Effect of Pilates combined with pelvic floor muscle training on continence of post-prostatectomy incontinence in patients with different body mass index

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.

Guiding Clinical Decision Making for Surgical Incontinence Treatment After Prostatectomy: A Review of the Literature

PURPOSE OF REVIEW

Stress urinary incontinence after prostatectomy is a common and debilitating side effect. Immediate post-prostatectomy management emphasizes pelvic floor muscle exercises. Per American Urologic Association guidelines, if incontinence persists for more than 12 months postoperatively, surgical interventions are the mainstay of treatment. Treatment decisions depend on a multitude of factors. The goal of this paper is to review recent literature updates regarding the diagnosis of male SUI to better guide surgical treatment decision-making.

RECENT FINDINGS

Patient history is a critical component in guiding surgical decision making with severity and bother being primary factors driving treatment decisions. Recent studies indicate that a history of pelvic radiation continues to impact the overall duration and complication rate associated with artificial urinary sphincters (AUS). Cystoscopy should be done on every patient preparing to undergo surgical SUI treatment. Urodynamics and standing cough stress tests are additional diagnostic testing options; these tests may augment the diagnosis of SUI and better delineate which patients may benefit from a male sling versus AUS. Treatment of SUI after prostatectomy can improve health-related quality of life. A patient history focused on severity and degree of bother in addition to the use of ancillary office testing can help guide surgical treatment decisions to optimize patient continence goals.

Effect of different postures of Pilates combined with Kegel training on pelvic floor muscle strength in post-prostatectomy incontinence

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.

Inter-observer variability in male pelvic-floor MRI measurements that might predict post-prostatectomy incontinence

INTRODUCTION

Current studies are focusing on the relationship between anatomical variables in preoperative prostate MRI and the development of post-prostatectomy incontinence (PPI). Nevertheless, there is little evidence regarding the reliability of these measurements. The objective of this study was to analyze the concordance between urologists and radiologists for anatomical measurements that might be PPI predictors.

MATERIAL AND METHODS

Pelvic floor measurements with 3T-MRI were performed by two radiologists and two urologists independently and blindly. Interobserver agreement was determined using the intraclass correlation coefficient (ICC) and the Bland-Altman plot.

RESULTS

The concordance was good-acceptable for most measurements, except for the levator ani and puborectalis muscle thickness (some ICC values  < 0.20/p value > 0.05). The anatomical parameters with the highest degree of agreement were intravesical prostatic protrusion (IPP) and prostate volume (most of the ICC values > 0.60). The membranous urethral length (MUL) and the angle of the membranous urethra-prostate axis (aLUMP) presented ICC > 0.40. The obturator internus muscle thickness (OIT), urethral width and intraprostatic urethral length presented a fair-moderate degree of agreement (ICC > 0.20). Regarding the agreement between different specialists, the highest degree was obtained for the two radiologists and for urologist 1-radiologist 2 (moderate median agreement), while urologist 2 with each of the radiologists had a regular median agreement.

CONCLUSIONS

MUL, IPP, prostate volume, aLUMP, OIT, urethral width and prostatic length show acceptable inter-observer concordance and they would be reliable as possible predictors of PPI. Levator ani and puborectalis muscle thickness show bad agreement. Interobserver agreement might not be greatly influenced by previous professional experience.

Long-Term Functional Outcomes and Quality of Life after Male Transobturator-Retrourethral Sling Surgery

INTRODUCTION

Post-prostatectomy urinary incontinence (PPUI) has an enormous impact in quality of life (QoL). Transobturator-rethrourethral sling (AdVanceTMXP sling) is a well-established treatment option although there is paucity of data on long-term outcomes. Our objective was to assess the long-term functional outcomes and QoL in a cohort of men undergoing AdVanceTMXP sling surgery.

METHODS

Retrospective observational study of men undergoing AdVanceTMXP sling in a tertiary referral institution from August 2013 to July 2020. 55 patients met the inclusion criteria, with a minimum follow-up of 12 months. Main outcomes were pre- and post-operative daily pad use and scoring in the ICIQ-SF questionnaire. Post-operative complications were assessed following the Clavien-Dindo classification system. QoL and satisfaction with the procedure were assessed through direct interview.

RESULTS

Mean number of pads prior to surgery was 3.1, and mean ICIQ-SF score was 13.5. After surgery, mean daily pads use went to 1.2, and mean ICIQ-SF dropped to 5. With a mean follow-up of 42.36 months, 21.8% patients did not use any pads/day and 76.4% achieved social continence (0-1 pad/day). We found no statistically significant differences in outcomes of patients with follow-up of <36 months, 36-48 months, and >48 months (p = 0.067).

CONCLUSIONS

AdVanceTMXP sling implantation in men with PPUI improves urinary incontinence and QoL, and their results are sustained over time.

Acupuncture for prostatectomy incontinence: study protocol for a multicenter single-blind randomized parallel controlled trial

BACKGROUND

Urinary incontinence is a common complication post radical prostatectomy. Acupuncture is considered an effective treatment for post-prostatectomy incontinence (PPI), but the evidence is still limited. We propose to evaluate the effectiveness of acupuncture in a rigorously conducted trial.

METHODS

Twenty hospitals will recruit 340 participants with urinary incontinence after radical prostatectomy in China from April 2021 to April 2022. Participants will be randomly allocated to acupuncture or sham acupuncture with a 1:1 ratio using computerized simple random sampling. The study plan consists of 1-week baseline, 6-week treatment, and 18-week follow-up. Eighteen 30-min sessions of acupuncture or sham acupuncture treatment will be provided between weeks 1 and 6. The primary outcome is the change in the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) score at the week 6 from the baseline. Secondary outcomes include the change in volume of urine leakage at weeks 4 and 6 from a baseline measured using the 1-h pad test; 72-h incontinence episode frequency based on a 72-h voiding diary; change in the Expanded prostate cancer Index Composite scale (EPIC-26); change in the Self-Rating Anxiety Scale; weekly consumption of pads; and the severity of urinary incontinence based on a 72-h bladder diary and self-assessment of the therapeutic effect. The safety of acupuncture will also be assessed.

DISCUSSION

This trial will help to identify whether acupuncture is effective for PPI, and, if so, whether it exerts a therapeutic rather than a placebo effect.

TRIAL REGISTRATION

www.Chictr.org.cn ChiCTR2100042500 . Retrospectively registered on 22 January 2021.

Outcomes of a Series of Patients with Post-Prostatectomy Incontinence Treated with an Adjustable Transobturator Male System or Artificial Urinary Sphincter

Introduction

A prospective evaluation of outcomes in a series of patients with post-prostatectomy incontinence (PPI) treated with two different devices is presented.

Methods

Consecutive patients with PPI underwent interventions with an adjustable transobturator male system (ATOMS) or artificial urinary sphincter (AUS). Decisions were based on patient preference after physician counselling. Patient characteristics and operative and postoperative parameters including dryness, satisfaction, complications, revision and device durability were evaluated.

Results

One hundred twenty-nine patients were included: 102 (79.1%) received ATOMS and 27 (20.9%) AUS. Mean follow-up was 34.9 ± 15.9 months. No difference was observed between patient age (p = 0.56), ASA score (p = 0.13), Charlson index (p = 0.57) and radiation (p = 0.3). BMI was higher for AUS (27.1 vs. 29.7; p = 0.003) and also baseline incontinence severity (7.9% mild, 44.1% moderate and 48% severe for ATOMS vs. 11.1% moderate and 88.9% severe for AUS; p = 0.0007). Differential pad test was higher for AUS (− 470 vs. − 1000 ml; p < 0.0001) and so was ICIQ-SF (15.62 vs. 18.3; p < 0.001), but total dryness (76.5 vs. 66.7%; p = 0.33), social continence (90.2 vs. 85.2%; p = 0.49) and satisfaction (92.2 vs. 88.9%; p = 0.69) were equivalent. The postoperative complication rate was similar (22.6 vs. 29.6%; p = 0.4). The surgical revision rate was higher for AUS (6.9 vs. 22.2%; p = 0.029) and also the explant rate but did not reach statistical significance (4.9 vs. 14.8%; p = 0.09). Time to explant was shorter for AUS (log-rank p = 0.021). Regression analysis revealed radiation (p = 0.003) and incontinence severity (p = 0.029) predict total dryness, while complications (p < 0.005) and type of device (p = 0.039) independently predict surgical revision.

Conclusions

Both ATOMS and AUS are effective devices. Pad test change for AUS exceeds that of ATOMS. The revision rate is higher for AUS, and durability is superior for ATOMS. The satisfaction rate is equivalent. Larger series and longer follow-up are needed to compare both devices more appropriately. According to our experience, the AUS is not the only gold standard for PPI.

Electronic supplementary material

The online version of this article (10.1007/s12325-020-01563-z) contains supplementary material, which is available to authorized users.

Efficacy of the VIRTUE male quadratic sling in the treatment of stress urinary incontinence: A retrospective study

AIM

To assess the efficacy and the impact on the quality of life (QoL) of patients suffering stress urinary incontinence (SUI) treated with VIRTUE © sling.

MATERIAL AND METHOD

Retrospective monocenteric study where patients treated with VIRTUE © sling were included between January 2016 and May 2018. The severity of the incontinence was judged based on the number of protection used per day (PPD) and/or on the 24hours pad test into mild, moderate and severe: ≥2 protections and/or <100ml/24h, 3-4 protections and/or 101-200ml/24h, >4 protections and/or>200ml/24h respectively. The criteria of success was achieved when the patient is dry or ameliorated. The ICIQ- UI sf questionnaire was used as a measure of QoL.

RESULTS

Thirty-five patients were included in this study with mean follow up time of 11 months (range: 3-26). Twenty-nine patients had a radical prostatectomy, 3 had endoscopic treatment for benign prostatic hyperplasia, 9 patient had radiotherapy of which one had a complementary focal treatment (HIFU), and two patients had spinal cord injury. The success rate was 83%. The score ICIQ-UI sf showed a statistical difference between the pre and post-operative periods in both success and failure groups (P<0.001). History of radiotherapy, low bladder compliance, and severe incontinence were associated with negative result. Pain was the most recorded post-operative complication and no>grade 2 Clavien Dindo complications were encountered.

CONCLUSION

The VIRTUE © sling seems to be an effective, safe tool treating SUI at short term.

LEVEL OF EVIDENCE

3.

Post-prostatectomy incontinence: multimodal modern-day management

As the rate of prostate cancer detection increases, so does the rate at which radical prostatectomy is performed. Post-prostatectomy incontinence (PPI) or urine leakage affects around 20% of men who undergo this procedure. Although affected individuals must be supported in maintaining hygiene with the use of urine capture devices, definitive treatment should also be offered if appropriate. A range of management options are available, from incontinence pads to artificial urinary sphincters. However, an understanding of the aetiology of the leak as well as patient factors is vital if the correct treatment option is to be selected. This article describes the potential causes of PPI and explores management options for this condition.

Functional recovery after radical prostatectomy for prostate cancer

With the enthusiasm regarding robotic application in radical prostatectomy in accordance with the widespread use of serum prostate-specific antigen as a screening test, the number of surgeries performed for complete removal of the gland is increasing continuously. However, owing to the adjacent anatomical location of the prostate to the nerve and urethral sphincter complex, functional recovery, namely improvement from post-prostatectomy incontinence (PPI) and post-prostatectomy erectile dysfunction, still remains a main problem for patients who are reluctant to undergo surgery and tend to choose alternative ways instead. Since the late 1980s, the introduction of radical prostatectomy by open surgical modalities, the depth of the anatomical understanding of the structure surrounding the prostate is getting tremendous, which leads to the development of new surgical modalities and techniques that are consequently aimed at reducing the incidences of PPI and erectile dysfunction. Briefly, recent data from robotic radical prostatectomy, particularly on PPI, are quite acceptable, but by contrast, the reported potency regain rate still remains <20%, which indicates the need for advanced surgical modification to overcome it. In this review, the authors summarized the recent findings on the anatomy and surgical techniques reported up to now.

Patterns and timing of artificial urinary sphincter failure

PURPOSE

To assess population-based trends in artificial urinary sphincter (AUS) placement after prostatectomy and determine the effect of timing on device survival and complications.

METHODS

We identified patients who underwent prostatectomy and AUS placement in SEER-Medicare from 2002 to 2011. We analyzed factors affecting the time of reoperation from AUS implantation and prostatectomy using multivariable Cox proportional hazard models.

RESULTS

In total, 841 men underwent AUS placement at a median 23 months after prostatectomy. Patients who underwent reoperation (28.5%) had higher clinical stage, more likely underwent open prostatectomy, or had prior sling placement (p < 0.03). There were no differences in rates of diabetes, smoking status, prior radiation therapy, or Charlson Comorbidity Index between those requiring reoperation vs. not (all p > 0.15). Patients with AUS placement > 15 months after prostatectomy (75%) initially experienced less need for operative reinterventions. Patients with later AUS placement were significantly more likely to have received radiation therapy [22.9 vs. 3.8% (p < 0.01)]. Nonetheless, late implantation was confirmed to be protective on multivariate analysis during the first 5 years after AUS placement [HR 0.79 (95% CI 0.67-0.92); p < 0.01]. Factors independently associated with a shorter interval time until reoperation included history of radiation [HR 1.93 (95% CI 1.33-2.80); p < 0.01] and history of prior sling [HR 1.70 (95% CI 1.08-2.68); p = 0.02]. Even for patients who underwent radiation therapy, delayed AUS implantation reduced reoperative risk.

CONCLUSIONS

Late AUS implantation in the Medicare population is associated with prolonged device survival initially, while radiation and prior sling surgery predict for earlier reoperation. Patients with delayed AUS implantation experience less immediate complications. Further work is required to identify patient-specific factors which may explain variability in timing for AUS.

AdVanceXP male sling: 2-year results of a multicentre study

PURPOSE

For the treatment of persistent post-prostatectomy incontinence (PPI), several surgical treatment options including male slings are available. In 2010, the second generation of the retrourethral male sling Advance, AdVanceXP, was introduced. Aim of the study was to examine in a prospective multicentre study the outcome of AdVanceXP in the treatment of PPI.

METHODS

Ninety-four patients were treated with AdVanceXP. Patients with nocturnal incontinence, previous incontinence surgery, with coaptive zone <1 cm and irradiated patients were excluded. Measurements included: daily pad usage, 24-h pad weight test, post-operative pain in the visual analogue scale, International Quality of Life questionnaire, International Consultation on Incontinence Questionnaire short form, IEEF5 and Patient Global Impression of Improvement. Adverse events were recorded. All patients with no pads and 0-5 g in the 24-h pad test were defined as cured and those with a reduction in urine loss >50 % as improved.

RESULTS

Preoperatively, the median 24-h pad weight test was 274 g and daily pad usage was 3. At 1-year follow-up, 66.3 % of patients could be classified as cured and 25.3 % as improved. After 2 years, 73.1 % could be classified as cured and 19.6 % as improved. Urine loss decreased (p < 0.001), and quality of life improved significantly (p < 0.001). Mean PGI was 1.5 after 1 year and 1.4 after 2 years. Majority of complications were minor. No intraoperative complications and five serious post-operative events occurred (grade IIIB complications). No explantation was necessary.

CONCLUSIONS

AdVanceXP, when correctly indicated, shows good effectiveness and low complication rates after up to 2 years.

Comparing Argus sling and artificial urinary sphincter in patients with moderate post-prostatectomy incontinence

Post-prostatectomy incontinence (PPI) is a main complication of radical prostatectomy. The purpose of this study was to compare the efficacy and safety of the Argus male sling (Argus) with that of artificial urinary sphincters (AUS) in patients with moderate PPI. A total of 33 moderate PPI patients underwent AUS or Argus implantation from January 2009 to June 2013 (13 AUS, 20 Argus). We defined moderate PPI as the use of 2-4 pads per day. To compare efficacy, we assessed the success rate between the two groups. Success was defined as the daily need for no pads or one small safety pad that remained dry most of the day. The mean patient age was 73.5±6.3 yr in the AUS group and 70.9±5.1 yr in the Argus group, and the mean follow-up period was 29.8±14.9 months in the AUS group and 24.7±11.8 months in the Argus group. The success rate was 72.7% in the AUS group and 85.0% in the Argus group (P=0.557). Abnormal postoperative pain persisted in more patients in the Argus group (6/20, 30%) than in the AUS group (1/13, 7.7%) (P=0.126). However, the rate of other complications was not different between the two groups (7.7% and 15.0% for AUS and Argus, respectively, P=0.822). Argus surgery showed similar success and complication rates to those of AUS in moderate PPI patients, indicating that it could be an alternative surgical option for the treatment of moderate PPI.