1
|
Amparore D, De Cillis S, Alladio E, Sica M, Piramide F, Verri P, Checcucci E, Piana A, Quarà A, Cisero E, Manfredi M, Di Dio M, Fiori C, Porpiglia F. Development of Machine Learning Algorithm to Predict the Risk of Incontinence After Robot-Assisted Radical Prostatectomy. J Endourol 2024; 38:871-878. [PMID: 38512711 DOI: 10.1089/end.2024.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Introduction: Predicting postoperative incontinence beforehand is crucial for intensified and personalized rehabilitation after robot-assisted radical prostatectomy. Although nomograms exist, their retrospective limitations highlight artificial intelligence (AI)'s potential. This study seeks to develop a machine learning algorithm using robot-assisted radical prostatectomy (RARP) data to predict postoperative incontinence, advancing personalized care. Materials and Methods: In this propsective observational study, patients with localized prostate cancer undergoing RARP between April 2022 and January 2023 were assessed. Preoperative variables included age, body mass index, prostate-specific antigen (PSA) levels, digital rectal examination (DRE) results, Gleason score, International Society of Urological Pathology grade, and continence and potency questionnaires responses. Intraoperative factors, postoperative outcomes, and pathological variables were recorded. Urinary continence was evaluated using the Expanded Prostate cancer Index Composite questionnaire, and machine learning models (XGBoost, Random Forest, Logistic Regression) were explored to predict incontinence risk. The chosen model's SHAP values elucidated variables impacting predictions. Results: A dataset of 227 patients undergoing RARP was considered for the study. Post-RARP complications were predominantly low grade, and urinary continence rates were 74.2%, 80.7%, and 91.4% at 7, 13, and 90 days after catheter removal, respectively. Employing machine learning, XGBoost proved the most effective in predicting postoperative incontinence risk. Significant variables identified by the algorithm included nerve-sparing approach, age, DRE, and total PSA. The model's threshold of 0.67 categorized patients into high or low risk, offering personalized predictions about the risk of incontinence after surgery. Conclusions: Predicting postoperative incontinence is crucial for tailoring rehabilitation after RARP. Machine learning algorithm, particularly XGBoost, can effectively identify those variables more heavily, impacting the outcome of postoperative continence, allowing to build an AI-driven model addressing the current challenges in post-RARP rehabilitation.
Collapse
Affiliation(s)
- Daniele Amparore
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Sabrina De Cillis
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Eugenio Alladio
- Department of Chemistry, University of Turin, Turin, Italy
- Centro Regionale Antidoping "A. Bertinaria" of Orbassano (Turin), Turin, Italy
| | - Michele Sica
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Federico Piramide
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Paolo Verri
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Alberto Piana
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Alberto Quarà
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Edoardo Cisero
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Matteo Manfredi
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Michele Di Dio
- Division of Urology, Department of Surgery, SS Annunziata Hospital, Cosenza, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| |
Collapse
|
2
|
Tutolo M, Giraudo D, Montorsi F. Re: Eileen V. Johnson, Kelsie Kaiser. Clinical Consultation Guide: Pelvic Floor Prehabilitation. Eur Urol Focus 2024;10:13-5. Eur Urol Focus 2024:S2405-4569(24)00120-2. [PMID: 39034186 DOI: 10.1016/j.euf.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/31/2024] [Indexed: 07/23/2024]
Affiliation(s)
- Manuela Tutolo
- Department of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Donatella Giraudo
- Department of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| |
Collapse
|
3
|
Bernard S, Evans H, Hoy NY, Suderman K, Cameron B, Sexsmith J, Kinnaird A, Rourke K, Dean L, Pituskin E, Usmani N, Tandon P, McNeely ML. Control4Life: A randomized controlled trial protocol examining the feasibility and efficacy of a combined pelvic health rehabilitation and exercise fitness program for individuals undergoing prostatectomy. Contemp Clin Trials 2024; 139:107482. [PMID: 38431130 DOI: 10.1016/j.cct.2024.107482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Urinary incontinence (UI), erectile dysfunction and cardiometabolic conditions are common after prostatectomy for prostate cancer (PCa). Although physical activity could improve overall survival and quality of survivorship, fear of UI can restrict participation in exercise. Individuals with PCa could benefit from therapeutic exercise programming to support continence recovery and cardiometabolic health. AIM The main objective of this study is to determine the feasibility and the effects of a combined pelvic health rehabilitation and exercise fitness program on UI after prostatectomy. The combined exercise program will be delivered both in-person and virtually. METHODS This study follows a modified Zelen, two-arm parallel randomized controlled trial design. A total of 106 individuals with PCa will be recruited before prostatectomy surgery. Participants will be randomized between two groups: one receiving usual care and one receiving a combined exercise fitness and intensive pelvic floor muscle training program. Exercise programming will begin 6-8 weeks after prostatectomy and will last 12 weeks. Outcomes include: the 24-h pad test (primary outcome for UI); physical fitness, metabolic indicators, and patient-reported outcomes on erectile function, self-efficacy, severity of cancer symptoms and quality of life. Important timepoints for assessments include before surgery (T0), after surgery (T1), after intervention (T3) and at one-year after surgery (T4). CONCLUSION This study will inform the feasibility of offering comprehensive exercise programming that has the potential to positively impact urinary continence, erectile function and cardiometabolic health of individuals undergoing prostatectomy for prostate cancer. CLINICALTRIALS REGISTRATION NUMBER NCT06072911.
Collapse
Affiliation(s)
- Stéphanie Bernard
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Québec, Canada
| | - Howard Evans
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Nathan Y Hoy
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Kirsten Suderman
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Bruce Cameron
- Patient-partner, Cancer Rehabilitation Clinic, Edmonton, Alberta, Canada
| | - John Sexsmith
- Patient-partner, Cancer Rehabilitation Clinic, Edmonton, Alberta, Canada
| | - Adam Kinnaird
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Keith Rourke
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Lucas Dean
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Edith Pituskin
- Cancer Care Alberta, Alberta Health Services, Edmonton, Alberta, Canada; Faculty of Nursing, University of Alberta, Edmonton; Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Nawaid Usmani
- Cross Cancer Institute, Division of Radiation Oncology, Edmonton, Alberta, Canada; Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Puneeta Tandon
- Department of Medicine, Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada
| | - Margaret L McNeely
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada; Cancer Care Alberta, Alberta Health Services, Edmonton, Alberta, Canada; Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
4
|
An D, Wang J, Zhang F, Jing H, Gao Y, Cong H, Su G, Ye M, Hu C, Wu J, Liao L. Effect of Pilates combined with pelvic floor muscle training on continence of post-prostatectomy incontinence in patients with different body mass index. BMC Urol 2024; 24:74. [PMID: 38549067 PMCID: PMC10976754 DOI: 10.1186/s12894-024-01451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/07/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Urinary incontinence symptoms severely affect older people with different body mass index (BMI).To compare the efficacy of the pelvic floor muscle training (PFMT) in patients with post-prostatectomy incontinence with different BMI. METHODS Thirty-seven patients with post-prostatectomy incontinence were included. They were divided into group A (BMI ≤ 25,12), group B (26 ≤ BMI ≤ 30,14), and group C (BMI ≥ 31,11) based on difference BMI. Three groups of patients underwent the same Pilates combined with kegel training. Participants were assessed with 1-hour pad test, the number of incontinence episodes, International Consultation on Incontinence Questionnaire and Oxford Grading Scale. RESULTS In the 1-hour pad test, the differences before and after training were statistically significant in all three groups of participants. Group A decreased from 81.83 ± 8.79 to 31.08 ± 5.64 g (P < 0.01). Group B decreased from 80.57 ± 8.87 to 35.85 ± 5.66 g (P < 0.01). Group C decreased from 83.55 ± 10.24 to 40.18 ± 7.01 g (P < 0.01). The number of incontinent episodes in group A decreased from 9.33 ± 1.07 to 3.25 ± 0.62 (P < 0.01). Group B decreased from 8.86 ± 1.09 to 3.79 ± 0.80 (P < 0.01). Group C decreased from 9.27 ± 1.10 to 4.09 ± 0.70 (P < 0.01). The correlation between the three groups of participants and the 1-hour pad test, with an R2 of 0.51. The correlation between the three groups of participants and the number of urinary incontinence episodes with a R2 of 0.43. CONCLUSIONS Pelvic floor muscle training can affect the recovery of urinary continence in patients with different BMI. Maintaining a lower BMI can be beneficial for improving urinary control. TRIAL REGISTRATION Date of trial registration: November 27, 2023.
Collapse
Affiliation(s)
- Di An
- Department of physiotherapy 2 (PT2), China Rehabilitation Research Center the School of Rehabilitation, Capital Medical University, NO 10, Jiaomen Beilu, Fengtai district, Beijing, 100068, China
| | - Jianxia Wang
- Department of Intensive Care Unit, Cancer Hospital Chinese Academy of Medical Science, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
| | - Fan Zhang
- Department of Urology, China Rehabilitation Research Center, Fengtai district, Beijing, China
| | - Huafang Jing
- Department of Urology, China Rehabilitation Research Center, Fengtai district, Beijing, China
| | - Yi Gao
- Department of Urology, China Rehabilitation Research Center, Fengtai district, Beijing, China
| | - Huiling Cong
- Department of Urology, China Rehabilitation Research Center, Fengtai district, Beijing, China
| | - Guodong Su
- Department of physiotherapy 3(PT3), China Rehabilitation Research Center, Fengtai district, Beijing, China
| | - Miao Ye
- Department of physiotherapy 2 (PT2), China Rehabilitation Research Center the School of Rehabilitation, Capital Medical University, NO 10, Jiaomen Beilu, Fengtai district, Beijing, 100068, China
| | - Chunying Hu
- Department of physiotherapy 2 (PT2), China Rehabilitation Research Center the School of Rehabilitation, Capital Medical University, NO 10, Jiaomen Beilu, Fengtai district, Beijing, 100068, China
| | - Juan Wu
- Department of Urology, China Rehabilitation Research Center, Fengtai district, Beijing, China
| | - Limin Liao
- China Rehabilitation Research Center (CRRC), Department of Urology of Beijing Boai Hospital, Department of Urology of Capital Medical University, NO 10, Jiaomen Beilu, Beijing, 100068, China.
| |
Collapse
|
5
|
Azevedo C, Ferreira da Mata LR, Cristina de Resende Izidoro L, de Castro Moura C, Bacelar Assis Araújo B, Pereira MG, Machado Chianca TC. Effectiveness of auricular acupuncture and pelvic floor muscle training in the management of urinary incontinence following surgical treatment for prostate cancer: A randomized clinical trial. Eur J Oncol Nurs 2024; 68:102490. [PMID: 38113770 DOI: 10.1016/j.ejon.2023.102490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 12/02/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE To evaluate the effectiveness of auricular acupuncture combined with pelvic floor muscle training to manage urinary incontinence following radical prostatectomy. METHODS This is a randomized clinical trial that was conducted between April 2019 and April 2020 with 60 participants allocated into two groups, namely: control (pelvic muscle training) and intervention (auricular acupuncture + pelvic muscle training). Interventions were carried out during eight weekly sessions. Generalized estimating equations and proportion difference tests were applied in the statistical analysis with a significance level of 0.05. RESULTS Urinary incontinence severity decreased between pre-test and post-test in both groups. There was a statistically significant difference of the impact of urinary incontinence on quality of life between the groups at post-test in the domain "severity measures" (p = 0.013), and only in the intervention group between pre-test and post-test in the domains "emotions" (p < 0.001) and "sleep and mood" (p = 0.008). The intervention group was 20.8% (p = 0.007) and 25.3% (p = 0.002) less likely to present nocturia and urinary urgency, respectively. CONCLUSIONS Auricular acupuncture combined with pelvic floor muscle training was more effective, compared to pelvic floor muscle training alone, in reducing the impact of urinary incontinence on quality of life and reducing the odds of nocturia and urinary urgency.
Collapse
Affiliation(s)
- Cissa Azevedo
- Federal University of São João del Rei, Campus Centro-Oeste Dona Lindu, Sebastião Gonçalves Coelho Street, 400, Chanadour, Divinópolis, Minas Gerais, 35501-296, Brazil.
| | - Luciana Regina Ferreira da Mata
- Nursing School and Postgraduate Program in Nursing of Federal University of Minas Gerais, 190 Prof. Alfredo Balena St., Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | | | - Caroline de Castro Moura
- Department of Medicine and Nursing, Federal University of Viçosa, Minas Gerais, 36570-900, Brazil
| | - Bianca Bacelar Assis Araújo
- Nursing School and Postgraduate Program in Nursing of Federal University of Minas Gerais, 190 Prof. Alfredo Balena St., Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - M Graça Pereira
- Clinical Psychology. University of Minho, School of Psychology. Braga, Portugal
| | - Tânia Couto Machado Chianca
- Nursing School and Postgraduate Program in Nursing of Federal University of Minas Gerais, 190 Prof. Alfredo Balena St., Belo Horizonte, Minas Gerais, 30130-100, Brazil
| |
Collapse
|
6
|
Sanchez-Salas R, Tourinho-Barbosa R, Sivaraman A, Borges RC, Candela L, Cathala N, Mombet A, Marra G, Sanchez LR, Boumezrag CB, Lanz C, Macek P, Korkes F, Cathelineau X. Assessing the efficacy of pelvic floor muscle training and duloxetine on urinary continence recovery following radical prostatectomy: A randomized clinical trial. Prostate 2024; 84:158-165. [PMID: 37904330 DOI: 10.1002/pros.24634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/09/2023] [Accepted: 09/18/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Urinary incontinence (UI) can negatively impact quality of life (QoL) after robot-assisted radical prostatectomy (RARP). Pelvic floor muscle training (PFMT) and duloxetine are used to manage post-RARP UI, but their efficacy remains uncertain. We aimed to investigate the efficacy of PFMT and duloxetine in promoting urinary continence recovery (UCR) after RARP. METHODS A randomized controlled trial involving patients with urine leakage after RARP from May 2015 to February 2018. Patients were randomized into 1 of 4 arms: (1) PFMT-biofeedback, (2) duloxetine, (3) combined PFMT-biofeedback and duloxetine, (4) control arm. PFMT consisted of pelvic muscle exercises conducted with electromyographic feedback weekly, for 3 months. Oral duloxetine was administered at bedtime for 3 months. The primary outcome was prevalence of continence at 6 months, defined as using ≤1 security pad. Urinary symptoms and QoL were assessed by using a visual analogue scale, and validated questionnaires. RESULTS From the 240 patients included in the trial, 89% of patients completed 1 year of follow-up. Treatment compliance was observed in 88% (92/105) of patients receiving duloxetine, and in 97% (104/107) of patients scheduled to PFMT-biofeedback sessions. In the control group 96% of patients had achieved continence at 6 months, compared with 90% (p = 0.3) in the PMFT-biofeedback, 73% (p = 0.008) in the duloxetine, and 69% (p = 0.003) in the combined treatment arm. At 6 months, QoL was classified as uncomfortable or worse in 17% of patients in the control group, compared with 44% (p = 0.01), 45% (p = 0.008), and 34% (p = 0.07), respectively. Complete preservation of neurovascular bundles (NVB) (OR: 2.95; p = 0.048) was the only perioperative intervention found to improve early UCR. CONCLUSIONS PFMT-biofeedback and duloxetine demonstrated limited impact in improving UCR after RP. Diligent NVB preservation, along with preoperative patient and disease characteristics, are the primary determinants for early UCR.
Collapse
Affiliation(s)
- Rafael Sanchez-Salas
- Department of Surgery, Division of Urology, McGill University, Montreal, Canada
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Tourinho-Barbosa
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
- Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil
| | - Arjun Sivaraman
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Castilho Borges
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
- Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil
| | - Luigi Candela
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Nathalie Cathala
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Annick Mombet
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Giancarlo Marra
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Lara Rodriguez Sanchez
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Chahrazad Bey Boumezrag
- Department of Research, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Camille Lanz
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Fernando Korkes
- Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| |
Collapse
|
7
|
Steenstrup B, Cartier M, Cornu JN. What more comprehensive physiotherapy techniques than pelvic floor muscles training should be investigated in the context of post-prostatectomy? A narrative review. Prog Urol 2023; 33:1092-1100. [PMID: 37798160 DOI: 10.1016/j.purol.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/04/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND In a previous article, we have underlined the emerging level of evidence for the effectiveness of a more comprehensive functional physical therapy than solely pelvic floor muscles training (PFMT) for men after radical prostatectomy (RP). More and more authors suggest that physiotherapy programs should not focus only on the side effect of continence, but more generally on the interaction of continence disorders with all other side effects related to patient's physical and emotional functioning. RESEARCH QUESTION The aims of this narrative review are to highlight rehabilitation approaches unrelated to analytical PFMT that would seem relevant to consider in the future for post-RP men. METHOD Our narrative review sought to map the body of literature relevant to the primary objective (non-PFMT), supplementing the data from our previous review with additional recent articles that were not eligible due to not meeting the inclusion criteria for a systematic review. RESULTS After full text screening, 13 interventional studies have been selected. Intervention strategies were based on five major type of exercises: flexibility, synergism & co-activation, coordination & movement control, strength & endurance, aerobic & games therapy. Most of the studies of this narrative review focused on synergies, co-activations and movement control techniques that emphasized the deep abdominal muscles and PFMs reflexive activation. The wide variety of countries represented in the 13 studies with consistent results point to the potential effectiveness and replicability across various socio-cultural, ethnical, or religious contexts. CONCLUSION We found 13 studies from 9 different countries that provide a more complete rehabilitation approach than PFMT alone in men post-RP. Intervention strategies were built around five main types of exercises, with the majority of them emphasizing synergies, co-activations, and movement control techniques. In light of these data, we hope that future research will enable us to offer the most relevant and patient-centered physiotherapy treatment.
Collapse
Affiliation(s)
- B Steenstrup
- Rouen University Hospital, Department of Urology, Rouen, France; La Musse Physiotherapy Training Institute, Saint-Sébastien-de-Morsent, France.
| | - M Cartier
- La Musse Physiotherapy Training Institute, Saint-Sébastien-de-Morsent, France
| | - J N Cornu
- Rouen University Hospital, Department of Urology, Rouen, France
| |
Collapse
|
8
|
Wu X, Wong CHM, Gandaglia G, Chiu PKF. Urinary continence in high-risk prostate cancer after robot-assisted radical prostatectomy. Curr Opin Urol 2023; 33:482-487. [PMID: 37646515 DOI: 10.1097/mou.0000000000001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW Urinary incontinence is common postoperative complication following robot-assisted radical prostatectomy (RARP) in patients with prostate cancer (PCa). Despite the increasing adoption of RARP in the treatment of high-risk PCa (HRPC), concerns persist regarding the adequacy of reported continence outcomes in this subgroup. This review aims to illuminate the state of continence recovery in HRPC patients post-RARP. RECENT FINDINGS Urinary continence (UC) recovery rates in HRPC was reported to be lower than the intermediate/low-risk counterparts from 6 to 24 months post-RARP. Predictive models showed that age, obesity, race, disease status, and surgical approaches represent predictors of continence recovery. Special techniques like NeuroSAFE technique and Retzius-Sparing approach also play a role in reducing incontinence also in the high-risk scenario. SUMMARY RARP for HRPC appears to be associated with worse continence compared with other risk groups. A multimodality approach for prediction and prevention of incontinence after RARP is vital. Further research into this area is necessary to enhance continence recovery outcomes in HRPC patients undergoing RARP.
Collapse
Affiliation(s)
- Xiaobo Wu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chris Ho-Ming Wong
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Peter Ka-Fung Chiu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
9
|
Benedetto G, Simone B, Gaia L, Mirko J, Ottavia B, Marco T. The added value of devices to pelvic floor muscle training in radical post-prostatectomy stress urinary incontinence: A systematic review with metanalysis. PLoS One 2023; 18:e0289636. [PMID: 37768987 PMCID: PMC10538711 DOI: 10.1371/journal.pone.0289636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/23/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE To investigate the role of pelvic floor devices (e.g., biofeedback, electrical stimulation, magnetic stimulation, or their combination) as adjunctive treatments in pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) after radical prostatectomy. MATERIALS AND METHODS A systematic review with meta-analysis. We searched for randomised controlled trials (RCTs) and prospective non-randomised studies investigating the effectiveness of pelvic floor devices as an adjunctive treatment for SUI symptoms assessed with weight pad-test or standardised questionnaires. To assess the risk of bias (RoB) and overall certainty of evidence, the RoB 2.0 or the ROBINS-I, and the GRADE approach were used. RESULTS Eleven RCTs met our eligibility criteria. One was at a 'low' RoB, one had 'some concerns', while nine were at a 'high' RoB. Two meta-analyses were conducted to analyse the pooled results of six RCTs included. Specifically, two RCTs reported at week 4 with a 1h pad test a mean difference of 0.64 (95% CI = [-13.09, 14.36]), and four RCTs reported at week 12 with a 24h pad test a mean difference of -47.75 (95% CI = [-104.18, 8.69]). The heterogeneity was high in both analyses (I2 = 80.0%; I2 = 80.6%). The overall level of certainty was very low. CONCLUSIONS In line with our results, we cannot conclude whether pelvic floor devices add any value as adjunctive treatment in the management of SUI after radical prostatectomy. Future studies require more comprehensive and standardised approaches to understand whether these devices are effective.
Collapse
Affiliation(s)
- Giardulli Benedetto
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Battista Simone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Leuzzi Gaia
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Job Mirko
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Buccarella Ottavia
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Testa Marco
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| |
Collapse
|
10
|
Wang L, Li Y, Qi Z, Wang W. Barriers and facilitators of the implementation of the application of pelvic floor muscle training in patients with prostate cancer: a scoping review. Front Public Health 2023; 11:1191508. [PMID: 37771836 PMCID: PMC10523151 DOI: 10.3389/fpubh.2023.1191508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/14/2023] [Indexed: 09/30/2023] Open
Abstract
Background Patients with prostate cancer (PCa) benefit significantly from pelvic floor exercises, but recent results indicate that these exercises have not been fully promoted in clinical settings. This scoping review aimed to identify the facilitators of and barriers to pelvic floor muscle training (PFMT) in PCa survivors. Methods A scoping review was conducted in November 2022. Relevant studies were identified from CINAHL, Embase, PubMed, PsycINFO, and Web of Science databases from their inception to 20 November 2022. Data were analyzed and extracted by two formally trained researchers. Results A total of 53 studies were included, most of which were randomized controlled trials. The Tailored Implementation for Chronic Diseases (TICD) model framework was used to identify the contents of seven barriers and promotion areas, as well as a series of sub-domains. The most common barriers to implementing pelvic floor muscle training (PFMT) included the following: the lack of a common scheme in guidelines and the measurement of common standardized outcomes, inadequate self-monitoring or feedback from healthcare professionals to improve PFMT compliance, poor patient compliance, and a lack of implementation equipment and financial support. Good treatment effects and easy operation were the facilitators of PFMT. Conclusion The implementation of PFMT faces several challenges and opportunities that should be understood thoroughly before implementation. In terms of guidelines and clinical practice, more work is needed, and the possibility of PFMT implementation in various hospitals and community health centers or clinics should be considered.
Collapse
Affiliation(s)
| | | | | | - Wei Wang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
11
|
Wu Y, Li P, Shi J, Li J, Zhang Y, Xiao B. Research trends of acupuncture therapy on stress urinary incontinence from 1992 to 2022: A bibliometric analysis. Heliyon 2023; 9:e19732. [PMID: 37810054 PMCID: PMC10559016 DOI: 10.1016/j.heliyon.2023.e19732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
Background Stress urinary incontinence (SUI), the most prevalent type of urinary incontinence disorder, has aroused increasing attention among societies since it has caused much inconvenience in daily life. In addition to conventional conservative treatments like medication and pelvic floor muscle training, acupuncture is now frequently advised. However, a bibliometric analysis of the trend of SUI therapies is still lacking. Objectives This article was carried out using CiteSpace (6.3.1) software to research the use of acupuncture therapy on SUI worldwide over the past 30 years (since the database's inception). Methods All related articles included were retrieved from the Web of Science Core Collection. CiteSpace (6.3.1) software was used to analyze the number of publications, countries and institutions, authors and cited authors, and burst keywords to assess the hotspots and trends over the previous three decades. And Microsoft Office Excel 2019 was also used for sorting data and generating tables. Results The articles were retrieved on August 31, 2022. A total of 108 records with publication dates ranging from 1992 to 2022 were discovered. The annual number of publications generally increased. In the aspect of publication regions, the USA ranked first in centrality, but China had the largest number of publications. The China Academic of Chinese Medical Sciences, Beijing University of Chinese Medicine, and Shanghai University of Traditional Chinese Medicine were the top 3 institutions, according to the institution map. Liu Z (Liu ZS) was the most productive author, and Chen Y ranked first in the centrality. The article published by Liu Z (Liu ZS) in 2017 was the most cited reference. "Bladder neck suspension", "electrical stimulation" and "acupuncture" were popular therapies mentioned among the top ten hot topics. The keywords "therapy", "postprostatectomy incontinence", "muscle", "cell therapy", and "symptom" ranked in the top five on citation burst. The four frontier topics were "efficacy", "symptom", "cell therapy", and "medical technology". Conclusion This study illustrated that the application of acupuncture on SUI had an increasing acceptance worldwide. Recent research has concentrated mainly on acupuncture and electroacupuncture, however, there is still not enough literature on these topics. The valuable information was provided for acupuncture researchers to identify prospects including potential collaborators, cooperation institutions, hot themes, and research frontiers.
Collapse
Affiliation(s)
| | | | - Jiani Shi
- Shanghai University of Traditional Chinese Medicine, China
| | - Jiawei Li
- Shanghai University of Traditional Chinese Medicine, China
| | - Yuchen Zhang
- Shanghai University of Traditional Chinese Medicine, China
| | - Bin Xiao
- Shanghai University of Traditional Chinese Medicine, China
| |
Collapse
|
12
|
Tan MY, Mo CY, Zhao Q. Efficacy and safety of acupuncture in the treatment of urinary incontinence after prostate surgery: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e072516. [PMID: 37597872 PMCID: PMC10441104 DOI: 10.1136/bmjopen-2023-072516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/02/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Urinary incontinence (UI) is a common complication after prostate surgery. Acupuncture treatment (AT) has been proposed as an alternative therapy for this condition. The purpose of this protocol aims to outline a systematic review and meta-analysis that aims to evaluate the effectiveness and safety of AT in patients with postprostate surgery UI. METHODS We will search for randomised controlled trials (RCTs) in eight databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang database, SinoMed and VIP database. Additionally, we will search two clinical trial registration platforms, namely the WHO's International Clinical Trials Registry Platform and the Chinese Clinical Trial Registry. The search will include articles from the inception of these databases until 30 September 2023. The extracted data will then be imported into the Stata V.15.0 software. Two authors will independently review the literature, collect data and use the Grades of Recommendation, Assessment, Development and Evaluation and the Cochrane Risk of Bias 2 tool to evaluate the risk of bias and the quality of the evidence. Outcomes for RCTs will include at least one of the following: International Consultation Incontinence Questionnaire-Urinary Incontinence Short Form, Individualised Care for People with long-term health conditions-Capability measure for Adults, Score of Frequency Incontinence Quality of Life Questionnaire, Patient Global Impression of Improvement, Visual Analogue Scale, Numeric Rating Scale, 1- hour pad test, Self-Rating Anxiety Scale, total efficiency and adverse event. We will use random or fixed effect models to analyse data according to heterogeneity. If significant heterogeneity exists along with sufficient data, we will perform subgroup analyses to identify the source of heterogeneity. ETHICS AND DISSEMINATION Ethical approval is not required for this study because the data we will extract are from published articles. The results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022382806.
Collapse
Affiliation(s)
- Mo-Yao Tan
- Chengdu Integrated TCM and Western Medicine Hospital, Chengdu, China
| | - Chao-Yue Mo
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qian Zhao
- Chengdu Integrated TCM and Western Medicine Hospital, Chengdu, China
| |
Collapse
|
13
|
Giraudo D, Lamberti G, Ciardi G. Pelvic Floor Muscle Training for Urinary Incontinence After Radical Prostatectomy: A Narrative Review. Urologia 2023; 90:445-453. [PMID: 37002838 DOI: 10.1177/03915603231166729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Rehabilitative treatment of urinary incontinence after prostatectomy has showed, on the basis of recent published evidence, encouraging results. At first, clinician applied evaluation and treatment approach suggested based on the studies and rationale of female stress urinary incontinence, but although long term literature suggested no evidence of benefits. Recent studies that have shown the real control mechanisms in male continence through the use of trans-perineal ultrasound, demonstrated that it is not appropriate to transfer the rehabilitation techniques applied in female stress incontinence to male incontinence after prostatectomy. Even that pathophysiology of urinary incontinence after prostatectomy is not fully understood, it's in part attributable to a urethral or bladder source. In particular, however, urethral sphincter dysfunction is predominant, secondary to surgical damage and to the partly organic and partly functional dysfunction of the external urethral sphincter; complementary action of all the muscles capable of contributing to the maintenance of urethral resistance is therefore important. As for rehabilitative approach to post-prostatectomy incontinence, the primary objective is to quantify the residual capacity of the muscular function that must replace the sphincter function, often compromised by surgery. Than a multimodal approach, comprising exercise and instrumental therapies, is needed. The present paper's aim was to overview current urinary dysfunction knowledge for male with radical prostatectomy, and to describe practical issue of evaluation and conservative treatment.
Collapse
Affiliation(s)
- Donatella Giraudo
- Department of Urology, San Raffaele Turro Hospital, Milano, Lombardia, Italy
| | - Gianfranco Lamberti
- Department of Rehabilitative Medicine, AUSL Piacenza, Piacenza, Emilia-Romagna, Italy
- Physiotherapy Degree Course, University of Parma, Parma, Italy
| | - Gianluca Ciardi
- Department of Rehabilitative Medicine, AUSL Piacenza, Piacenza, Emilia-Romagna, Italy
- Physiotherapy Degree Course, University of Parma, Parma, Italy
| |
Collapse
|
14
|
Geng E, Yin S, Yang Y, Ke C, Fang K, Liu J, Wang D. The effect of perioperative pelvic floor muscle exercise on urinary incontinence after radical prostatectomy: a meta-analysis. Int Braz J Urol 2023; 49:441-451. [PMID: 37267610 PMCID: PMC10482454 DOI: 10.1590/s1677-5538.ibju.2023.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/09/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Pelvic floor muscle exercise (PFME) is the most common conservative management for urinary incontinence (UI) after radical prostatectomy (RP). We performed this meta-analysis to investigate whether PFME during the entire perioperative period, including before and after RP, can significantly improve the recovery of postoperative UI. METHODS We systematically reviewed randomized controlled trials (RCT) from PubMed, Medline, web of science, Cochrane library, and clinicalitrials.com prior to October 2022. Efficacy data were pooled and analyzed using Review Manager Version 5.3. Pooled analyses of urinary incontinence rates 1, 3, 6, and 12 months postoperatively were conducted, using odds ratio (OR) and 95% confidence intervals (CIs). RESULTS We included a total of 15 RCT studies involving 2178 patients received RP. Postoperative UI could be improved after 1 month, 3 months and 6 months, and the OR were 0.26 (95%CI:0.15-0.46) 0.30 (95%CI: 0.11-0.80) 0.20 (95%CI: 0.07- 0.56) in postoperative PFME group compared to no PFME group. However, there was no significant difference between the two groups in 12 months after surgery, and the OR was 0.85(95%CI: 0.48,1.51). There were similar results in perioperative PFME group compared to no PFME group with the OR of 0.35 (95%CI: 0.12, 0.98) and 0.40 (95%CI: 0.21, 0.75) in 1 and 3 months after surgery. Our results indicated no significant difference between perioperative PFME group and postoperative PFME group. The OR was 0.58 (95%CI: 0.20-1.71) 0.58 (95%CI:0.20-0.71) and 0.66 (95%CI: 0.32-1.38) in 1, 3 and 6 months after surgery. CONCLUSION Application of PFME after RP significantly reduced the incidence of early postoperative UI, and additional preoperative PFME had no significant improvement on the recovery of UI.
Collapse
Affiliation(s)
- Erkang Geng
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| | - Sifan Yin
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| | - Yulin Yang
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| | - Changxing Ke
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| | - Kewei Fang
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| | - Jianhe Liu
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| | - Daoqi Wang
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| |
Collapse
|
15
|
Huaqi Y, Zheng D, Yongkang M, Shiming Z, Zhenghui S, Zhiwei W, Congyu L, Qian L, Bingqi D, Mingkai Z, Chaoshuai Z, Jiangshan P, Tiejun Y. The significance of transrectal ultrasound and urologist_dually guided pelvic floor muscle exercise in improving urinary continence after radical prostatectomy. Eur J Med Res 2023; 28:171. [PMID: 37179346 PMCID: PMC10182606 DOI: 10.1186/s40001-023-01133-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND To determine whether transrectal ultrasound and urologist_dually guided pelvic floor muscle exercise is associated with immediate, early and long-term urinary continence after radical prostatectomy. MATERIALS AND METHODS Data from 114 patients with localized prostate cancer (PC) who underwent RP at Henan Cancer Hospital from November 2018 to April 2021 were included in the retrospective study. Of the 114 patients, 50 patients in the observation group underwent transrectal ultrasound and urologist_dually guided PFME, and 64 patients in the control group underwent verbally_guided PFME. Contractile function of the external urinary sphincter was in the observation group was evaluated. The immediate, early and long-term urinary continence rates were assessed in both groups, and the factors affecting urinary continence were analyzed. RESULTS The urinary continence rate at 2 weeks and 1, 3, 6 and 12 months in the observation group after RP was significantly higher than that in the control group (52.0% vs. 29.7%, 70.0% vs. 39.1%, 82% vs. 57.8, 88% vs. 70.3%, 98.0 vs. 84.4%, p < 0.05). The contractile function of the external urinary sphincter was obviously correlated with urinary continence at multiple visits after RP, except for the 12-month visit. Transrectal ultrasound and urologist-dually guided PFME was verified to be an independent positive factor for urinary continence at 2 weeks and 1, 3, 6 and 12 months using logistic regression analysis. However, TURP was a negative factor for postoperative urinary continence at different times. CONCLUSIONS Transrectal ultrasound and urologist_dually guided PFME had a significant role in improving immediate, early and long-term urinary continence after RP and acted as an independent prognostic factor.
Collapse
Affiliation(s)
- Yin Huaqi
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Du Zheng
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Ma Yongkang
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Zhao Shiming
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Sun Zhenghui
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Wang Zhiwei
- Department of Ultrasound, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Li Congyu
- Department of Ultrasound, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Li Qian
- Department of Ultrasound, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Dong Bingqi
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Zhu Mingkai
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Zhu Chaoshuai
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Peng Jiangshan
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Yang Tiejun
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China.
| |
Collapse
|
16
|
Yang JM, Ye H, Long Y, Zhu Q, Huang H, Xie HY, Luo Y, Zhong YB, Chen J, Wang MY. Effect of pelvic floor muscle training on urinary incontinence after radical prostatectomy: An umbrella review of meta-analysis and systematic review. Clin Rehabil 2023; 37:494-515. [PMID: 36305082 DOI: 10.1177/02692155221136046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyse the specific exercise effects of pelvic floor muscle training (PFMT) with or without biofeedback or electrical stimulation on urinary incontinence rehabilitation after radical prostatectomy. DATA SOURCES We searched PubMed, Embase, Cochrane Database of Systematic Reviews, Web of Science and Scopus databases for systematic reviews and meta-analyses on PFMT for urinary incontinence after radical prostatectomy from inception to 3 October 2022. REVIEW METHODS Two authors independently extracted key data from the included studies. The methodological quality of the included studies was assessed using the A Measure Tool to Assess Systematic Reviews-2 checklist. Grading of Recommendations Assessment Development and Evaluation was used to evaluate the quality of the outcomes. RESULTS A total of 18 studies with 29,925 patients were included, all of which were of critically low methodological quality. Biofeedback therapy seemed to show additional benefits compared to PFMT alone; however, the adjunctive role of electrical stimulation remained more controversial due to the lack of strong evidence. Preoperative PFMT sometimes, but not always, showed the potential to improve urinary incontinence. PFMT with the guidance of a therapist could bring some benefits to the patient and was more acceptable to the patient, but consumed some medical resources. CONCLUSIONS PFMT has a good effect on improving post-radical prostatectomy incontinence in men, and biofeedback can have an additional beneficial effect on patients, especially in the short-term and medium-term. However, there is insufficient evidence to suggest that electrical stimulation is beneficial for patients with urinary incontinence.
Collapse
Affiliation(s)
- Jia-Ming Yang
- Department of Rehabilitation Medicine, 477808First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China.,74554Gannan Medical University, Ganzhou, Jiangxi, China
| | - Hua Ye
- 74554Gannan Medical University, Ganzhou, Jiangxi, China
| | - Yi Long
- 74554Gannan Medical University, Ganzhou, Jiangxi, China
| | - Qiang Zhu
- Department of Rehabilitation Medicine, 477808First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Hui Huang
- Department of Rehabilitation Medicine, 477808First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Hui-Yong Xie
- 74554Gannan Medical University, Ganzhou, Jiangxi, China
| | - Yun Luo
- Department of Rehabilitation Medicine, 477808First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Yan-Biao Zhong
- Department of Rehabilitation Medicine, 477808First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China.,Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou, Jiangxi, China
| | - Jing Chen
- Department of Rehabilitation Medicine, 477808First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Mao-Yuan Wang
- Department of Rehabilitation Medicine, 477808First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China.,Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou, Jiangxi, China
| |
Collapse
|
17
|
Effect of different postures of Pilates combined with Kegel training on pelvic floor muscle strength in post-prostatectomy incontinence. Int Urol Nephrol 2023; 55:519-527. [PMID: 36534222 DOI: 10.1007/s11255-022-03423-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Urinary incontinence seriously affects the daily ability of older males. This study compared the effect of different postures of Pilates combined with Kegel training on pelvic floor muscle strength in post-prostatectomy incontinence. METHODS We included 38 valid samples [group A = 13 (less than 3 months after surgery), group B = 15 (4-6 months after surgery), group C = 10 (more than 6 months after surgery)] and surface electromyography (EMG) was used to record the maximum, and root mean square values of participants in the three groups under four postures. RESULTS There were significant differences in the maximum and mean values among the three groups. In group A, the mean values were 13.04 ± 1.56, 16.98 ± 1.76, 41.58 ± 4.17, and 24.53 ± 2.45 (P < 0.01), respectively. In group B, the mean values were 13.85 ± 1.55, 18.63 ± 1.44, 45.87 ± 3.31, and 28.63 ± 2.02 (P < 0.01), respectively. In group C, the mean values were 14.80 ± 1.32, 19.59 ± 1.55, 47.85 ± 5.05, and 30.11 ± 2.26 (P < 0.01), respectively. The mean and peak values of surface EMG in the three groups correlated with the four basic movements. R2 values were 0.76 and 0.85, 0.77 and 0.88, 0.77 and 0.91, respectively. CONCLUSIONS Pilates with Kegel training was superior to Kegel training alone in unit recruitment ability of the pelvic floor muscles. Pilates training in different positions is recommended according to the patient's condition.
Collapse
|
18
|
Notenboom‐Nas FJM, Knol‐de Vries GE, Beijer L, Tolsma Y, Slieker‐ten Hove MCP, Dekker JH, van Koeveringe GA, Blanker MH. Exploring pelvic floor muscle function in men with and without pelvic floor symptoms: A population-based study. Neurourol Urodyn 2022; 41:1739-1748. [PMID: 35876473 PMCID: PMC9795878 DOI: 10.1002/nau.24996] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/17/2022] [Accepted: 06/01/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pelvic floor symptoms (PFS), such as lower urinary tract symptoms, defecation disorders, sexual problems, and genital-pelvic pain, are prevalent in men. Thorough physical assessments of the external anal sphincter (EAS) and the puborectal muscle (PRM) are the keys to unraveling the role of muscle dysfunction. OBJECTIVES To explore associations within and between the EAS and PRM and between muscle (dys-) function and the number of male PFS. METHODS This cross-sectional study purposively enrolled men aged ≥21 years with 0-4 symptoms from a larger study. After extensive external and internal digital pelvic floor assessment, we explored (1) agreement between muscle function of the EAS versus PRM (using cross tabulation), (2) associations within and between the EAS and PRM (using heatmaps), and (3) associations between muscle function and number of PFS (using a visual presentation [heatmaps] and χ2 tests). RESULTS Overall, 42 out of 199 men (21%) had completely normal muscle function. Sixty-six (33.2%) had no symptoms, of which 53 (80%) had some degree of muscle dysfunction. No clear dose-response relationship existed between muscle (dys-) function and the number of symptoms. The PRM showed both more dysfunction and severer dysfunction than the EAS. CONCLUSIONS No clear association exists between muscle dysfunction and the number of symptoms, and the absence of PFS does not indicate normal muscle function for all men. Dysfunction levels are highest for the PRM. Further pelvic floor muscle research is warranted in men with PFS.
Collapse
Affiliation(s)
- Françoise J. M. Notenboom‐Nas
- Department of General Practice and Elderly Care Medicine, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Grietje E. Knol‐de Vries
- Department of General Practice and Elderly Care Medicine, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Lotte Beijer
- Department of General Practice and Elderly Care Medicine, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Yme Tolsma
- Department of General Practice and Elderly Care Medicine, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Marijke C. Ph. Slieker‐ten Hove
- Department of General Practice and Elderly Care Medicine, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Janny H. Dekker
- Department of General Practice and Elderly Care Medicine, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | | | - Marco H. Blanker
- Department of General Practice and Elderly Care Medicine, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| |
Collapse
|
19
|
Stafford RE, Doorbar‐Baptist S, Hodges PW. The relationship between pre- and postprostatectomy measures of pelvic floor muscle function and development of early incontinence after surgery. Neurourol Urodyn 2022; 41:1722-1730. [PMID: 36066088 PMCID: PMC9826381 DOI: 10.1002/nau.25034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/07/2022] [Accepted: 07/21/2022] [Indexed: 01/11/2023]
Abstract
AIMS The aim of this study is to investigate (i) whether pelvic floor muscle (PFM) shortening can be enhanced by provision of training focused on striated urethral sphincter (SUS) with feedback before prostatectomy, (ii) whether PFM shortening during voluntary efforts and coughing before and after prostatectomy differs between men who do and do not report symptoms of urinary incontinence 1 month after prostatectomy, and (iii) the relationship between severity of incontinence after prostatectomy and features of pelvic floor function (muscle shortening) and urethral length before and after prostatectomy. METHODS Sixty men referred for preoperative PFM training before radical prostatectomy participated. The International Continence Society Male Short Form questionnaire was used to quantify continence status. Transperineal ultrasound (US) imaging was used to record pelvic displacements related to activation of striated urethral sphincter, bulbocavernosus (BC) and puborectalis muscles during cough, "natural" voluntary contraction following pamphlet instruction, and trained voluntary contraction after formal physiotherapist instruction including US feedback. RESULTS Pelvic floor displacements following training differed between continent and incontinent men; continent participants demonstrated increased SUS shortening after training (compared with "natural"), but no difference was observed between trained and "natural" contractions for incontinent participants. Motion at ano-rectal junction during cough was reduced following surgery, but voluntary and involuntary activation of SUS or BC was not consistently affected by surgery. CONCLUSIONS Participants' capacity to improve function of the SUS with training appears related to postprostatectomy continence outcome.
Collapse
Affiliation(s)
- Ryan E. Stafford
- The University of QueenslandSchool of Health and Rehabilitation SciencesBrisbaneQLDAustralia,School of Human Sciences (Exercise Science)The University of Western AustraliaPerthWAAustralia
| | | | - Paul W. Hodges
- The University of QueenslandSchool of Health and Rehabilitation SciencesBrisbaneQLDAustralia
| |
Collapse
|
20
|
Mata LRFD, Azevedo C, Menezes AC, Chagas SDC, Izidoro LCDR, Estevam FEB, Chianca TCM. Cross-cultural adaptation and validation of the Urinary Incontinence Scale After Radical Prostatectomy for the Brazilian context. Rev Gaucha Enferm 2022; 43:e20210163. [PMID: 35976379 DOI: 10.1590/1983-1447.2022.20210163.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/16/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To translate, adapt, and validate the Urinary Incontinence Scale After Radical Prostatectomy for Brazil. METHOD Methodological study: cross-cultural adaptation (translation, synthesis, back translation, expert committee (n=25), pre-testing (n=40) and presentation to original authors) and evaluation of measurement properties (n=80). Data were collected between January 2018 and February 2019 in an oncology unit. The calculated measurement properties: structural validity, hypothesis testing, criterion validity and reliability. RESULTS The Brazilian version was called Escala de Incontinência Urinária Pós-Prostatectomia Radical. One item was excluded due to low factor loading (0.322). A significant correlation was identified between the total score of the scale and instruments applied (p<0.001). Incontinent men had higher scores on the total scale in relation to continents (p<0.001). Cronbach's alpha was 0.94 and composite reliability was 0.97. CONCLUSION The Brazilian version was considered valid and reliable for the assessment of urinary incontinence in prostatectomized patients.
Collapse
Affiliation(s)
| | - Cissa Azevedo
- Universidade Federal de Minas Gerais (UFMG). Escola de Enfermagem. Belo Horizonte, Minas Gerais, Brasil
| | | | | | | | | | | |
Collapse
|
21
|
Tutolo M, Rosiello G, Stabile G, Tasso G, Oreggia D, De Wever L, De Ridder D, Pellegrino A, Esposito A, De Cobelli F, Salonia A, Briganti A, Montorsi F, Everaerts W, Van der Aa F. The key role of levator ani thickness for early urinary continence recovery in patients undergoing robot-assisted radical prostatectomy: A multi-institutional study. Neurourol Urodyn 2022; 41:1563-1572. [PMID: 35781824 DOI: 10.1002/nau.25001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 06/12/2022] [Accepted: 06/19/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Urinary continence (UC) recovery dramatically affects quality of life after robot-assisted radical prostatectomy (RARP). Membranous urethral length (MUL) has been the most studied anatomical variable associated with UC recovery. OBJECTIVE To investigate whether levator ani thickness (LAT), assessed with multi-parametric magnetic resonance imaging (mpMRI), correlates with UC recovery after RARP. DESIGN, SETTING, AND PARTICIPANTS The study included 209 patients treated with RARP by expert surgeons with extensive robotic experience from 2017 to 2019. All patients had complete, clinical, mpMRI, pathological, and postoperative data including pelvic floor muscle training (PFMT) protocols. INTERVENTION After a radiologist-specific training, two urologists independently examined the files, blinded to clinical and pathological findings as well as to postoperative continence status. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS On mpMRI, LAT, bladder neck (BN) shape, MUL, and apex overlapping (AO) were measured. UC recovery was defined as use of 0 or 1 safety pad at follow-up. Multivariable models were used to assess the association between variables and UC recovery. RESULTS AND LIMITATIONS Overall, 173 (82.8%) patients were continent after a median follow-up of 23 months (interquartile range [IQR]: 17-28). Of these, 98 (46.9%) recovered within 3 months after surgery, 42 (20.1%) from 3 to 6 months, and 33 (15.8%) from 6 months onwards. A significant higher rate of patients with LAT > 10 mm (88.1 vs.75.8%; p = 0.03) experienced UC recovery, compared to those with LAT < 10 mm. This difference was observed in the first 3 months after surgery. At multivariable analysis, LAT (odds ratio [OR]: 1.18, 95% confidence interval [CI]: 1.02-1.37; p = 0.02), Preoperative ICIQ score (OR: 0.91, 95% CI: 0.82-0.98, p = 0.03) and PFMT (OR: 1.98, 95% CI: 1.01-3.93; p = 0.04) independently predict higher UC recovery within 3 months, after accounting for age, BMI, preoperative PSA, D'Amico risk group, MUL, BN shape and AO. CONCLUSIONS LAT greater than 1 cm was associated with greater UC recovery. Specifically, LAT greater than 1 cm seems to be associated with higher UC rate at 3 months after RARP, compared to those with LAT < 1 cm. PATIENT SUMMARY Magnetic resonance features can help in predicting the risk of incontinence after robot-assisted radical prostatectomy and should be taken into account when counseling patients before surgery.
Collapse
Affiliation(s)
- Manuela Tutolo
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.,Department of Radiology, University Hospitals Leuven, Leuven, Belgium.,Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Giuseppe Rosiello
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Stabile
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Tasso
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Davide Oreggia
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Liesbeth De Wever
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Department of Urology, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Antony Pellegrino
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Salonia
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Wouter Everaerts
- Department of Urology, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Frank Van der Aa
- Department of Urology, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| |
Collapse
|
22
|
Are We Treating Prostate Cancer–Related Incontinence Effectively? REHABILITATION ONCOLOGY 2022. [DOI: 10.1097/01.reo.0000000000000314] [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]
|
23
|
Steenstrup B, Cartier M, Nouhaud F, Kerdelhue G, Gilliaux M. A systematic review of supervised comprehensive functional physiotherapy after radical prostatectomy. Prog Urol 2022; 32:525-539. [DOI: 10.1016/j.purol.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/19/2022] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
|
24
|
He KJ, Yang XN, Zhu Z, Dai D, Zhang JC, Chen JX, Duan Y. Clinical effect of micturition interruption exercise on urinary incontinence after radical prostatectomy. Support Care Cancer 2022; 30:3241-3247. [PMID: 34984550 DOI: 10.1007/s00520-021-06780-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To explore the effectiveness of micturition interruption exercise in improving the incidence of urinary incontinence after radical prostatectomy. MATERIALS AND METHODS With a retrospective case-control study, 96 patients admitted in the Second Affiliated Hospital of Zhejiang Chinese Medical University from August 2014 to August 2020 and underwent radical prostatectomy were collected as the subjects. Those patients who used micturition interruption exercise (n = 48) were set as the therapy group, and the control group was collected according to the ratio of 1:1; the patients used Kegel exercise (n = 48) to compare the rehabilitation of urinary incontinence in patients and the effect of training compliance on rehabilitation. RESULTS The recovery time of urinary incontinence in the therapy group was significantly shorter than that of the control group. In the therapy group, 83.3% of patients with training compliance reached an average or above, while the control group only accounted for 58.3%. International Consultation on Incontinence Questionnaire Short-Form score of the therapy group was lower than that of the control group after surgery. Spearman analysis suggests that there is a negative correlation between the postoperative urinary incontinence recovery time and compliance with the micturition interruption exercise. CONCLUSIONS Micturition interruption exercise could not only improve the compliance of patients with exercise, but also significantly shorten the recovery time of urinary incontinence after radical prostatectomy.
Collapse
Affiliation(s)
- Kang-Jie He
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
| | - Xiang-Nan Yang
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
| | - Zheng Zhu
- Department of Nursing, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310000, China
| | - Di Dai
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
| | - Jia-Cheng Zhang
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
| | - Jia-Xing Chen
- Department of Urology Surgery, Jiangshan People's Hospital of Zhejiang Province, Jiangshan, Zhejiang, 324100, China
| | - Yue Duan
- Department of Urology Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, 318 Chaowang Road, Hangzhou, Zhejiang, 310000, China.
| |
Collapse
|
25
|
Mata LRFD, Azevedo C, Menezes AC, Chagas SDC, Izidoro LCDR, Estevam FEB, Chianca TCM. Adaptação transcultural e validação da Urinary Incontinence Scale After Radical Prostatectomy para o contexto brasileiro. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20210163.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: Traduzir, adaptar e validar a Urinary Incontinence Scale After Radical Prostatectomy para o Brasil. Método: Estudo tipo metodológico: adaptação transcultural (tradução, síntese, retrotradução, comitê de especialistas (n=25), pré-teste (n=40) e apresentação para os autores originais) e avaliação das propriedades de medida (n=80). Os dados foram coletados entre janeiro de 2018 e fevereiro de 2019 em unidade oncológica. As propriedades de medida calculadas: validade estrutural, teste de hipótese, validade de critério e confiabilidade. Resultados: A versão brasileira denominou-se Escala de Incontinência Urinária Pós-Prostatectomia Radical. Um item foi excluído devido carga fatorial baixa (0,322). Identificou-se correlação significativa entre escore total da escala e instrumentos aplicados (p<0,001). Homens incontinentes apresentaram maior escore no total da escala em relação aos continentes (p<0,001). Alfa de Cronbach foi 0,94 e confiabilidade composta 0,97. Conclusão: A versão brasileira foi considerada válida e confiável para avaliação da incontinência urinária em prostatectomizados.
Collapse
|
26
|
Cowley D, Stafford RE, Hodges PW. The influence of prostatectomy and body position on location and displacement of pelvic landmarks with pelvic floor muscle contraction. Neurourol Urodyn 2021; 41:203-210. [PMID: 34529870 DOI: 10.1002/nau.24794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/08/2021] [Accepted: 08/25/2021] [Indexed: 12/24/2022]
Abstract
AIMS To compare pelvic floor muscle (PFM) anatomy and function (i) between pre- and post-prostatectomy in standing, and (ii) between sitting and standing postprostatectomy. METHODS Thirty-two men scheduled to undergo a prostatectomy volunteered to participate. Transperineal ultrasound imaging was used to visualize five anatomical pelvic landmarks that have been validated to reflex anatomy and activity of PFMs (pubic symphysis, anorectal junction [ARJ], mid-urethra [MU], bulb of penis [BP], and urethrovesical junction [UVJ]). Both before and after prostatectomy, participants performed three submaximal PFM contractions in sitting and/or standing positions while ultrasound data were recorded. RESULTS Postprostatectomy the UVJ location was more caudal and dorsal, the ARJ (puborectalis) vector was longer, the BP was more ventral than preprostatectomy, and these landmarks moved less ventrally with contraction. After prostatectomy, the MU, BP, and ARJ were more ventral in standing than sitting. The UVJ was more caudal and elevated more with contraction in standing than sitting after prostatectomy. CONCLUSION These data demonstrate differences in the anatomy and mechanics of PFMs post- versus pre-prostatectomy, and between sitting and standing positions postprostatectomy. Findings are consistent with surgical changes to the bladder and urethral anatomy. Reduced passive support for the urethra and bladder are likely to may contribute to differences between standing and sitting postprostatectomy.
Collapse
Affiliation(s)
- David Cowley
- School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Ryan E Stafford
- School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia.,School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
27
|
Rodriguez-Rodriguez AM, Blanco-Diaz M, Lopez-Diaz P, de la Fuente-Costa M, Sousa-Fraguas MC, Escobio-Prieto I, Casaña J. Quality Analysis of YouTube Videos Presenting Pelvic Floor Exercises after Prostatectomy Surgery. J Pers Med 2021; 11:jpm11090920. [PMID: 34575697 PMCID: PMC8471666 DOI: 10.3390/jpm11090920] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023] Open
Abstract
Background: Prostate cancer (PC) is a major cause of disease and mortality among men. Surgical treatment involving the removal of the prostate may result in temporary or permanent erectile dysfunction (ED) and urinary incontinence (UI), with considerable impact on quality of life. Pelvic floor muscle training (PFMT) is one of the recommended techniques for the prevention, treatment, and rehabilitation of postoperative complications. The aim of this observational study was to assess the quality of YouTube videos—accessible to any patient—related to exercises after prostatectomy surgery. Methods: A systematic search was performed on YouTube on 24 September 2020. One hundred and fifty videos were selected and analyzed. Two statistical analyses were conducted based on machine-learning techniques, and videos were classified as ‘Relevant’ or ‘Non-Relevant’ using Principal Component Analysis (PCA) models. Two reviewers conducted independent analyses. Inter-observer agreement and individual correlations of video data were evaluated with the Intraclass Correlation Coefficient (ICC). Information quality, reliability, and accuracy were measured using the DISCERN Scale and Global Quality Score (GQS), while video popularity was evaluated using the Video Power Index (VPI). Results: DISCERN scored a mean of 3.35 and GQS scored 3.38. Average number of views was 124,354, mean duration was 14:42 min, mean days online was 1777, mean view ratio was 138.30, mean Likes was 1082, mean Dislikes was 68.58, and mean VPI was 92.28. Conclusions: The quality of the videos available on YouTube regarding the recommended pelvic floor exercises in PC surgery, according to the scores obtained, is High. Educational and health institutions, health professionals, government health authorities, and policy makers need to be involved in the proper development of policies to improve the information available on the web in order to have a positive impact on the healthy behavior of the population.
Collapse
Affiliation(s)
- Alvaro Manuel Rodriguez-Rodriguez
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (A.M.R.-R.); (J.C.)
| | - Maria Blanco-Diaz
- Physiotherapy and Translational Research Group (FINTRA-RG), Institute of Health Research of the Principality of Asturias (ISPA), Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Spain; (P.L.-D.); (M.d.l.F.-C.); (M.C.S.-F.)
- Correspondence: ; Tel.: +34-667-681-858
| | - Pedro Lopez-Diaz
- Physiotherapy and Translational Research Group (FINTRA-RG), Institute of Health Research of the Principality of Asturias (ISPA), Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Spain; (P.L.-D.); (M.d.l.F.-C.); (M.C.S.-F.)
| | - Marta de la Fuente-Costa
- Physiotherapy and Translational Research Group (FINTRA-RG), Institute of Health Research of the Principality of Asturias (ISPA), Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Spain; (P.L.-D.); (M.d.l.F.-C.); (M.C.S.-F.)
| | - Maria Cruz Sousa-Fraguas
- Physiotherapy and Translational Research Group (FINTRA-RG), Institute of Health Research of the Principality of Asturias (ISPA), Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Spain; (P.L.-D.); (M.d.l.F.-C.); (M.C.S.-F.)
| | - Isabel Escobio-Prieto
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain;
| | - Jose Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (A.M.R.-R.); (J.C.)
| |
Collapse
|
28
|
Sabbagh P, Dupuis H, Cornu JN. State of the art on stress incontinence management after benign prostatic obstruction surgery. Curr Opin Urol 2021; 31:473-478. [PMID: 34397505 DOI: 10.1097/mou.0000000000000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Stress urinary incontinence (SUI) is mostly seen after prostate surgery (radical prostatectomy or benign prostatic obstruction [BPO] relief). As new surgical techniques (laser, endoscopic enucleation) have been dramatically expanded in the past decade, a focus on postoperative SUI is necessary to provide the best management in this iatrogenic situation. RECENT FINDINGS Surgery is the main option for curative management of SUI after BPO as no oral medication is recommended. Preoperative work-up is mandatory to assess concomitant bladder dysfunction. All available surgical options (peri-urethral injections, periurethral balloons, various male slings, and artificial urinary sphincter) have been studied, but the level of evidence is very low. In this setting, SUI after BPO management is widely inspired from post-PR SUI management, mainly based on clinical experience. SUMMARY The available literature regarding persistent SUI after BPO relief is very scarce and further studies are warranted in this specific population.
Collapse
Affiliation(s)
- Paul Sabbagh
- From the Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France
| | | | | |
Collapse
|
29
|
Cowley D, Stafford RE, Hodges PW. The repeatability of measurements of male pelvic floor anatomy and function made from transperineal ultrasound images of healthy men and those before and after prostatectomy. Neurourol Urodyn 2021; 40:1539-1549. [PMID: 34130355 DOI: 10.1002/nau.24701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/20/2021] [Accepted: 05/03/2021] [Indexed: 11/09/2022]
Abstract
AIMS To investigate the inter- and intratester repeatability of measurement of the location and displacement of five pelvic landmarks related to pelvic floor muscles with transperineal ultrasound (TPUS) imaging recorded from healthy men and men before and after prostatectomy. METHODS TPUS images were selected from four different participant groups: healthy men, men awaiting prostatectomy, men 2 weeks after prostatectomy, and men 12 months after prostatectomy. On two separate occasions, two assessors with different levels of experience performed analysis of location and displacement of five pelvic landmarks in images made at rest and during voluntary contraction. A two-way mixed effects, single measurement, absolute agreement intraclass correlation coefficient (ICC) was used to investigate the repeatability. RESULTS Intertester reliability of all locations at rest for all groups was excellent (ICCs > 0.8) except for the craniocaudal coordinate of the ventral urethrovesical junction for men 2 weeks postprostatectomy and the anorectal junction for men with a cancerous prostate. Intertester reliability of the measurement of landmark displacement was acceptable (>0.5) for the dorsoventral axis of motion but not for the craniocaudal axis of motion for all landmarks across all groups. The more experienced assessor was consistently more repeatable. More deeply placed landmarks were more often excluded from analysis and had poorer reliability. CONCLUSIONS Analysis of TPUS images across clinical groups is repeatable for both location and displacement of pelvic landmarks related to pelvic floor muscles when measures are made twice. Analysis experience, landmark depth and optimization of ultrasound settings appear to be important factors in reliability.
Collapse
Affiliation(s)
- David Cowley
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Ryan E Stafford
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Division of Exercise Science, School of Human Sciences, The University of Western Australia, Perth, Australia
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| |
Collapse
|
30
|
Brandt C. Physiotherapy and pelvic floor health within a contemporary biopsychosocial model of care: From research to education and clinical practice. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1538. [PMID: 34192209 PMCID: PMC8182461 DOI: 10.4102/sajp.v77i1.1538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/05/2021] [Indexed: 11/06/2022] Open
Abstract
Background Pelvic floor dysfunction (PFD) is a common problem in both men and women. Despite the high prevalence and negative effects on quality of life, there is still a lack of research in this area which translates into clinical practice and education. Objectives My study discusses how gaps and controversies in current research and evidence on PFD might be addressed by positioning PFD within a contemporary biopsychosocial model of care (BPSM). Method Various databases were searched for relevant studies published between 2010 and 2020 to support hypotheses and statements. Results My study focuses on the available evidence of PFD in both men and women as related to the themes and sub-themes of the BPSM, and how this available evidence might translate into education and clinical practice. It highlights areas of research, education and clinical practice that need to be explored and how the different components of healthcare may influence one another. Conclusion Biomedical aspects regarding pelvic health are mostly investigated and taught, whilst psychological, cognitive, behavioural, social and occupational factors, individualised care, communication and therapeutic alliances are still under-investigated and not integrated or translated at a sufficient level into research, education and clinical practice. Clinical implications Incorporating the integration of all factors of the BPSM into research is important for effective knowledge translation and enhancement of a de-compartmentalised approach to management. The interaction between the different components of the BPSM should be investigated especially in a South African population.
Collapse
Affiliation(s)
- Corlia Brandt
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
31
|
Mungovan SF, Carlsson SV, Gass GC, Graham PL, Sandhu JS, Akin O, Scardino PT, Eastham JA, Patel MI. Preoperative exercise interventions to optimize continence outcomes following radical prostatectomy. Nat Rev Urol 2021; 18:259-281. [PMID: 33833445 PMCID: PMC8030653 DOI: 10.1038/s41585-021-00445-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 01/31/2023]
Abstract
Urinary incontinence is a common and predictable consequence among men with localized prostate cancer who have undergone radical prostatectomy. Despite advances in the surgical technique, urinary continence recovery time remains variable. A range of surgical and patient-related risk factors contributing to urinary incontinence after radical prostatectomy have been described, including age, BMI, membranous urethral length and urethral sphincter insufficiency. Physical activity interventions incorporating aerobic exercise, resistance training and pelvic floor muscle training programmes can positively influence the return to continence in men after radical prostatectomy. Traditional approaches to improving urinary continence after radical prostatectomy have typically focused on interventions delivered during the postoperative period (rehabilitation). However, the limited efficacy of these postoperative approaches has led to a shift from the traditional reactive model of care to more comprehensive interventions incorporating exercise-based programmes that begin in the preoperative period (prehabilitation) and continue after surgery. Comprehensive prehabilitation interventions include appropriately prescribed aerobic exercise, resistance training and specific pelvic floor muscle instruction and exercise training programmes. Transperineal ultrasonography is a non-invasive and validated method for the visualization of the action of the pelvic floor musculature, providing real-time visual biofeedback to the patient during specific pelvic floor muscle instruction and training. Importantly, the waiting time before surgery can be used for the delivery of comprehensive prehabilitation exercise-based interventions to increase patient preparedness in the lead-up to surgery and optimize continence and health-related quality-of-life outcomes following radical prostatectomy.
Collapse
Affiliation(s)
- Sean F Mungovan
- Westmead Private Physiotherapy Services, Westmead Private Hospital, Westmead, New South Wales, Australia.
- The Clinical Research Institute, Westmead, New South Wales, Australia.
- Department of Professions, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia.
| | - Sigrid V Carlsson
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Gregory C Gass
- The Clinical Research Institute, Westmead, New South Wales, Australia
- Physical Therapy Program, University of Jamestown, Fargo, ND, USA
| | - Petra L Graham
- Department of Mathematics and Statistics, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Jaspreet S Sandhu
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter T Scardino
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James A Eastham
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Manish I Patel
- Specialty of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Urology, Westmead Hospital, Westmead, New South Wales, Australia
| |
Collapse
|
32
|
Nahon I. Physiotherapy management of incontinence in men. J Physiother 2021; 67:87-94. [PMID: 33753017 DOI: 10.1016/j.jphys.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/19/2021] [Indexed: 12/24/2022] Open
Affiliation(s)
- Irmina Nahon
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Australia.
| |
Collapse
|
33
|
Long-term follow-up 3 years after a randomized rehabilitation study among radiated prostate cancer survivors. J Cancer Surviv 2020; 15:668-676. [DOI: 10.1007/s11764-020-00958-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/10/2020] [Indexed: 12/15/2022]
|
34
|
Feng D, Liu S, Li D, Han P, Wei W. Analysis of conventional versus advanced pelvic floor muscle training in the management of urinary incontinence after radical prostatectomy: a systematic review and meta-analysis of randomized controlled trials. Transl Androl Urol 2020; 9:2031-2045. [PMID: 33209667 PMCID: PMC7658159 DOI: 10.21037/tau-20-615] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background The underutilization of additional supportive muscles is one of the potential reasons for suboptimal efficacy of conventional pelvic floor muscle training (CPFMT). The present study concentrates on any advantage of advanced pelvic floor muscle training (APFMT) in patients with urinary incontinence (UI) after radical prostatectomy (RP). Methods Literature search was conducted on PubMed, Embase, Cochrane Library and Web of Science from database inception to February 2020. The data analysis was performed by the Cochrane Collaboration's software RevMan 5.3. Results Both APFMT and CPFMT groups indicates superiority over baseline in terms of pad number, the International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF) score, pad weight at short-term follow-up, and PFME and PFMS at intermediate-term follow-up. No adverse events were reported in all included studies. Patients receiving APFMT had a similar attrition rate to those receiving CPFMT (18/236 vs. 22/282, P=0.61). Compared to CPFMT group, APFMT group provided intermediate-term advantages in terms of pad number (MD: −0.75, 95% CI: −1.36 to −0.14; P=0.02), ICIQ-SF score (MD: −3.79, 95% CI: −5.89 to −1.69; P=0.0004), PFME (MD: 1.93, 95% CI: 0.99 to 2.87; P<0.0001) and pad weight (MD: −1.40, 95% CI: −1.70 to −1.00; P<0.00001). Conclusions Current evidence indicated that APFMT might facilitate the recovery of UI after RP according to intermediate-term advantages over CPFMT in terms of pad number, ICIQ-SF score, PFME and pad weight. Further standardized, physiotherapist-guided and well-designed clinical trials conducted by large multicenter and experienced multidisciplinary clinicians are still warranted.
Collapse
Affiliation(s)
- Dechao Feng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Shengzhuo Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Dengxiong Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Han
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Wuran Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
35
|
Sayner A, Nahon I. Pelvic Floor Muscle Training in Radical Prostatectomy and Recent Understanding of the Male Continence Mechanism: A Review. Semin Oncol Nurs 2020; 36:151050. [PMID: 32674975 DOI: 10.1016/j.soncn.2020.151050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Pelvic floor muscle training (PFMT) is recommended as part of supportive care for patients with prostate cancer. It can assist in reducing treatment-related symptoms such as urinary incontinence. This literature review aims to discuss recent innovative findings on the pathophysiology of the male continence mechanism and implications for PFMT in radical prostatectomy. DATA SOURCES CINAHL, Embase, Web of Science, Emcare and PsycINFO were searched until January 2020. CONCLUSION Nurses providing supportive care for patients undergoing radical prostatectomy can engage in-clinic in the instruction and recommendation of pre- and postoperative PFMT and delivering guidance on home-based programs to promote motor learning. IMPLICATIONS FOR NURSING PRACTICE Optimal postoperative urinary incontinence outcomes are suggested to be promoted by preoperative PFMT. Training focused on the urethral and anterior pelvic floor muscle complex has been shown to facilitate mid urethral occlusion required for continence. Prescription of PFMT should be individualised, focusing on skill acquisition and motor learning, which is in line with recent knowledge developments in male pelvic floor anatomy.
Collapse
Affiliation(s)
- Alesha Sayner
- University of Canberra, Australian Capital Territory, Australia; Western Health, Chronic and Complex Care/Physiotherapy Department, Melbourne, Australia; Australian Prostate Centre, Melbourne, Australia.
| | - Irmina Nahon
- University of Canberra, Australian Capital Territory, Australia
| |
Collapse
|
36
|
Kim YU, Lee DG, Ko YH. Pelvic floor muscle exercise with biofeedback helps regain urinary continence after robot-assisted radical prostatectomy. Yeungnam Univ J Med 2020; 38:39-46. [PMID: 32668526 PMCID: PMC7787894 DOI: 10.12701/yujm.2020.00276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background To determine the benefit of pelvic floor muscle exercise (PFME) with visual biofeedback on promoting patient recovery from incontinence, we investigated variables associated with the early restoration of continence for patients who robot-assisted radical prostatectomy (RARP). Methods Of the 83 patients enrolled, 41 consecutive patients completed PFME (the exercise group), and the other 42 consecutive patients just before the PFME program commenced (the control group). The primary outcome was whether PFME engagement was associated with zero pad continence restoration within 3 months of surgery. Results Continence restoration percentages (defined as zero pads used per day) at 1, 3, and 6 months after surgery were 49.4%, 77.1%, and 94.0%, respectively. The exercise group achieved significantly higher recovery rates at 1 month (p=0.037), 3 months (p<0.001), and 6 months (p=0.023). Cox regression analysis demonstrated that a lower Gleason score (<8; hazard ratio [HR], 2.167), lower prostate specific antigen (<20 ng/dL; HR, 2.909), and engagement in PFME (HR, 3.731) were independent predictors of early recovery from postprostatectomy incontinence. Stratification by age showed that those younger than 65 years did not benefit significantly from exercise (log-rank test, p=0.08), but that their elderly counterparts, aged 65–70 years (p=0.007) and >70 years old (p=0.002) benefited significantly. Conclusion This study suggests that postoperative engagement in PFME with biofeedback speeds up the recovery of continence in elderly patients (≥65 years old) that undergo RARP.
Collapse
Affiliation(s)
- Yeong Uk Kim
- Department of Urology, Yeungnam Hospital of Medicine, Daegu, Korea
| | - Dong Gyu Lee
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
| | - Young Hwii Ko
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
| |
Collapse
|
37
|
Marchioni M, Primiceri G, Castellan P, Schips L, Mantica G, Chapple C, Papalia R, Porpiglia F, Scarpa RM, Esperto F. Conservative management of urinary incontinence following robot-assisted radical prostatectomy. MINERVA UROL NEFROL 2020; 72:555-562. [PMID: 32432436 DOI: 10.23736/s0393-2249.20.03782-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Robotic assisted radical prostatectomy (RARP) is getting more and more popular becoming the most common radical prostatectomy technique. Unfortunately, a not negligible proportion of patients in whom RARP is performed experience urinary incontinence. We aimed to systematically review the current literature evidence on urinary incontinence conservative treatment after RARP. EDIDENCE AQUISITION A systematic literature review search using PubMed (Medline), Scopus, and Web of Science databases was performed in December 2019. PRISMA guidelines have been adopted. Population consisted of patients with urinary incontinence after RARP (P), conservative intervention was considered of interest (I). No comparator was considered mandatory (C). Outcomes of interest were the recovery of continence and quality of life (O). EVIDEDENCE SYNTHESIS Six studies were included. Four of them investigated the use of pelvic floor muscle training (PFMT). PFMT improved pelvic muscle strength. Continence recovery was faster when guided PFMT was adopted. Moreover, two studies tested the effect of solifenacin on urinary incontinence. One of them, a randomized clinical trial, failed to show shorter time to continence in solifenacin group compared to placebo. CONCLUSIONS The use of pads is associated with a detrimental effect on quality of life thus active treatments for UI post-RARP are warranted. PFMT has the main advantage to shorten the time for recovery. The use of solifenacin seems to not offer striking advantages in UI following RARP. Future studies should focus on testing the efficacy of these treatments when used after robotic vs. open radical prostatectomy.
Collapse
Affiliation(s)
- Michele Marchioni
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. d'Annunzio University, Chieti, Italy - .,Department of Urology, ASL Abruzzo 2, Chieti, Italy - .,European Association of Urology - European Society of Residents in Urology (EAU-ESRU) -
| | - Giulia Primiceri
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. d'Annunzio University, Chieti, Italy
| | | | - Luigi Schips
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. d'Annunzio University, Chieti, Italy.,Department of Urology, ASL Abruzzo 2, Chieti, Italy
| | - Guglielmo Mantica
- European Association of Urology - European Society of Residents in Urology (EAU-ESRU).,Department of Urology, San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy
| | - Christopher Chapple
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Francesco Esperto
- European Association of Urology - European Society of Residents in Urology (EAU-ESRU).,Department of Urology, Campus Bio-Medico University, Rome, Italy
| |
Collapse
|
38
|
Effect of the Nurse-Led Sexual Health Discharge Program on the Sexual Function of Older Patients Undergoing Transurethral Resection of Prostate: A Randomized Controlled Trial. Geriatrics (Basel) 2020; 5:geriatrics5010013. [PMID: 32131446 PMCID: PMC7150998 DOI: 10.3390/geriatrics5010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/29/2020] [Accepted: 03/01/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Sexual dysfunction is a complication of transurethral resection of prostate (TURP). There is a lack of knowledge of the effect of discharge programs aiming at improving sexual function in older patients undergoing TURP. Objective: To investigate the effect of the nurse-led sexual health discharge program on the sexual function of older patients undergoing TURP. Methods: This randomized controlled clinical trial was conducted on 80 older patients undergoing TURP in an urban area of Iran. Samples were selected using a convenience method and were randomly assigned into intervention and control groups (n = 40 in each group). The sexual health discharge program was conducted by a nurse in three sessions of 30-45 min for the intervention group. Sexual function scores were measured using the International Index of Erectile Function (IIEF) Questionnaire, one and three months after the intervention. Results: The intervention significantly improved erectile function (p = 0.044), sexual desire (p = 0.01), satisfaction with sexual intercourse (p = 0.03), overall satisfaction with sexual function (p = 0.01), and the general score of sexual function (p = 0.038), three months after the program. In the first month after the intervention, except in sexual desire (p = 0.028), no statistically significant effect of the program was reported (p > 0.05). Conclusion: The nurse-led sexual health discharge program led to the improvement of the sexual function of older patients undergoing TURP over time. This program can be incorporated into routine discharge programs for the promotion of well-being in older patients.
Collapse
|
39
|
Cowley D, Stafford RE, Hodges PW. Influence of body position on dynamics of the pelvic floor measured with transperineal ultrasound imaging in men. Neurourol Urodyn 2020; 39:954-961. [PMID: 32027772 DOI: 10.1002/nau.24301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/23/2020] [Indexed: 11/12/2022]
Abstract
AIMS This paper aims to evaluate the feasibility of transperineal ultrasound imaging (TPUS) for visualizing the motion of pelvic landmarks associated with striated pelvic floor muscle contraction in men in standing; to compare the locations of pelvic landmarks between sitting and standing; and to compare the effects of different body positions on measures of pelvic floor muscle contraction. METHODS Thirty-five men awaiting prostatectomy volunteered to participate. Participants performed three repetitions of submaximal pelvic floor contraction in sitting and again in standing. Movement of pelvic landmarks with contraction was recorded using an ultrasound imaging transducer placed on the perineum. RESULTS The feasibility of TPUS in men in standing was demonstrated through the visualization of three out of four pelvic landmarks in more than 95% of images in the standing position. Analysis of pelvic landmarks and their respective relationships with muscle shortening demonstrated that the anorectal junction and urethrovesical junction were lower and the estimated length of puborectalis was shorter in standing than sitting. The mid-urethra (striated urethral sphincter) and anorectal junction (puborectalis) landmark displaced further cranially in standing than sitting. CONCLUSIONS TPUS can be used to visualize three pelvic landmarks in men with cancerous prostates. Puborectalis is shorter at rest in standing than sitting, and elevation of the mid-urethra and the anorectal junction is more in standing than sitting. Together these findings indicate that feedback for pelvic floor muscle training is possible in both positions, but the position needs to be standardized for a comparative assessment.
Collapse
Affiliation(s)
- David Cowley
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Ryan E Stafford
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,School of Human Sciences, The University of Western Australia, Perth, Australia
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| |
Collapse
|
40
|
Hall LM, Neumann P, Hodges PW. Do features of randomized controlled trials of pelvic floor muscle training for postprostatectomy urinary incontinence differentiate successful from unsuccessful patient outcomes? A systematic review with a series of meta-analyses. Neurourol Urodyn 2020; 39:533-546. [PMID: 31977112 DOI: 10.1002/nau.24291] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/13/2020] [Indexed: 01/08/2023]
Abstract
AIMS Efficacy of pelvic floor muscle training (PFMT) for postprostatectomy incontinence (PPI) differs between randomized clinical trials (RCT). This might be explained by variation in content/delivery of PFMT (eg, biofeedback, muscles targeted, and time of commencement of training). This review investigated whether outcome of meta-analysis differs based on presence or not of specific RCT features. METHODS PubMed, CINAHL, EMBASE, Physiotherapy Evidence Database (PEDro), and Cochrane were searched for RCTs that investigated efficacy of PFMT on PPI. PFMT details and outcomes were extracted. Methodological quality and comprehensiveness of PFMT reporting was assessed using the PEDro scale and Consensus on Reporting Template, respectively. Effect size and 95% confidence intervals were calculated for incontinence rate at 3 months. To identify features that influenced efficacy, separate meta-analyses were performed for studies with and without specific features. RESULTS Twenty-two trials were included, and 15 were used for meta-analysis of 3-month outcomes. Overall, meta-analysis showed reduced incontinence with PFMT (risk ratio [RR] = 0.85; I2 = 55%; P = .005). Meta-analyses showed better outcomes for PFMT than control groups when the study included preoperative PFMT (RR = 0.76; I2 = 30%; P = .006), biofeedback (RR = 0.73; I2 = 58%; P = .006), instruction to contract around the urethra (RR = 0.9; I2 = 43%; P = .009), a control group without PFMT instruction (RR = 0.85; I2 = 69%; P = .05), inclusion of all men irrespective of continence status (RR = 0.84; I2 = 30%; P = .003) and continence defined as no leakage (RR = 0.85; I2 = 48%; P = .05). CONCLUSIONS Preoperative PFMT, biofeedback, urethral instructions, no PFMT instruction for controls, inclusion of all men, and continence defined as no leakage are features associated with successful patient outcomes. Future studies should consider these features in design of interventions and pooling data for meta-analysis.
Collapse
Affiliation(s)
- Leanne M Hall
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Patricia Neumann
- Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Paul W Hodges
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|