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Zaidan P, Silva EBD. Pelvic floor muscle exercises with or without electric stimulation and post-prostectomy urinary incontinence: a systematic review. FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/1980-5918.029.003.ao21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Abstract Introduction: Urinary incontinence (UI) after prostatectomy is difficult to treat and causes profound adverse impacts on the individual's quality of life. The main clinical treatments available for post-prostatectomy UI consist of behavioral techniques and physical therapy techniques, such as exercises, electrical stimulation and biofeedback for pelvic floor muscles (PFMs). Objective: To investigate the effectiveness of PFM exercises with or without electrical stimulation for reducing post-prostatectomy UI. Methods: We included only randomized controlled trials (RCTs) which used PFM exercises with or without electrical stimulation. The search was conducted in August of 2013 in the databases of the U.S. National Library of Medicine (MEDLINE), Scientific Electronic Library Online (SciELO), Physiotherapy Evidence Database (PEDro) and Virtual Health Library (VHL). We searched for RCTs published between 1999 and 2013. As keywords for our search, we used the following descriptors from the Health Sciences Descriptors (DeCS): urinary incontinence, pelvic diaphragm, prostatectomy, pelvic floor exercises, electrostimulation and electrical stimulation. We also used the following descriptors from the Medical Subject Headings (MeSH): electrical stimulation, pelvic floor, urinary incontinence, prostatectomy, physiotherapy and exercise therapy. Results: Of the 59 RCTs found, 26 were excluded as duplicates, and 28 were excluded for not displaying a minimum score of 5.0 on the PEDro Scale, which left us with five RCTs. Conclusion: PFM exercises can be effective for treating UI after radical prostatectomy, especially if begun soon after surgery. Associating electrical stimulation with PFM exercises did not show additional benefit for treating urinary incontinence. However, the selected studies presented some methodological weaknesses that may have compromised their internal validity.
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Gilmore B, Ezekian B, Sun Z, Peterson A, Mantyh C. Urinary Dysfunction in the Rectal Cancer Survivor. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0357-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brilleman SL, Metcalfe C, Peters TJ, Hollingworth W. The Reporting of Treatment Nonadherence and Its Associated Impact on Economic Evaluations Conducted Alongside Randomized Trials: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:99-108. [PMID: 26797242 DOI: 10.1016/j.jval.2015.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 05/06/2015] [Accepted: 07/22/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To review trial-based economic evaluations, identifying 1) the proportion reporting adherence, 2) methods for assigning intervention costs according to adherence, 3) which participants were included in the economic analysis, and 4) statistical methods to estimate cost-effectiveness in those who adhered. We provide recommendations on handling nonadherence in economic evaluations. METHODS The National Health Service Economic Evaluation Database was searched for recently published trials. We extracted information on the methods used to assign shared costs in the presence of nonadherence and methods to account for nonadherence in the economic analysis. RESULTS Ninety-six eligible trials were identified. For one-off interventions, 86% reported the number of participants initiating treatment. For recurring interventions, 56% and 73%, respectively, reported the number initiating and completing treatment, whereas 66% reported treatment intensity. Most studies (23 of 31 [74%] trials and 42 of 53 [79%] trials of one-off and recurring interventions, respectively) reported strict intention-to-treat or complete case analyses. A minority (3 of 31 [10%] and 7 of 53 [13%], respectively), however, performed a per-protocol analysis. No studies used statistical methods to adjust for nonadherence directly in the economic evaluation. Only 13 studies described patient-level allocation of intervention costs; there was variation in how fixed costs were assigned according to adherence. CONCLUSIONS Most of the trials reported a measure of adherence, but reporting was not comprehensive. A nontrivial proportion of studies report a primary per-protocol analysis that potentially produces biased results. Alongside primary intention-to-treat analysis, statistical methods for obtaining an unbiased estimate of cost-effectiveness in adherers should be considered.
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Affiliation(s)
- Samuel L Brilleman
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tim J Peters
- School of Clinical Sciences, University of Bristol, Bristol, UK
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Stafford RE, Coughlin G, Lutton NJ, Hodges PW. Validity of Estimation of Pelvic Floor Muscle Activity from Transperineal Ultrasound Imaging in Men. PLoS One 2015; 10:e0144342. [PMID: 26642347 PMCID: PMC4671687 DOI: 10.1371/journal.pone.0144342] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 11/17/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the relationship between displacement of pelvic floor landmarks observed with transperineal ultrasound imaging and electromyography of the muscles hypothesised to cause the displacements. MATERIALS AND METHODS Three healthy men participated in this study, which included ultrasound imaging of the mid-urethra, urethra-vesical junction, ano-rectal junction and bulb of the penis. Fine-wire electromyography electrodes were inserted into the puborectalis and bulbocavernosus muscles and a transurethral catheter electrode recorded striated urethral sphincter electromyography. A nasogastric sensor recorded intra-abdominal pressure. Tasks included submaximal and maximal voluntary contractions, and Valsalva. The relationship between each of the parameters measured from ultrasound images and electromyography or intra-abdominal pressure amplitudes was described with nonlinear regression. RESULTS Strong, non-linear relationships were calculated for each predicted landmark/muscle pair for submaximal contractions (R2-0.87-0.95). The relationships between mid-urethral displacement and striated urethral sphincter electromyography, and bulb of the penis displacement and bulbocavernosus electromyography were strong during maximal contractions (R2-0.74-0.88). Increased intra-abdominal pressure prevented shortening of puborectalis, which resulted in weak relationships between electromyography and anorectal and urethravesical junction displacement during all tasks. CONCLUSIONS Displacement of landmarks in transperineal ultrasound imaging provides meaningful measures of activation of individual pelvic floor muscles in men during voluntary contractions. This method may aid assessment of muscle function or feedback for training.
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Affiliation(s)
- Ryan E. Stafford
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Geoff Coughlin
- Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Nicholas J Lutton
- Department of Colorectal Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - Paul W. Hodges
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
- * E-mail:
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Tibaek S, Gard G, Dehlendorff C, Iversen HK, Biering-Soerensen F, Jensen R. Is Pelvic Floor Muscle Training Effective for Men With Poststroke Lower Urinary Tract Symptoms? A Single-Blinded Randomized, Controlled Trial. Am J Mens Health 2015; 11:1460-1471. [PMID: 26483291 DOI: 10.1177/1557988315610816] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of the current study was to evaluate the effect of pelvic floor muscle training in men with poststroke lower urinary tract symptoms. Thirty-one poststroke men, median age 68 years, were included in this single-blinded randomized controlled trial. Thirty participants, 15 in each group, completed the study. The intervention consisted of 3 months (12 weekly sessions) of pelvic floor muscle training in groups and home exercises. The effect was evaluated by the DAN-PSS-1 (Danish Prostate Symptom Score) questionnaire, a voiding diary, and digital anal palpation of the pelvic floor muscle. The DAN-PSS-1, symptom score indicated a statistical significant improvement ( p < .01) in the treatment group from pretest to posttest, but not in the control group. The DAN-PSS-1, total score improved statistically significantly in both groups from pretest to posttest (treatment group: p < .01; control group: p = .03). The median voiding frequency per 24 hours decreased from 11 at pretest to 7 (36%; p = .04) at posttest and to 8 (27%; p = .02) at follow-up in treatment group, although not statistical significantly more than the control group. The treatment group but not the control group improved statistically significantly in pelvic floor muscle function ( p < .01) and strength ( p < .01) from pretest to posttest and from pretest to follow-up ( p = .03; p < .01). Compared with the control group the pretest to posttest was significantly better in the treatment group ( p = .03). The results indicate that pelvic floor muscle training has an effect for lower urinary tract symptoms, although statistical significance was only seen for pelvic floor muscle.
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Faithfull S, Lemanska A, Aslet P, Bhatt N, Coe J, Drudge-Coates L, Feneley M, Glynn-Jones R, Kirby M, Langley S, McNicholas T, Newman J, Smith CC, Sahai A, Trueman E, Payne H. Integrative review on the non-invasive management of lower urinary tract symptoms in men following treatments for pelvic malignancies. Int J Clin Pract 2015; 69:1184-208. [PMID: 26292988 PMCID: PMC5042099 DOI: 10.1111/ijcp.12693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
AIM To develop a non-invasive management strategy for men with lower urinary tract symptoms (LUTS) after treatment for pelvic cancer, that is suitable for use in a primary healthcare context. METHODS PubMed literature searches of LUTS management in this patient group were carried out, together with obtaining a consensus of management strategies from a panel of authors for the management of LUTS from across the UK. RESULTS Data from 41 articles were investigated and collated. Clinical experience was sought from authors where there was no clinical evidence. The findings discussed in this paper confirm that LUTS after the cancer treatment can significantly impair men's quality of life. While many men recover from LUTS spontaneously over time, a significant proportion require long-term management. Despite the prevalence of LUTS, there is a lack of consensus on best management. This article offers a comprehensive treatment algorithm to manage patients with LUTS following pelvic cancer treatment. CONCLUSION Based on published research literature and clinical experience, recommendations are proposed for the standardisation of management strategies employed for men with LUTS after the pelvic cancer treatment. In addition to implementing the algorithm, understanding the rationale for the type and timing of LUTS management strategies is crucial for clinicians and patients.
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Affiliation(s)
- S Faithfull
- School of Health Sciences, University of Surrey, Stag Hill, Guildford, UK
| | - A Lemanska
- School of Health Sciences, University of Surrey, Stag Hill, Guildford, UK
| | - P Aslet
- Department of Urology, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire, UK
| | - N Bhatt
- Sutton & Merton Community Services, The Royal Marsden NHS Foundation Trust, London, UK
| | - J Coe
- University College Hospital, London, UK
| | | | - M Feneley
- University College Hospital, London, UK
| | | | - M Kirby
- Faculty of Health & Human Sciences, Centre for Research in Primary & Community Care (CRIPACC), University of Hertfordshire, Hertfordshire, UK
| | - S Langley
- The Royal Surrey County Hospital, Guildford, UK
| | | | - J Newman
- Oxford University Hospital, Oxford, UK
| | - C C Smith
- School of Health and Social Care, Bournemouth University, Dorset, UK
| | - A Sahai
- Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - E Trueman
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - H Payne
- University College Hospital, London, UK
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Shao IH, Chou CY, Huang CC, Lin CF, Chang YH, Tseng HJ, Wu CT. A Specific Cystography Pattern Can Predict Postprostatectomy Incontinence. Ann Surg Oncol 2015; 22 Suppl 3:S1580-6. [DOI: 10.1245/s10434-015-4847-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Indexed: 11/18/2022]
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58
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Dumoulin C, Hay-Smith J, Frawley H, McClurg D, Alewijnse D, Bo K, Burgio K, Chen SY, Chiarelli P, Dean S, Hagen S, Herbert J, Mahfooza A, Mair F, Stark D, Van Kampen M. 2014 consensus statement on improving pelvic floor muscle training adherence: International Continence Society 2011 State-of-the-Science Seminar. Neurourol Urodyn 2015; 34:600-5. [PMID: 25998603 DOI: 10.1002/nau.22796] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 04/20/2015] [Indexed: 11/05/2022]
Abstract
AIMS To summarize the findings and "expert-panel" consensus of the State-of-the-Science Seminar on pelvic floor muscle training (PFMT) adherence held prior to the 41st International Continence Society scientific meeting, Glasgow, 2011. METHODS Summaries of research and theory about PFMT adherence (based on a comprehensive literature search) were presented by subject experts at the 2011 Seminar to generate discussion and guidance for clinical practice and future research. Supplemental research, post-seminar, resulted in, three review papers summarizing: (1) relevant behavioral theories, (2) adherence measurement, determinants and effectiveness of PFMT adherence interventions, and (3) patients' PFMT experiences. A fourth, reported findings from an online survey of health professionals and the public. RESULTS Few high-quality studies were found. Paper I summarizes 12 behavioral frameworks relevant to theoretical development of PFMT adherence interventions and strategies. Findings in Paper II suggest both PFMT self-efficacy and intention-to-adhere predict PFMT adherence. Paper III identified six potential adherence modifiers worthy of further investigation. Paper IV found patient-related factors were the biggest adherence barrier to PFMT adherence. CONCLUSION Given the lack of high-quality studies, the conclusions were informed by expert opinion. Adherence is central to short- and longer-term PFMT effect. More attention and explicit reporting is needed regarding: (1) applying health behavior theory in PFMT program planning; (2) identifying adherence determinants; (3) developing and implementing interventions targeting known adherence determinants; (4) using patient-centred approaches to evaluating adherence barriers and facilitators; (5) measuring adherence, including refining and testing instruments; and (6) testing the association between adherence and PFMT outcome.
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Affiliation(s)
- Chantale Dumoulin
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Canada.,Urogynecological Health and Aging Research Chair, Research Centre of the Institut Universitaire de Geriatrie de Montreal, Montreal, Canada
| | - Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand.,Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, New Zealand
| | - Helena Frawley
- School of Allied Health, La Trobe University, Melbourne, Australia.,Allied Health Research, Cabrini Health, Melbourne, Australia
| | - Doreen McClurg
- Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, Scotland
| | - Dianne Alewijnse
- PR and Marketing, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands
| | - Kari Bo
- Departement of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Kathryn Burgio
- Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham.,Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Department of Veterans Affairs, Birmingham
| | | | | | - Sarah Dean
- Psychology Applied to Health, University of Exeter Medical School, Exeter, United Kingdom
| | - Suzanne Hagen
- Nursing Midwifery & Allied Health Professions (NMAHP) Research Unit
| | | | | | - Frances Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Scotland
| | - Diane Stark
- Functional Bowel Service, Clinic 2 Balmoral Building, Leicester Royal infirmary, Leicester, United Kingdom
| | - Marijke Van Kampen
- Faculty of Kinesiology and Rehabilitation Sciences, K.U.Leuven, Leuven, Belgium
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Dumoulin C, Alewijnse D, Bo K, Hagen S, Stark D, Van Kampen M, Herbert J, Hay-Smith J, Frawley H, McClurg D, Dean S. Pelvic-Floor-Muscle Training Adherence: Tools, Measurements and Strategies-2011 ICS State-of-the-Science Seminar Research Paper II of IV. Neurourol Urodyn 2015; 34:615-21. [PMID: 25998493 DOI: 10.1002/nau.22794] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/17/2015] [Indexed: 11/05/2022]
Abstract
AIMS This paper on pelvic-floor-muscle training (PFMT) adherence, the second of four from the International Continence Society's 2011 State-of-the-Science Conference, aims to (1) identify and collate current adherence outcome measures, (2) report the determinants of adherence, (3) report on PFMT adherence strategies, and (4) make actionable clinical and research recommendations. METHOD Data were amassed from a literature review and an expert panel (2011 conference), following consensus statement methodology. Experts in pelvic floor dysfunction collated and synthesized the evidence and expert opinions on PFMT adherence for urinary incontinence (UI) and lower bowel dysfunction in men and women and pelvic organ prolapse in women. RESULTS The literature was scarce for most of the studied populations except for limited research on women with UI. OUTCOME MEASURES Exercise diaries were the most widely-used adherence outcome measure, PFMT adherence was inconsistently monitored and inadequately reported. Determinants: Research, mostly secondary analyses of RCTs, suggested that intention to adhere, self-efficacy expectations, attitudes towards the exercises, perceived benefits and a high social pressure to engage in PFMT impacted adherence. STRATEGIES Few trials studied and compared adherence strategies. A structured PFMT programme, an enthusiastic physiotherapist, audio prompts, use of established theories of behavior change, and user-consultations seem to increase adherence. CONCLUSION The literature on adherence outcome measures, determinants and strategies remains scarce for the studied populations with PFM dysfunction, except in women with UI. Although some current adherence findings can be applied to clinical practice, more effective and standardized research is urgently needed across all the sub-populations.
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Affiliation(s)
- Chantal Dumoulin
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Canada.,Urogynacological Health and Aging Chair, Research Centre of the Institut Universitaire de Geriatrie de Montreal, Montreal, Canada
| | - Dianne Alewijnse
- Patient Education, PR and Marketing, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands
| | - Kari Bo
- Departement of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Suzanne Hagen
- Health Services Research, Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Diane Stark
- Functional Bowel Service, Clinic 2 Balmoral Building, Leicester Royal infirmary, Leicester, United Kingdom
| | - Marijke Van Kampen
- Faculty of Kinesiology and Rehabilitation Sciences, K.U. Leuven, Leuven, Belgium
| | | | - Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand.,Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Helena Frawley
- School of Allied Health, La Trobe University, Melbourne, Australia.,Allied Health Research, Cabrini Health, Melbourne, Australia
| | - Doreen McClurg
- Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Sarah Dean
- Psychology Applied to Health, University of Exeter Medical School, Exeter, United Kingdom
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Stafford RE, Ashton-Miller JA, Constantinou C, Coughlin G, Lutton NJ, Hodges PW. Pattern of activation of pelvic floor muscles in men differs with verbal instructions. Neurourol Urodyn 2015; 35:457-63. [PMID: 25727781 DOI: 10.1002/nau.22745] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/14/2015] [Indexed: 11/08/2022]
Abstract
AIMS To investigate the effect of instruction on activation of pelvic floor muscles (PFM) in men as quantified by transperineal ultrasound imaging (US) and to validate these measures with invasive EMG recordings. METHODS Displacement of pelvic floor landmarks on transperineal US, intra-abdominal pressure (IAP) recorded with a nasogastric transducer, and surface EMG of the abdominal muscles and anal sphincter were recorded in 15 healthy men during sub-maximal PFM contractions in response to different verbal instructions: "tighten around the anus," "elevate the bladder," "shorten the penis," and "stop the flow of urine." In three men, fine-wire EMG recordings were made from puborectalis and bulbocavernosus, and trans-urethral EMG recordings from the striated urethral sphincter (SUS). Displacement data were validated by analysis of relationship with invasive EMG. Displacement, IAP, and abdominal/anal EMG were compared between instructions. RESULTS Displacement of pelvic landmarks correlated with the EMG of the muscles predicted anatomically to affect their locations. Greatest dorsal displacement of the mid-urethra and SUS activity was achieved with the instruction "shorten the penis." Instruction to "elevate the bladder" induced the greatest increase in abdominal EMG and IAP. "Tighten around the anus" induced greatest anal sphincter activity. CONCLUSIONS The pattern of urethral movement measured from transperineal US is influenced by the instructions used to teach activation of the pelvic floor muscles in men. Efficacy of PFM training may depend on the instructions used to train activation. Instructions that optimize activation of muscles with a potential to increase urethral pressure without increasing abdominal EMG/IAP are likely ideal. Neurourol. Urodynam. 35:457-463, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Ryan E Stafford
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - James A Ashton-Miller
- Departments of Mechanical and Biomedical Engineering, Institute of Gerontology, The University of Michigan, Ann Arbor, Michigan
| | - Chris Constantinou
- Department of Urology, School of Medicine, Stanford University, Palo Alto, California
| | - Geoff Coughlin
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Nicholas J Lutton
- Department of Colorectal Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - Paul W Hodges
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
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Anderson CA, Omar MI, Campbell SE, Hunter KF, Cody JD, Glazener CMA. Conservative management for postprostatectomy urinary incontinence. Cochrane Database Syst Rev 2015; 1:CD001843. [PMID: 25602133 PMCID: PMC7025637 DOI: 10.1002/14651858.cd001843.pub5] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Urinary incontinence is common after radical prostatectomy and can also occur in some circumstances after transurethral resection of the prostate (TURP). Conservative management includes pelvic floor muscle training with or without biofeedback, electrical stimulation, extra-corporeal magnetic innervation (ExMI), compression devices (penile clamps), lifestyle changes, or a combination of methods. OBJECTIVES To determine the effectiveness of conservative management for urinary incontinence up to 12 months after transurethral, suprapubic, laparoscopic, radical retropubic or perineal prostatectomy, including any single conservative therapy or any combination of conservative therapies. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register (5 February 2014), CENTRAL (2014, Issue 1), EMBASE (January 2010 to Week 3 2014), CINAHL (January 1982 to 18 January 2014), ClinicalTrials.gov and World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (both searched 29 January 2014), and the reference lists of relevant articles. SELECTION CRITERIA Randomised or quasi-randomised controlled trials evaluating conservative interventions for urinary continence in men after prostatectomy. DATA COLLECTION AND ANALYSIS Two or more review authors assessed the methodological quality of the trials and abstracted data. We tried to contact several authors of included studies to obtain extra information. MAIN RESULTS Fifty trials met the inclusion criteria, 45 in men after radical prostatectomy, four trials after TURP and one trial after either operation. The trials included 4717 men of whom 2736 had an active conservative intervention. There was considerable variation in the interventions, populations and outcome measures. Data were not available for many of the pre-stated outcomes. Men's symptoms improved over time irrespective of management.There was no evidence from eight trials that pelvic floor muscle training with or without biofeedback was better than control for men who had urinary incontinence up to 12 months after radical prostatectomy; the quality of the evidence was judged to be moderate (for example 57% with urinary incontinence in the intervention group versus 62% in the control group, risk ratio (RR) for incontinence after 12 months 0.85, 95% confidence interval (CI) 0.60 to 1.22). One large multi-centre trial of one-to-one therapy showed no difference in any urinary or quality of life outcome measures and had narrow CIs. It seems unlikely that men benefit from one-to-one PFMT therapy after TURP. Individual small trials provided data to suggest that electrical stimulation, external magnetic innervation, or combinations of treatments might be beneficial but the evidence was limited. Amongst trials of conservative treatment for all men after radical prostatectomy, aimed at both treatment and prevention, there was moderate evidence of an overall benefit from pelvic floor muscle training versus control management in terms of reduction of urinary incontinence (for example 10% with urinary incontinence after one year in the intervention groups versus 32% in the control groups, RR for urinary incontinence 0.32, 95% CI 0.20 to 0.51). However, this finding was not supported by other data from pad tests. The findings should be treated with caution because the risk of bias assessment showed methodological limitations. Men in one trial were more satisfied with one type of external compression device, which had the lowest urine loss, compared to two others or no treatment. The effect of other conservative interventions such as lifestyle changes remained undetermined as no trials involving these interventions were identified. AUTHORS' CONCLUSIONS The value of the various approaches to conservative management of postprostatectomy incontinence after radical prostatectomy remains uncertain. The evidence is conflicting and therefore rigorous, adequately powered randomised controlled trials (RCTs) which abide by the principles and recommendations of the CONSORT statement are still needed to obtain a definitive answer. The trials should be robustly designed to answer specific well constructed research questions and include outcomes which are important from the patient's perspective in decision making and are also relevant to the healthcare professionals. Long-term incontinence may be managed by an external penile clamp, but there are safety problems.
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Affiliation(s)
| | - Muhammad Imran Omar
- University of AberdeenAcademic Urology UnitAberdeenUKAB25 2ZD
- London School of Hygiene and Tropical MedicineLondonUK
| | - Susan E Campbell
- University of East AngliaSchool of Health SciencesEdith Cavell BuildingNorwich Research ParkNorwichUKNR4 7TJ
| | - Kathleen F Hunter
- University of AlbertaFaculty of Nursing3rd Floor Clinical Sciences BuildingEdmontonABCanadaT6G 2G3
| | - June D Cody
- University of AberdeenCochrane Incontinence Review Group2nd Floor, Health Sciences BuildingHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Cathryn MA Glazener
- University of AberdeenHealth Services Research Unit3rd Floor, Health Sciences BuildingForesterhillAberdeenScotlandUKAB25 2ZD
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Cook JA, Hislop J, Altman DG, Fayers P, Briggs AH, Ramsay CR, Norrie JD, Harvey IM, Buckley B, Fergusson D, Ford I, Vale LD. Specifying the target difference in the primary outcome for a randomised controlled trial: guidance for researchers. Trials 2015; 16:12. [PMID: 25928502 PMCID: PMC4302137 DOI: 10.1186/s13063-014-0526-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 12/19/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Central to the design of a randomised controlled trial is the calculation of the number of participants needed. This is typically achieved by specifying a target difference and calculating the corresponding sample size, which provides reassurance that the trial will have the required statistical power (at the planned statistical significance level) to identify whether a difference of a particular magnitude exists. Beyond pure statistical or scientific concerns, it is ethically imperative that an appropriate number of participants should be recruited. Despite the critical role of the target difference for the primary outcome in the design of randomised controlled trials, its determination has received surprisingly little attention. This article provides guidance on the specification of the target difference for the primary outcome in a sample size calculation for a two parallel group randomised controlled trial with a superiority question. METHODS This work was part of the DELTA (Difference ELicitation in TriAls) project. Draft guidance was developed by the project steering and advisory groups utilising the results of the systematic review and surveys. Findings were circulated and presented to members of the combined group at a face-to-face meeting, along with a proposed outline of the guidance document structure, containing recommendations and reporting items for a trial protocol and report. The guidance and was subsequently drafted and circulated for further comment before finalisation. RESULTS Guidance on specification of a target difference in the primary outcome for a two group parallel randomised controlled trial was produced. Additionally, a list of reporting items for protocols and trial reports was generated. CONCLUSIONS Specification of the target difference for the primary outcome is a key component of a randomized controlled trial sample size calculation. There is a need for better justification of the target difference and reporting of its specification.
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Affiliation(s)
- Jonathan A Cook
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK.
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresthill, Aberdeen, AB25 2ZD, UK.
| | - Jenni Hislop
- Institute of Health and Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| | - Douglas G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK.
| | - Peter Fayers
- Population Health, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
- Department of Cancer Research and Molecular, Norwegian University of Science and Technology, Mailbox 8905, Trondheim, N-7491, Norway.
| | - Andrew H Briggs
- Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
| | - Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresthill, Aberdeen, AB25 2ZD, UK.
| | - John D Norrie
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Health Sciences Building, Aberdeen, AB25 2ZD, UK.
| | - Ian M Harvey
- Faculty of Medicine and Health Sciences, University of East Anglia, Elizabeth Fry Building, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Brian Buckley
- National University of Ireland, University Road, Galway, Ireland.
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, ON, K1Y 4E9, Canada.
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow, G12 8QQ, UK.
| | - Luke D Vale
- Institute of Health and Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
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Abstract
Urinary incontinence is a significant impairment of the quality of life. Many patients are treated insufficiently or even suffer from complications of incontinence surgery. Psychosomatic primary care serves to improve the diagnostic work-up and helps to select the appropriate therapeutic option. It also optimizes the treatment outcome by supplementing the somatically oriented urological therapy with the psychosomatically aligned extended medical dialogue and body-oriented methods. Psychosomatic primary care is based on the biopsychosocial model and uses theoretical knowledge and practical techniques that can be learnt under professional guidance.
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Affiliation(s)
- U Hohenfellner
- Praxis für Urologie, Ambulantes Urologisches Rehabilitationszentrum für Urologie und Gynäkologie Heidelberg, Friedrich-Ebert-Anlage 1, 69117, Heidelberg, Deutschland,
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64
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Traitements palliatifs et conservateurs de l’incontinence urinaire masculine non neurologique : une revue de littérature du CTMH de l’AFU. Prog Urol 2014; 24:610-5. [DOI: 10.1016/j.purol.2014.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/02/2014] [Accepted: 01/06/2014] [Indexed: 11/20/2022]
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Hirschhorn AD, Kolt GS, Brooks AJ. A multicomponent theory-based intervention improves uptake of pelvic floor muscle training before radical prostatectomy: a 'before and after' cohort study. BJU Int 2014; 113:383-92. [PMID: 24053154 PMCID: PMC4155862 DOI: 10.1111/bju.12385] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the effect of a multicomponent theory-based intervention, incorporating patient information guides, an evidence summary, audit and feedback processes and a provider directory, in the provision/receipt of preoperative pelvic floor muscle training (PFMT) among patients undergoing radical prostatectomy. SUBJECTS AND METHODS Over an 18-month period (9 months before and 9 months after the intervention), we measured the provision/receipt of preoperative PFMT using surveys of patients undergoing radical prostatectomy at one public hospital (n = 32) and two private hospitals (n = 107) in Western Sydney, Australia, as well as practice audits of associated public sector (n = 4) and private sector (n = 2) providers of PFMT. Self-report urinary incontinence was assessed 3 months after radical prostatectomy using the International Consultation on Incontinence Questionnaire - Urinary Incontinence Form (ICIQ-UI Short Form). RESULTS There was a significant increase in the proportion of survey respondents receiving preoperative PFMT post-intervention (post-intervention: 42/58 respondents, 72% vs pre-intervention: 37/81 respondents, 46%, P = 0.002). There was a corresponding significant increase in provision of preoperative PFMT by private sector providers (mean [sd] post-intervention: 16.7 [3.7] patients/month vs pre-intervention: 12.1 [3.6] patients/month, P = 0.018). Respondents receiving preoperative PFMT had significantly better self-report urinary incontinence at 3 months after radical prostatectomy than those who did not receive preoperative PFMT (mean [sd] ICIQ-UI Short Form sum-scores: 6.2 [5.0] vs 9.2 [5.8], P = 0.002). CONCLUSIONS The intervention increased the provision/receipt of preoperative PFMT among patients undergoing radical prostatectomy. Additional component strategies aimed at increasing the use of public sector providers may be necessary to further improve PFMT receipt among patients undergoing radical prostatectomy in the public hospital system.
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Affiliation(s)
- Andrew D Hirschhorn
- School of Science and Health, University of Western Sydney, Penrith; Westmead Private Physiotherapy Services, NSW, Australia
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66
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Efficacy of physiotherapy for urinary incontinence following prostate cancer surgery. BIOMED RESEARCH INTERNATIONAL 2014; 2014:785263. [PMID: 24868546 PMCID: PMC4017841 DOI: 10.1155/2014/785263] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/04/2014] [Indexed: 11/25/2022]
Abstract
The study enrolled 81 with urinary incontinence following radical prostate-only prostatectomy for prostatic carcinoma. The patients were divided into two groups. The patients in Group I were additionally subdivided into two subgroups with respect to the physiotherapeutic method used. The patients of subgroup IA received a rehabilitation program consisting of three parts. The patients of subgroup IB rehabilitation program consist of two parts. Group II, a control group, had reported for therapy for persistent urinary incontinence following radical prostatectomy but had not entered therapy for personal reasons. For estimating the level of incontinence, a 1-hour and 24-hour urinary pad tests, the miction diary, and incontinence questionnaire were used, and for recording the measurements of pelvic floor muscles tension, the sEMG (surface electromyography) was applied. The therapy duration depended on the level of incontinence and it continued for not longer than 12 months. Superior continence outcomes were obtained in Group I versus Group II and the difference was statistically significant. The odds ratio for regaining continence was greater in the rehabilitated Group I and smaller in the group II without the rehabilitation. A comparison of continence outcomes revealed a statistically significant difference between Subgroups IA versus IB. The physiotherapeutic procedures applied on patients with urine incontinence after prostatectomy, for most of them, proved to be an effective way of acting, which is supported by the obtained results.
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67
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Effect of preoperative pelvic floor muscle therapy with biofeedback versus standard care on stress urinary incontinence and quality of life in men undergoing laparoscopic radical prostatectomy: A randomised control trial. Neurourol Urodyn 2013; 34:144-50. [DOI: 10.1002/nau.22523] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 10/10/2013] [Indexed: 11/07/2022]
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Hirschhorn AD, Kolt GS, Brooks AJ. Barriers and enablers to the provision and receipt of preoperative pelvic floor muscle training for men having radical prostatectomy: a qualitative study. BMC Health Serv Res 2013; 13:305. [PMID: 23938150 PMCID: PMC3751161 DOI: 10.1186/1472-6963-13-305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 08/06/2013] [Indexed: 11/25/2022] Open
Abstract
Background Strong evidence exists to support preoperative pelvic floor muscle training (PFMT) to reduce the severity and duration of urinary incontinence after radical prostatectomy. Receipt of preoperative PFMT amongst men having radical prostatectomy in Western Sydney, however, is suboptimal. This study was undertaken to investigate barriers and enablers to provision/receipt of preoperative PFMT from the perspectives of potential referrers to and providers of PFMT, and of men having radical prostatectomy. Methods A qualitative research design was used. Semi-structured, one-to-one interviews were conducted with participants from three groups: (i) current and potential referrers to PFMT, including urological cancer surgeons, urological cancer nurses and general practitioners (n = 11); (ii) current and potential providers of PFMT across public and private sector hospital and outpatient settings, including physiotherapists and continence nurses (n = 14); and (iii) men having had radical prostatectomy at a specific public and co-located private hospital in Western Sydney (n = 13). Interview schedules were developed using Michie’s theoretical domains for investigating the implementation of evidence-based practice, and allowed participants to identify potential and actual barriers and enablers to preoperative PFMT. Transcribed interview data were analysed using a framework approach, and key themes were identified. Results Participant groups concurred that a recommendation for PFMT from the urological cancer surgeon, accompanied with a referral to a specific provider, was a key enabler of preoperative PFMT. Perceived barriers varied between participant groups and across public and private healthcare settings. Perceptions of financial cost of private sector PFMT, limited knowledge amongst referrers of public sector providers of PFMT, and limited awareness amongst patients of the benefits of PFMT were all posited to contribute to suboptimal PFMT provision and receipt. Conclusions This study has provided valuable data on barriers and enablers to preoperative PFMT, with implications for the planning of a behaviour change intervention to improve provision and receipt of preoperative PFMT in Western Sydney.
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Affiliation(s)
- Andrew D Hirschhorn
- School of Science and Health, University of Western Sydney, Sydney, Australia.
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69
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Hou CP, Chen TY, Chang CC, Lin YH, Chang PL, Chen CL, Hsu YC, Tsui KH. Use of the SF-36 quality of life scale to assess the effect of pelvic floor muscle exercise on aging males who received transurethral prostate surgery. Clin Interv Aging 2013; 8:667-73. [PMID: 23766642 PMCID: PMC3679969 DOI: 10.2147/cia.s44321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose We used the Short Form (SF)-36® Health Survey scale to assess the effect of pelvic floor muscle exercise (PFE) on aging males who received transurethral resection of the prostate (TUR-P). Methods From April 2010 to December 2010, a total of 66 patients who underwent TUR-P were enrolled in this study. They were randomized into two groups (with 33 patients in each group) – an experimental group who performed postoperative PFE every day and a control group. Data, including the International Prostate Symptom Score (IPSS), uroflowmetry study, and the SF-36 quality of life measure, were collected before the operation, and at 1, 4, 8, and 12 weeks after the operation. We analyzed the differences between the two groups with respect to their IPSS scores, maximal urinary flow rate, residual urine amount, and life quality. Results A total of 61 patients (experimental group: 32 patients, and control group: 29 patients) completed this study. We found that at 12 weeks postop, patients who performed PFE every day had a better maximal urinary flow rate (16.41 ± 6.20 vs 12.41 ± 7.28 mL/min) (P = 0.026) compared with patients in the control group. The experimental group had a much greater decrease in IPSS score (P < 0.001). As for the SF-36 scale, the experimental group had higher scores than did the control group on both the physiological domain (54.86 vs 49.86) (P = 0.029) and the psychological domain (61.88 vs 52.69) (P = 0.005). However, there were no significant differences with respect to the postvoiding residual urine between the two groups (57.24 ± 52.95 vs 64.68 ± 50.63 mL) (P = 0.618). Conclusion Compared with the control group, patients who performed PFE for 12 weeks after TUR-P showed improvement in their maximal urinary flow rate and lower urinary tract symptoms, and had a better quality of life. The immediate initiation of PFE is suggested for patients who undergo TUR-P.
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Affiliation(s)
- Chen-Pang Hou
- Department of Urology, Chang Gung Memorial Hospital Linko, Chang Gung University, Taiwan, Republic of China
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Close A, Robertson C, Rushton S, Shirley M, Vale L, Ramsay C, Pickard R. Comparative cost-effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of men with localised prostate cancer: a health technology assessment from the perspective of the UK National Health Service. Eur Urol 2013; 64:361-9. [PMID: 23498062 DOI: 10.1016/j.eururo.2013.02.040] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 02/25/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Robot-assisted laparoscopic prostatectomy is increasingly used compared with a standard laparoscopic technique, but it remains uncertain whether potential benefits offset higher costs. OBJECTIVE To determine the cost-effectiveness of robotic prostatectomy. DESIGN, SETTING, AND PARTICIPANTS We conducted a care pathway description and model-based cost-utility analysis. We studied men with localised prostate cancer able to undergo either robotic or laparoscopic prostatectomy for cure. We used data from a meta-analysis, other published literature, and costs from the UK National Health Service and commercial sources. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Care received by men for 10 yr following radical prostatectomy was modelled. Clinical events, their effect on quality of life, and associated costs were synthesised assuming 200 procedures were performed annually. RESULTS AND LIMITATIONS Over 10 yr, robotic prostatectomy was on average (95% confidence interval [CI]) £1412 (€1595) (£1304 [€1473] to £1516 [€1713]) more costly than laparoscopic prostatectomy but more effective with mean (95% CI) gain in quality-adjusted life-years (QALYs) of 0.08 (0.01-0.15). The incremental cost-effectiveness ratio (ICER) was £18 329 (€20 708) with an 80% probability that robotic prostatectomy was cost effective at a threshold of £30 000 (€33 894)/QALY. The ICER was sensitive to the throughput of cases and the relative positive margin rate favouring robotic prostatectomy. CONCLUSIONS Higher costs of robotic prostatectomy may be offset by modest health gain resulting from lower risk of early harms and positive margin, provided >150 cases are performed each year. Considerable uncertainty persists in the absence of directly comparative randomised data.
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Affiliation(s)
- Andrew Close
- School of Biology, Newcastle University, Newcastle upon Tyne, UK
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71
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Patel MI, Yao J, Hirschhorn AD, Mungovan SF. Preoperative pelvic floor physiotherapy improves continence after radical retropubic prostatectomy. Int J Urol 2013; 20:986-92. [PMID: 23432098 DOI: 10.1111/iju.12099] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 01/06/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Urinary incontinence is a predictable sequela of radical retropubic prostatectomy, and is most severe in the early postoperative phase. The present study aimed to evaluate the effect of a physiotherapist-guided pelvic floor muscle training program, commenced preoperatively, on the severity and duration of urinary continence after radical retropubic prostatectomy. METHODS A retrospective analysis of men undergoing radical retropubic prostatectomy by one high-volume surgeon (n = 284) was carried out. The intervention group received physiotherapist-guided pelvic floor muscle training from 4 weeks preoperatively (n = 152), whereas the control group was provided with verbal instruction on pelvic floor muscle exercise by the surgeon alone (n = 132). Postoperatively, all patients received physiotherapist-guided pelvic floor muscle training. The primary outcome measure was 24-h pad weight at 6 weeks and 3 months postoperatively. Secondary outcome measures were the percentage of patients experiencing severe urinary incontinence, and patient-reported time to one and zero pad usage daily. RESULTS At 6 weeks postoperatively, the 24-h pad weight was significantly lower (9 g vs 17 g, P < 0.001) for the intervention group, which also showed less severe urinary incontinence (24-h pad weight >50 g; 8/152 patients vs 33/132 patients, P < 0.01). There was no significant difference between groups in the 24-h pad weight at 3 months (P = 0.18). Patient-reported time to one and zero pad usage was significantly less for the intervention group (P < 0.05). Multivariate Cox regression showed that preoperative physiotherapist-guided pelvic floor muscle training reduced time to continence (1 pad usage daily) by 28% (P < 0.05). CONCLUSIONS A physiotherapist-guided pelvic floor muscle training program, commenced 4 weeks preoperatively, significantly reduces the duration and severity of early urinary incontinence after radical retropubic prostatectomy.
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Affiliation(s)
- Manish I Patel
- Urological Cancer Outcomes Center, Discipline of Surgery, The University of Sydney
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72
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Smith BH, Guthrie B, Sullivan FM, Morris AD. Commentary: A thesis that still warrants defence and promotion. Int J Epidemiol 2013; 41:1518-22. [PMID: 23283711 DOI: 10.1093/ije/dys178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mosli HA. Review Article: Practical Aspects of Testosterone Deficiency Syndrome in Clinical Urology. AFRICAN JOURNAL OF UROLOGY 2012. [DOI: 10.1016/j.afju.2012.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Buckley BS, Lapitan MCM, Glazener CM. The effect of urinary incontinence on health utility and health-related quality of life in men following prostate surgery. Neurourol Urodyn 2012; 31:465-9. [PMID: 22396387 DOI: 10.1002/nau.21231] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 09/20/2011] [Indexed: 11/07/2022]
Abstract
AIMS The impact of urinary incontinence (UI) on health-related quality of life (HRQoL) has been less well researched in men than women and the general population. This study aims to assess the association between UI and HRQoL in men 1 year after prostate surgery. METHODS Planned secondary analysis of data from two parallel randomized controlled trials of active conservative treatment for UI in 853 men following radical prostatectomy (RP) and transurethral resection of the prostate (TURP). Men of any age were eligible for trial inclusion if they were experiencing UI 6 weeks after undergoing RP or TURP at 34 centers in the United Kingdom. Univariate and multivariate analysis considered associations between health status (SF-12 and EQ-5D) and self-reported UI. Multivariate analysis controlled for age, obesity, UI prior to surgery, and concomitant fecal incontinence. RESULTS Mean age of 411 men in the RP trial was 62.3 years (SD 5.7) and 442 men in the TURP trial was 68.0 (SD 7.9). Of men with UI at 6 weeks after surgery, 76.7% in the RP group and 63.2% in the TURP group still had UI at 12 months. Any UI at 12 months was significantly associated with reduced HRQoL in the RP group and lower EQ-5D and SF-12 Mental Component Scores in the TURP group. CONCLUSION Any UI is a significant factor in reduced HRQoL in men following prostate surgery, particularly younger men who undergo RP. Its importance to patients as an adverse outcome should not be underestimated.
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Affiliation(s)
- Brian S Buckley
- Department of General Practice, National University of Ireland, Galway, Ireland.
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Campbell SE, Glazener CM, Hunter KF, Cody JD, Moore KN. Conservative management for postprostatectomy urinary incontinence. Cochrane Database Syst Rev 2012; 1:CD001843. [PMID: 22258946 DOI: 10.1002/14651858.cd001843.pub4] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Urinary incontinence is common after both radical prostatectomy and transurethral resection of the prostate (TURP). Conservative management includes pelvic floor muscle training with or without biofeedback, electrical stimulation, extra-corporeal magnetic innervation (ExMI), compression devices (penile clamps), lifestyle changes, or a combination of methods. OBJECTIVES To assess the effects of conservative management for urinary incontinence after prostatectomy. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register (searched 24 August 2011), EMBASE (January 1980 to Week 48 2009), CINAHL (January 1982 to 20 November 2009), the reference lists of relevant articles, handsearched conference proceedings and contacted investigators to locate studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials evaluating conservative interventions for urinary continence in men after prostatectomy. DATA COLLECTION AND ANALYSIS Two or more review authors assessed the methodological quality of trials and abstracted data. We tried to contact several authors of included studies to obtain extra information. MAIN RESULTS Thirty-seven trials met the inclusion criteria, 33 amongst men after radical prostatectomy, three trials after transurethral resection of the prostate (TURP) and one trial after either operation. The trials included 3399 men, of whom 1937 had an active conservative intervention. There was considerable variation in the interventions, populations and outcome measures. Data were not available for many of the pre-stated outcomes. Men's symptoms improved over time irrespective of management. Adverse effects did not occur or were not reported.There was no evidence from eight trials that pelvic floor muscle training with or without biofeedback was better than control for men who had urinary incontinence after radical prostatectomy (e.g. 57% with urinary incontinence versus 62% in the control group, risk ratio (RR) for incontinence after 12 months 0.85, 95% confidence interval (CI) 0.60 to 1.22) as the confidence intervals were wide, reflecting uncertainty. However, one large multicentre trial of one-to-one therapy showed no difference in any urinary or quality of life outcome measures and had narrower confidence intervals. There was also no evidence of benefit for erectile dysfunction (56% with no erection in the pelvic floor muscle training group versus 55% in the control group after one year, RR 1.01, 95% CI 0.84 to 1.20). Individual small trials provided data to suggest that electrical stimulation, external magnetic innervation or combinations of treatments might be beneficial but the evidence was limited. One large trial demonstrated that there was no benefit for incontinence or erectile dysfunction from a one-to-one pelvic floor muscle training based intervention to men who were incontinent after transurethral resection of the prostate (TURP) (e.g. 65% with urinary incontinence versus 62% in the control group, RR after 12 months 1.05, 95% CI 0.91 to 1.23).In eight trials of conservative treatment of all men after radical prostatectomy aimed at both treatment and prevention, there was an overall benefit from pelvic floor muscle training versus control management in terms of reduction of UI (e.g. 10% with urinary incontinence after one year versus 32% in the control groups, RR for urinary incontinence 0.32, 95% CI 0.20 to 0.51). However, this finding was not supported by other data from pad tests. The findings should be treated with caution, as most trials were of poor to moderate quality and confidence intervals were wide. Men in one trial were more satisfied with one type of external compression device, which had the lowest urine loss, compared to two others or no treatment. The effect of other conservative interventions such as lifestyle changes remains undetermined as no trials involving these interventions were identified. AUTHORS' CONCLUSIONS The value of the various approaches to conservative management of postprostatectomy incontinence after radical prostatectomy remains uncertain. It seems unlikely that men benefit from one-to-one pelvic floor muscle training therapy after transurethral resection of the prostate (TURP). Long-term incontinence may be managed by external penile clamp, but there are safety problems.
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Affiliation(s)
- Susan E Campbell
- School of Nursing Sciences, Faculty of Medicine and Health Sciences,University of East Anglia, Norwich, UK
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Manassero F, Giannarini G, Pistolesi D, Valent F, Selli C. Pelvic floor muscle training after prostate surgery. Lancet 2012; 379:119-20; author reply 121. [PMID: 22243820 DOI: 10.1016/s0140-6736(12)60057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Affiliation(s)
- Marcus J Drake
- Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK.
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