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.

Impacto de la rehabilitación del piso pelviano en la calidad de vida de mujeres con incontinencia urinaria / Impact of Pelvic Floor Rehabilitation on the Quality of Life of Women with Urinary Incontinence

Objetivos: Evaluar el impacto en la calidad de vida de mujeres con diversos tipos de incontinencia urinaria, en quienes se realizó un programa de entrenamiento de la musculatura del piso pelviano (EMPP). Materiales y métodos: Se llevó a cabo un estudio retrospectivo, descriptivo y analítico que evaluó a mujeres con incontinencia urinaria derivadas al Centro Urológico Profesor Bengió para realizar rehabilitación del piso pelviano entre enero de 2014 y diciembre de 2015. Todas las pacientes recibieron EMPP como primera línea de tratamiento. La calidad de vida fue evaluada mediante cuestionarios validados, entre los que se realizó UDI-6 (Urogenital Distress Index), IIQ-7 (Incontinence Impact Questionnaire) versión corta e IQoL (Incontinence Quality of Life). Las variables continuas fueron comparadas a través de pruebas pareadas de T test y las categóricas por el método de chi cuadrado (X2 ). Las puntuaciones fueron evaluadas previo y posterior al EMPP. Se definió una p<0,05 como estadísticamente significativa. Resultados: La población en estudio se remitió a 82 pacientes. La mejoría subjetiva expresada por las pacientes en una escala de 0-10 fue de 6,33 (desvío estándar [DE]=2,42) con una mediana de 7. En la población general existe una declinación en el cuestionario UDI-6 (-2,6; p<0,0001), IIQ-7 (-2,4; p=0,0001) y un aumento en IQoL (11,35; p<0,0001). En los diferentes tipos de incontinencia urinaria (esfuerzo, urgencia y mixta) también se observó una mejoría individual en todos los cuestionarios en cada tipo de incontinencia urinaria, excepto en el cuestionario IQoL (p=0,34) en pacientes con incontinencia de orina de esfuerzo. Conclusiones: El EMPP representa una terapia no invasiva efectiva en el tratamiento de diversas formas de incontinencia de orina, produciendo un impacto favorable en la calidad de vida de mujeres que padecen esta patología.(AU)

Objectives: To assess the impact on the quality of life in women with different types of urinary incontinence, who was a training of the musculature of the pelvic floor muscle (TMPP) program. Materials and methods: Was a retrospective, descriptive and analytical study evaluated women with urinary incontinence derived for rehabilitation of pelvic floor between January 2014 and December 2015. All patients received TMPP as first line treatment. Quality of life was evaluated performing validated questionnaires, which was carried out: UDI-6 (Urogenital Distress Index), IIQ-7 (Incontinence Impact Questionnaire) short version and IQoL (Incontinence Quality of Life). Continuous variables were compared through the categorical and paired T test tests by chi square (X2 ) method. Scores were assessed pre and post the TMPP. Defined a p<0.05 as statistically significant. Results: The study population was referred to 82 patients. Subjective improvement expressed by patients on a scale of 0-10 was 6.33 (standard deviation [SD]=2.42) with a median of 7. In the general population, there is a decline in the UDI-6 questionnaire (-2.6; p<0.0001), IIQ-7 (-2.4; p=0.0001) and an increase in the IQoL (11.35; p<0.0001). In the different types of urinary incontinence (stress, urgency and mixed) also find an individual improvement in all the questionnaires in each type of urinary incontinence, except in questionnaire IQoL (p=0.34) in patients who are stress urinary incontinence. Conclusions: The TMPP represents a therapy effective non-invasive in the treatment of various forms of urinary incontinence producing a positive impact on the quality of life of women living with this disease.(AU)

Laparoscopic versus open radical prostatectomy in high prostate volume cases: impact on oncological and functional results

ABSTRACT Background and objective: To prospectively compare the laparoscopic versus open approach to RP in cases with high prostate volume and to evaluate a possible different impact of prostate volume. Materials and Methods: From March 2007 to March 2013 a total of 120 cases with clinically localized prostate cancer (PC) and a prostate volume>70cc identified for radical prostatectomy (RP), were prospectively analyzed in our institute. Patients were offered as surgical technique either an open retropubic or an intraperitoneal laparoscopic (LP) approach. In our population, 54 cases were submitted to LP and 66 to open RP. We analyzed the association of the surgical technique with perioperative, oncological and postoperative functional parameters. Results: In those high prostate volume cases, the surgical technique (laparoscopic versus open) does not represent a significant independent factor able to influence positive surgical margins rates and characteristics (p=0.4974). No significant differences (p>0.05) in the overall rates of positive margins was found, and also no differences following stratification according to the pathological stage and nerve sparing (NS) procedure. The surgical technique was able to significantly and independently influence the hospital stay, time of operation and blood loss (p<0.001). On the contrary, in our population, the surgical technique was not a significant factor influencing all pathological and 1-year oncological or functional outcomes (p>0.05). Conclusions: In our prospective non randomized analysis on high prostate volumes, the laparoscopic approach to RP is able to guarantee the same oncological and functional results of an open approach, maintaining the advantages in terms of perioperative outcomes.

Perfil das pacientes do ambulatório de uroginecologia de um hospital público de Porto Alegre com relação à incontinência urinária e à qualidade de vida / Profile of female patients in the urogynecology ambulatory care of a public hospital in southern Brazil regarding urinary incontinence and quality of life

Introdução: A incontinência urinária (IU) é a perda involuntária de urina e pode ser classificada de acordo com os sintomas, sendo os tipos mais comuns: IU de esforço (IUE), IU de urgência (IUU) e IU mista (IUM). Ela causa impacto físico e psicológico negativo, piorando a qualidade de vida. A fisioterapia pélvica é importante no tratamento conservador da IU, pois é segura, não invasiva e com mínimos efeitos colaterais. Objetivos: Descrever o perfil das mulheres avaliadas pela fisioterapia pélvica no Ambulatório de Uroginecologia do Hospital de Clínicas de Porto Alegre (HCPA) com relação à IU e qualidade de vida. Métodos: Estudo descritivo, transversal e retrospectivo, realizado a partir de informações dos prontuários das pacientes avaliadas pela fisioterapia pélvica no Ambulatório de Uroginecologia do HCPA, de agosto de 2013 a dezembro de 2014. Resultados: Dos 164 prontuários analisados, a média de idade das pacientes foi de 58,07 anos (±10,98), 55% realizaram parto normal, 51% fizeram episiotomia, todas eram multíparas, 60,4% apresentavam prolapso de órgão pélvico e a IUM foi a mais prevalente, sendo que 71,3% perdiam urina em jato. Quanto à força dos músculos do assoalho pélvico, a maioria apresentava grau 2 (31,1%), seguido de grau 1 (28%) e grau 3 (24,4%), conforme a Escala de Oxford Modificada, e 75,6% acionavam musculatura acessória. O International Consultation on Incontinence Questionnaire - Short Form (ICIS-SF) mostrou que o impacto da IU foi grave em 62,8%. Conclusão: Este estudo permitiu identificar as principais demandas da população feminina com IU, facilitando o delineamento de estratégias de reabilitação eficazes e compatíveis com a prática clínica (AU)

Introduction: Urinary incontinence (UI) is an involuntary loss of urine and can be classified according to its symptoms. The most common types are the following: stress UI (SUI), urge UI (UUI), and mixed UI (MUI). It causes negative physical and psychological impact and consequent deterioration in quality of life. Pelvic physical therapy plays an important role in the conservative treatment of UI, since it is noninvasive, safe, and with minimal side effects. Objectives: To describe the profile of female patients evaluated through pelvic physiotherapy at the Urogynecology Ambulatory Care of Porto Alegre Clinical Hospital (HCPA) regarding urinary incontinence and quality of life. Methods: A descriptive, cross-sectional, retrospective, documentary study that used information from the medical records of patients evaluated through pelvic physiotherapy at the Urogynecology Ambulatory Care of HCPA, from August 2013 to December 2014. Results: Of the 164 medical records analyzed, patients' average age was 58.07 years (±10.98), 55% of them underwent vaginal delivery, 51% received episiotomy, all were multiparous, 60.4% had pelvic organ prolapse, and 71.3% had urinary leakage in jets. MUI was the most prevalent type of IU. Regarding the strength of pelvic floor muscles, most patients had grade 2 (31.1%), followed by grade 1 (28%) and grade 3 (24.4%), according to the modified Oxford Grading Scale. 75.6% of the patients used some accessory musculature. Quality of life was measured by the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), which showed that the impact of UI was severe in 62.8% of the patients. Conclusion: The present study identified the main demands of the female population with symptoms of UI, facilitating the design of effective rehabilitation strategies which are compatible with clinical practice (AU)

Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part I

Objective To compare the use of polypropylene mesh (PM) and the traditional anterior vaginal wall colporraphy in women with anterior vaginal wall prolapse (AVWP) using objective and subjective tests and evaluation of quality of life (QoL). Materials and Methods One hundred women were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a PM implant and the control group (n = 55) was submitted to traditional colporraphy. Postoperatory follow-up was done after 12 months. The primary objective was the correction of the Ba point ≤ -2 POP-Q (Pelvic Organ Prolapse Quantification System) and the secondary objective was the improvement of vaginal symptoms and QoL through ICIQ-VS (International Consultation on Incontinence Questionnaire - Vaginal Symptoms). Complications related to the use of PM or not were also described. Results There was a significant difference between all POP-Q measures of pre- and postoperatory periods of each group in particular. There was a significant difference of the Ba point of the postoperatory period between the Mesh and Control group. The mean of Ba point in the Mesh group was statistically lower than of the Control group, depicting the better anatomical result of the first group. Both techniques improved vaginal symptoms and QoL. The most frequent complication of the Mesh group was prepubic hematoma in the perioperative period. In 9.3% of the cases treated with mesh it was observed PM exposition at the anterior vaginal wall after 12 months, being most of them treated clinically. Conclusion The treatment of AVWP significantly improved the Ba point in the Mesh group in comparison to the Control group. There were no differences of the vaginal symptoms and QoL between the two groups after 12 months. There were few and low grade complications on both groups. .

Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part II

Objective To compare the effects of two surgical procedures for the correction of anterior vaginal wall prolapse (AVWP) on the lower urinary tract symptoms (LUTS) using symptom questionnaires and quality of life (QoL). Materials and Methods One hundred women with Pelvic Organ Prolapse Quantification stage (POP-Q) ≥ 2 were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a polypropylene mesh (PM) implant and the control group (n = 55) was submitted to anterior colporraphy with or without synthetic sling. Postoperatory follow-up was done after 12 months. The primary objective was to compare the effect of the surgeries on LUTS using the final scores of the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) and Overactive Bladder Questionnaire (OAB-V8), as well as the analysis of the incapacitating urinary symptoms and “de novo” urinary symptoms after 12 months of surgery in both groups. Results Although there was a different number of women in each group, randomization was adequate, resulted in homogeneous groups that could be compared regarding socio demographic, clinical and gynecological (POP-Q) variables. Patients of both groups showed improvements regarding LUTS and QoL, whether using polypropylene mesh or not, based on the final scores of the ICIQ-UI SF and OAB-V8 questionnaires after 12-month follow-up. There were few incapacitating and “de novo” urinary symptoms, without any significant statistical difference between both groups after 12 months of surgery. Conclusion There was a general improvement of LUTS and QoL in both groups after 12-month follow-up. However, there was no significant difference of LUTS, as well as the more incapacitating and “de novo” urinary symptoms between both groups after 12 months of surgery. .

Between suffering and hope: rehabilitation from urinary incontinence as an intervening component / Entre o sofrimento e a esperança: a reabilitação da incontinência urinária como componente interveniente

This is a qualitative study seeking to understand Brazilian women's experience of urinary incontinence (UI) and design a representative theoretical model for the experience. Theoretical saturation occurred after analysis of the 18th non-directive interview in accordance with Grounded Theory. Two phenomena emerged: living with the challenges of UI and experiencing the hope and disappointment of rehabilitation from UI. Upon re-alignment of the components, the core category emerged, namely: between suffering and hope - rehabilitation from urinary incontinence as an intervening component. From the analysis in light of symbolic interactionism, pregnancy and vaginal birth were observed to be symbols of women's vulnerability to the suffering from living with the moral and physio-psychosocial challenges of UI. It is also inferred that the lack of consideration of the Unified Health System (SUS) in investing in the process of rehabilitation from UI may be having a negative effect on the incentive programs for promoting vaginal birth. Most of all, it reveals the ongoing suffering of women with UI, most of whom do not have access to rehabilitation due to the lack of programs geared to the real needs of these users of the Unified Health System.

Estudo de natureza qualitativa com os objetivos de compreender a experiência de mulheres com incontinência urinária e elaborar um modelo teórico representativo da mesma. A saturação teórica se deu mediante a análise da 18ª entrevista não diretiva, segundo a Teoria Fundamentada nos Dados. Emergiram dois fenômenos: convivendo com os desafios da Incontinência Urinária (IU) e vivenciando a esperança e a desilusão de reabilitar-se da IU. Do re-alinhamento dos componentes provindos dos fenômenos emergiu a categoria central, denominada: entre o sofrimento e a esperança - o apoio e o acesso a reabilitação da IU como componente interveniente. Da análise à luz do Interacionismo Simbólico verificou-se que a gravidez e o parto vaginal emergem como símbolos de vulnerabilidade da mulher ao sofrimento de conviver com o desafio moral e fisiopsicossocial da IU. Bem como a inferência de que a desconsideração do Sistema Único de Saúde (SUS) com investimentos no processo de reabilitação da IU possa estar fragilizando os próprios programas de incentivo ao parto vaginal. Aponta a perpetuação do sofrimento da mulher com a IU, que na maioria não tem acesso à reabilitação por falta de programas voltados às reais necessidades dessas usuárias do SUS.