias da Próstata/epidemiologia , Estudos Retrospectivos , Fatores de Risco
6.
Cochrane Database Syst Rev ; 10: CD012414, 2018 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-30352488

RESUMO

BACKGROUND: Despite efforts to preserve the neurovascular bundles with nerve-sparing surgery, erectile dysfunction remains common following radical prostatectomy. Postoperative penile rehabilitation seeks to restore erectile function but results have been conflicting. OBJECTIVES: To evaluate the effects of penile rehabilitation strategies in restoring erectile function following radical prostatectomy for prostate cancer. SEARCH METHODS: We performed a comprehensive search of multiple databases (CENTRAL, MEDLINE, Embase), the Cochrane Library, Web of Science, clinical trial registries (ClinicalTrials.gov, International Clinical Trials Registry Platform) and a grey literature repository (Grey Literature Report) from their inception through to 3 January 2018. We also searched the reference lists of other relevant publications and abstract proceedings. We applied no language restrictions. SELECTION CRITERIA: We included randomised or quasi-randomised trials with a parallel or cross-over design. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. Two review authors independently screened the literature, extracted data, assessed risk of bias and rated quality of evidence according to GRADE on a per-outcome basis. Primary outcomes were self-reported potency, erectile function measured by validated questionnaires (with potency defined as an International Index of Erectile Function (IIEF-EF) score of 19 or greater and or an IIEF-5 of score of 17 or greater) and serious adverse events. For all quality of life assessments on a continuous scale, higher values indicated better quality of life. MAIN RESULTS: We included eight randomised controlled trials with 1699 participants across three comparisons. This abstract focuses on the primary outcomes of this review only.Scheduled phosphodiesterase type 5 inhibitors (PDE5I) versus placebo or no treatmentScheduled PDE5I may have little or no effect on short-term (up to 12 months) self-reported potency (risk ratio (RR) 1.13, 95% confidence interval (CI) 0.91 to1.41; very low quality evidence), which corresponds to 47 more men with self-reported potency per 1000 (95% CI 33 fewer to 149 more) and short-term erectile function as assessed by a validated instrument (RR 1.11, 95% CI 0.80 to 1.55; very low quality evidence), which corresponds to 28 more men per 1000 (95% CI 50 fewer to 138 more), but we are very uncertain of both of these findings. Scheduled PDE5I may result in fewer serious adverse events compared to placebo (RR 0.32, 95% CI 0.11 to 0.94; low quality evidence), though this does not appear biologically plausible and may represent a chance finding. We are also very uncertain of this finding. We found no long-term (longer than 12 months) data for any of the three primary outcomes.Scheduled PDE5I versus on-demand PDE5I Daily PDE5I appears to result in little to no difference in both short-term and long-term (greater than 12 months) self-reported potency (short term: RR 0.97, 95% CI 0.62 to 1.53; long term: RR 1.00, 95% CI 0.60 to 1.67; both very low quality evidence); this corresponds to nine fewer men with self-reported short-term potency per 1000 (95% CI 119 fewer to 166 more) and zero fewer men with self-reported long-term potency per 1000 (95% CI 153 fewer to 257 more). We are very uncertain of these findings. Daily PDE5I appears to result in little to no difference in short-term and long-term erectile function (short term: RR 1.00, 95% CI 0.65 to 1.55; long term; RR 0.74, 95% CI 0.48 to 1.14; both very-low quality evidence), which corresponds to zero men with short-term erectile dysfunction per 1000 (95% CI 80 fewer to 125 more) and 119 fewer men with long-term erectile dysfunction per 1000 (95% CI 239 fewer to 64 more). We are very uncertain of these findings. Scheduled PDE5I may result in little or no effects on short-term adverse events (RR 0.69 95% CI 0.12 to 4.04; very low quality evidence), which corresponds to seven fewer men with short-term serious adverse events (95% CI 18 fewer to 64 more), but we are very uncertain of these findings. We found no long-term data for serious adverse events.Scheduled PDE5I versus scheduled intraurethral prostaglandin E1At short-term follow-up, daily PDE5I may result in little or no effect on self-reported potency (RR 1.10, 95% CI 0.79, to 1.52; very low quality evidence), which corresponds to 46 more men per 1000 (95% CI 97 fewer to 241 more). Daily PDE5I may result in a small improvement of erectile function (RR 1.64, 95% CI 0.84 to 3.20; very low quality evidence), which corresponds to 92 more men per 1000 (95% CI 23 fewer to 318 more) but we are very uncertain of both these findings. We found no long-term (longer than 12 months) data for any of the three primary outcomes.We found no evidence for any other comparisons and were unable to perform any of the preplanned subgroup analyses based on nerve-sparing approach, age or baseline erectile function. AUTHORS' CONCLUSIONS: Based on mostly very-low and some low-quality evidence, penile rehabilitation strategies consisting of scheduled PDE5I use following radical prostatectomy may not promote self-reported potency and erectile function any more than on demand use.


Assuntos
Disfunção Erétil/reabilitação , Ereção Peniana/fisiologia , Complicações Pós-Operatórias/reabilitação , Prostatectomia/reabilitação , Neoplasias da Próstata/cirurgia , Alprostadil/administração & dosagem , Esquema de Medicação , Disfunção Erétil/etiologia , Humanos , Masculino , Inibidores da Fosfodiesterase 5/efeitos adversos , Inibidores da Fosfodiesterase 5/uso terapêutico , Prostatectomia/efeitos adversos , Qualidade de Vida , Inquéritos e Questionários , Agentes Urológicos/administração & dosagem , Suspensão de Tratamento/estatística & dados numéricos
7.
Int Urol Nephrol ; 50(11): 2007-2014, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30232721

RESUMO

AIM: To evaluate the role of low-intensity extra corporeal shock wave therapy (LI-ESWT) in penile rehabilitation (PR) post nerve-sparing radical cystoprostatectomy (NS-RCP). MATERIALS AND METHODS: This study included 152 sexually active men with muscle invasive bladder cancer. After bilateral NS-RCP with orthotopic diversion by a single expert surgeon between June 2014 and July 2016, 128 patients were available categorized into three groups: LI-ESWT group (42 patients), phosphodiesterase type-5 inhibitors (PDE5i) group (43 patients), and control group (43 patients). RESULTS: Mean age was 53.2 ± 6.5 years. Mean ± SD follow-up period was 21 ± 8 months. During first follow-up FU1, all patients of the three groups had insufficient erection for vaginal penetration; with decrease of preoperative IIEF-EF mean score from 27.9 to 6.9. Potency recovery rates at 9 months were 76.2%, 79.1%, and 60.5% in LI-ESWT, PDE5i, and control groups, respectively. There was statistically significant increase in IIEF-EF and EHS scores during all follow-up periods in all the study groups (p < 0.001). However, there was no significant difference between the three groups during all follow-up periods. Statistical evaluation showed no significant difference in continence and oncological outcomes during all follow-up points among the three groups (p = 0.55 and 0.07, respectively). CONCLUSIONS: During last follow-up, 16% more patients in LI-ESWT group had recovery of potency as compared to the control group. Although the difference is not statistically significant, but of clinical importance. LI-ESWT is safe as oral PDE5i in penile rehabilitation post nerve-sparing radical cystoprostatectomy.


Assuntos
Carcinoma/cirurgia , Cistectomia/reabilitação , Disfunção Erétil/reabilitação , Tratamento por Ondas de Choque Extracorpóreas/métodos , Prostatectomia/reabilitação , Neoplasias da Bexiga Urinária/cirurgia , Adulto , Carcinoma/patologia , Cistectomia/efeitos adversos , Disfunção Erétil/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Fosfodiesterase 5/uso terapêutico , Prostatectomia/efeitos adversos , Recuperação de Função Fisiológica , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologia
8.
Surg Oncol ; 27(2): 289-298, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29937184

RESUMO

INTRODUCTION: Preoperative exercise and fitness are predictors of surgical recovery; however, little is known of the effect of preoperative exercise-based conditioning, known as prehabilitation, in this for men undergoing radical prostatectomy. Our study examined the feasibility and effects of prehabilitation on perioperative and postoperative outcomes in men undergoing radical prostatectomy. METHODS: This feasibility RCT compared prehabilitation (PREHAB) versus a control condition (CON) in 86 men undergoing radical prostatectomy. PREHAB consisted of home-based, moderate-intensity exercise prior to surgery. Both groups received a preoperative pelvic floor training regimen. Feasibility was assessed via rates of recruitment, attrition, intervention duration and adherence, and adverse events. Clinical outcomes included surgical complications, and length of stay. The following outcomes were assessed at baseline, prior to surgery, and 4, 12, and 26-weeks postoperatively: 6-min walk test (6MWT), upper-extremity strength, quality of life, psychosocial wellbeing, urologic symptoms, and physical activity volume. RESULTS: The recruitment rate was 47% and attrition rates were 25% and 33% for PREHAB and CON, respectively. Adherence to PREHAB was 69% with no serious intervention-related adverse events. After the intervention and prior to surgery, PREHAB participants demonstrated less anxiety (P = 0.035) and decreased body fat percentage (P = 0.001) compared to CON. Four-weeks postoperatively, PREHAB participants had greater 6MWT scores of clinical significance compared to CON (P = 0.006). Finally, compared to CON, grip strength and anxiety were also greater in the PREHAB at 26-weeks (P = 0.022) and (P = 0.025), respectively. CONCLUSION: While feasible and safe, prehabilitation has promising benefits to physical and psychological wellbeing at salient timepoints relative to radical prostatectomy.


Assuntos
Terapia por Exercício/métodos , Complicações Pós-Operatórias , Cuidados Pré-Operatórios/métodos , Prostatectomia/reabilitação , Neoplasias da Próstata/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Viabilidade , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/psicologia , Qualidade de Vida , Resultado do Tratamento
9.
Enferm. glob ; 17(50): 542-556, abr. 2018. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-173564

RESUMO

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


Assuntos
Humanos , Masculino , Incontinência Urinária/enfermagem , Incontinência Urinária/terapia , Prostatectomia/enfermagem , Bibliometria , Cuidados de Enfermagem/estatística & dados numéricos , Prostatectomia/reabilitação
10.
Fisioterapia (Madr., Ed. impr.) ; 40(2): 101-104, mar.-abr. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-171703

RESUMO

Antecedentes y objetivos: La incontinencia urinaria posprostatectomía radical es la complicación secundaria a la cirugía más común y afecta negativamente a la calidad de vida. A pesar de que el entrenamiento de la musculatura del suelo pélvico es una de las opciones más recomendadas de tratamiento conservador para la incontinencia urinaria posprostatectomía, en los últimos años el ejercicio hipopresivo (EH) ha cobrado popularidad como método de fisioterapia alternativo. El objetivo del estudio fue describir los resultados y el protocolo de intervención basado en EH con contracción añadida de la musculatura del suelo pélvico en un caso de incontinencia urinaria posprostatectomía. Descripción del caso: Se presenta un paciente de 46 años con incontinencia urinaria persistente 6 meses después de una prostatectomía radical por neoplasia de próstata. Inicialmente, el paciente requiere del uso de 3 compresas diarias y presenta incontinencia urinaria severa al esfuerzo al puntuar 15 en el cuestionario International Consultation on Incontinence Questionnaire-Short Form. Intervención: Se aplicó un protocolo de 30 semanas consistente en una sesión semanal supervisada de 8 EH con contracción añadida de la musculatura del suelo pélvico. A partir de las semana 12 se añade una sesión domiciliaria semanal de 3 EH combinados. Resultados: Tras completar 48 sesiones a lo largo de 30 semanas, el paciente no requiere el uso de compresas y se reducen la sintomatología y la severidad de la incontinencia urinaria, obteniendo una puntuación de 6 en el International Consultation on Incontinence Questionnaire-Short Form. Discusión: La evolución tras el tratamiento de fisioterapia ha sido favorable tras 30 semanas de intervención


Background and objective: Post-prostatectomy urinary incontinence is the most common secondary complication from surgery and negatively affects quality of life. Although the training of the pelvic floor muscles is one of the most recommended options for the conservative treatment of post-prostatectomy urinary incontinence, in the past few years hypopressive exercise (HE) has gained popularity as an alternative method. The purpose of this study was to describe the protocol and clinical outcomes of an intervention based on HE combined with contraction of the pelvic floor muscles in a case of post-prostatectomy urinary incontinence. Case report: The patient was a 46-year-old male with persistent incontinence 6 months after surgery. Initially, the patient used up to 3 incontinence pads daily and presented with severe stress urinary incontinence. The assessment, based on the International Consultation on Incontinence Questionnaire-Short Form, revealed a score of 15. Intervention: The 30-week protocol consisted of one weekly supervised session of 8 HE combined with contraction of the pelvic floor muscles. In addition to the supervised sessions, after 12 weeks of training, 3 HE were performed at home once per week. Results: Following 48 sessions over 30 weeks, the patient no longer used pads and reduced the symptoms and severity of urinary incontinence with a score of 6 on the International Consultation on Incontinence Questionnaire-Short Form


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Incontinência Urinária/reabilitação , Incontinência Urinária/cirurgia , Terapia por Exercício , Prostatectomia/reabilitação , Modalidades de Fisioterapia , Diafragma da Pelve/fisiologia , Inquéritos e Questionários
11.
Fisioterapia (Madr., Ed. impr.) ; 40(1): 44-47, ene.-feb. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-171541

RESUMO

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


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Incontinência Urinária/reabilitação , Disfunção Erétil/reabilitação , Prostatectomia/métodos , Prostatectomia/reabilitação , Modalidades de Fisioterapia , Cuidados Pós-Operatórios/reabilitação , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/reabilitação
12.
Investig Clin Urol ; 58(5): 331-338, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28868504

RESUMO

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.


Assuntos
Sobrepeso/complicações , Prostatectomia/reabilitação , Neoplasias da Próstata/cirurgia , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/reabilitação , Idoso , Índice de Massa Corporal , Disfunção Erétil/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Obesidade/complicações , Medidas de Resultados Relatados pelo Paciente , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Incontinência Urinária/etiologia
15.
Prostate Cancer Prostatic Dis ; 20(4): 395-400, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28462944

RESUMO

BACKGROUND: To ascertain 3-year urinary continence (UC) and sexual function (SF) recovery following robot-assisted radical prostatectomy (RARP) for clinically high-risk prostate cancer (PCa). METHODS: Retrospective analyses of a prospectively maintained database for 769 patients with D'Amico high-risk PCa undergoing RARP at two tertiary care centers in the United States and Europe between 2001 and 2014. The association between time since RARP and recovery of UC (defined as 0 pad/one safety liner per day) and SF (defined as sexual health inventory for men (SHIM) score ⩾17) was tested in separate preoperative and post-operative Cox-proportional hazards regression models. Sensitivity analyses were conducted using continence 0 pad per day and erection sufficient for intercourse as end points for UC and SF recovery, respectively. RESULTS: Mean age of the cohort was 62.3 years, and 62.1% harbored ⩾PT3a disease. Nerve sparing (unilateral or bilateral) RARP was performed in 87.7% of patients. Kaplan-Meier estimates of UC recovery at 12, 24 and 36 months after surgery was 85.2%, 89.1% and 91.2%, respectively, while 33.8, 52.3 and 69.0% of preoperatively potent men (preoperative SHIM ⩾17; n=548; 71.3%) recovered SF. Similar results were noted in sensitivity analyses. Patient age and year of surgery were associated with UC and SF recovery; additionally, preoperative SHIM score, degree of nerve sparing, pT3b-T4 disease and surgical margins were associated with SF recovery over the period of observation. CONCLUSIONS: Patients with D'Amico high-risk PCa treated with RARP may continue to recover UC and SF beyond 12 months of surgery and show promising outcomes at 3-year follow-up. Appropriate patient selection and counseling may aid in setting realistic expectations for functional recovery post RARP.


Assuntos
Disfunção Erétil/fisiopatologia , Prostatectomia/reabilitação , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/reabilitação , Idoso , Disfunção Erétil/reabilitação , Disfunção Erétil/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/fisiopatologia , Neoplasias da Próstata/reabilitação , Robótica , Resultado do Tratamento , Coletores de Urina
16.
Rehabilitation (Stuttg) ; 56(4): 248-256, 2017 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-28359112

RESUMO

We evaluated processes in in- and outpatient rehabilitation after radical prostatectomy. Overall, we analyzed motivation and expectations of 119 in- and 719 outpatients (aged≤64) at the beginning of rehabilitation as well as satisfaction and the amount of interventions at the end. Compared to inpatients outpatients had a higher socio-economic status and better physical condition. Both groups reported similar outcomes regarding motivation, expectation and satisfaction. Furthermore in- and outpatients got a comparable amount of interventions, but both groups differed to some extent in regard to the kind of interventions. In- and outpatients are comparable in regard to their received amount of interventions. Discrepancies concerning the kind of interventions are due to differences between in- and outpatients. The results indicate specific patients' characteristics in both settings, but more research is needed to verify these findings.


Assuntos
Assistência Ambulatorial , Admissão do Paciente , Prostatectomia/reabilitação , Neoplasias da Próstata/cirurgia , Glândulas Seminais/cirurgia , Assistência Ambulatorial/psicologia , Seguimentos , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Satisfação do Paciente , Prostatectomia/psicologia , Neoplasias da Próstata/psicologia , Inquéritos e Questionários , Resultado do Tratamento
17.
J Sex Med ; 14(3): 285-296, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28262099

RESUMO

INTRODUCTION: Sexual dysfunction is common in patients after radical prostatectomy (RP) for prostate cancer. AIM: To provide the International Consultation for Sexual Medicine (ICSM) 2015 recommendations concerning prevention and management strategies for post-RP erectile function impairment in terms of preoperative patient characteristics and intraoperative factors that could influence erectile function recovery. METHODS: A literature search was performed using Google and PubMed databases for English-language original and review articles published up to August 2016. MAIN OUTCOME MEASURES: Levels of evidence (LEs) and grades of recommendations (GRs) based on a thorough analysis of the literature and committee consensus. RESULTS: Nine recommendations are provided by the ICSM 2015 committee on sexual rehabilitation after RP. Recommendation 1 states that clinicians should discuss the occurrence of postsurgical erectile dysfunction (temporary or permanent) with every candidate for RP (expert opinion, clinical principle). Recommendation 2 states that validated instruments for assessing erectile function recovery such as the International Index of Erectile Function and Expanded Prostate Cancer Index Composite questionnaires are available to monitor EF recovery after RP (LE = 1, GR = A). Recommendation 3 states there is insufficient evidence that a specific surgical technique (open vs laparoscopic vs robot-assisted radical prostatectomy) promotes better results in postoperative EF recovery (LE = 2, GR = C). Recommendation 4 states that recognized predictors of EF recovery include but are not limited to younger age, preoperative EF, and bilateral nerve-sparing surgery (LE = 2, GR = B). Recommendation 5 states that patients should be informed about key elements of the pathophysiology of postoperative erectile dysfunction, such as nerve injury and cavernous venous leak (expert opinion, clinical principle). CONCLUSIONS: This article discusses Recommendations 1 to 5 of the ICSM 2015 committee on sexual rehabilitation after RP. Salonia A, Adaikan G, Buvat J, et al. Sexual Rehabilitation After Treatment for Prostate Cancer-Part 1: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med 2017;14:285-296.


Assuntos
Disfunção Erétil/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Prostatectomia/reabilitação , Idoso , Disfunção Erétil/reabilitação , Medicina Baseada em Evidências , Humanos , Cooperação Internacional , Masculino , Pessoa de Meia-Idade , Ereção Peniana/fisiologia , Complicações Pós-Operatórias/reabilitação , Período Pós-Operatório , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Recuperação de Função Fisiológica , Comportamento Sexual
18.
J Sex Med ; 14(3): 297-315, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28262100

RESUMO

INTRODUCTION: Sexual dysfunction is common in patients after radical prostatectomy (RP) for prostate cancer. AIM: To provide the International Consultation for Sexual Medicine (ICSM) 2015 recommendations concerning management strategies for post-RP erectile function impairment and to analyze post-RP sexual dysfunction other than erectile dysfunction. METHODS: A literature search was performed using Google and PubMed database for English-language original and review articles published up to August 2016. MAIN OUTCOME MEASURES: Levels of evidence (LEs) and grades of recommendations (GRs) are provided based on a thorough analysis of the literature and committee consensus. RESULTS: Nine recommendations are provided by the ICSM 2015 committee on sexual rehabilitation after RP. Recommendation 6 states that the recovery of postoperative erectile function can take several years (LE = 2, GR = C). Recommendation 7 states there are conflicting data as to whether penile rehabilitation with phosphodiesterase type 5 inhibitors improves recovery of spontaneous erections (LE = 1, GR = A). Recommendation 8 states that the data are inadequate to support any specific regimen as optimal for penile rehabilitation (LE = 3, GR = C). Recommendation 9 states that men undergoing RP (any technique) are at risk of sexual changes other than erectile dysfunction, including decreased libido, changes in orgasm, anejaculation, Peyronie-like disease, and changes in penile size (LE = 2, GR = B). CONCLUSION: This article discusses Recommendations 6 to 9 of the ICSM 2015 committee on sexual rehabilitation after RP. Salonia A, Adaikan G, Buvat J, et al. Sexual Rehabilitation After Treatment For Prostate Cancer-Part 2: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med 2017;14:297-315.


Assuntos
Disfunção Erétil/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Prostatectomia/reabilitação , Idoso , Disfunção Erétil/reabilitação , Medicina Baseada em Evidências , Humanos , Cooperação Internacional , Masculino , Pessoa de Meia-Idade , Ereção Peniana/fisiologia , Complicações Pós-Operatórias/reabilitação , Período Pós-Operatório , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Recuperação de Função Fisiológica , Comportamento Sexual
20.
Br J Health Psychol ; 22(1): 42-59, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27743412

RESUMO

OBJECTIVES: Extending individual planning of health behaviour change to the level of the dyad, dyadic planning refers to a target person and a planning partner jointly planning the target person's health behaviour change. To date, predictors of dyadic planning have not been systematically investigated. Integrating cognitive predictors of individual planning with four established predictor domains of social support provision, we propose a framework of predictors of dyadic planning. Including target persons' and partners' perspectives, we examine these predictor domains in the context of prostate cancer patients' rehabilitative pelvic floor exercise (PFE) following radical prostatectomy. DESIGN: Longitudinal data from 175 patients and their partners were analysed in a study with four post-surgery assessments across 6 months. METHODS: PFE-related dyadic planning was assessed from both partners together with indicators from four predictor domains: context, target person, partner, and relationship factors. Individual planning and social support served as covariates. RESULTS: Findings from two-level models nesting repeated assessments in individuals showed that context (patients' incontinence), target person (i.e., positive affect and self-efficacy), and relationship factors (i.e., relationship satisfaction) were uniquely associated with dyadic planning, whereas partner factors (i.e., positive and negative affects) were not. Factors predicting patients' and partners' accounts of dyadic planning differed. CONCLUSIONS: Resembling prior findings on antecedents of support provision in this context, partner factors did not prevail as unique predictors of dyadic planning, whereas indicators from all other predictor domains did. To establish predictive direction, future work should use lagged predictions with shorter intermeasurement intervals. Statement of contribution What is already known on this subject? Dyadic planning has been shown to be linked to health behaviour change. However, its role in behaviour regulation frameworks is not well investigated, especially regarding factors that might be predictive of dyadic planning. What does this study add? A framework of predictors of dyadic planning in the health behaviour change process is presented. The framework is investigated accounting for both planning partners' perspectives. Context, target person, and relationship factors were related to dyadic planning.


Assuntos
Comportamento Cooperativo , Comportamentos Relacionados com a Saúde , Diafragma da Pelve , Complicações Pós-Operatórias/reabilitação , Prostatectomia/reabilitação , Neoplasias da Próstata/cirurgia , Cônjuges , Incontinência Urinária/reabilitação , Adulto , Idoso , Cognição , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Autoeficácia , Apoio Social , Sobreviventes
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