OBJECTIVES: Urinary incontinence is a predictable sequela of radical retropubic prostatectomy, and is most severe in the early postoperative phase.
The present study aimed to evaluate the effect of a physiotherapist-guided pelvic floor muscle training program, commenced preoperatively, on the severity and duration of urinary continence after radical retropubic prostatectomy.
METHODS: A retrospective analysis of men undergoing radical retropubic prostatectomy by one high-volume surgeon (n = 284) was carried out. The intervention group received physiotherapist-guided pelvic floor muscle training from 4 weeks preoperatively (n = 152), whereas the control group was provided with verbal instruction on pelvic floor muscle exercise by the surgeon alone (n = 132). Postoperatively, all patients received physiotherapist-guided pelvic floor muscle training. The primary outcome measure was 24-h pad weight at 6 weeks and 3 months postoperatively. Secondary outcome measures were the percentage of patients experiencing severe urinary incontinence, and patient-reported time to one and zero pad usage daily.
RESULTS: At 6 weeks postoperatively, the 24-h pad weight was significantly lower (9 g vs 17 g, P < 0.001) for the intervention group, which also showed less severe urinary incontinence (24-h pad weight >50 g; 8/152 patients vs 33/132 patients, P < 0.01). There was no significant difference between groups in the 24-h pad weight at 3 months (P = 0.18). Patient-reported time to one and zero pad usage was significantly less for the intervention group (P < 0.05). Multivariate Cox regression showed that preoperative physiotherapist-guided pelvic floor muscle training reduced time to continence (1 pad usage daily) by 28% (P < 0.05).
CONCLUSIONS: A physiotherapist-guided pelvic floor muscle training program, commenced 4 weeks preoperatively, significantly reduces the duration and severity of early urinary incontinence after radical retropubic prostatectomy.
Written by:
Patel MI, Yao J, Hirschhorn AD, Mungovan SF. Are you the author?
Urological Cancer Outcomes Center, Discipline of Surgery, The University of Sydney.
Reference: Int J Urol. 2013 Feb 21. Epub ahead of print.
doi: 10.1111/iju.12099
PubMed Abstract
PMID: 23432098
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