Effects of perioperative pelvic floor muscle training on early recovery of urinary continence and erectile function in men undergoing radical prostatectomy: a randomized clinical trial

Gislano Heverton Soares de Lira, Alexandre Fornari, Luiz Felipe Cardoso, Magda Aranchipe, Carmem Kretiska, Ernani Luis Rhoden, Gislano Heverton Soares de Lira, Alexandre Fornari, Luiz Felipe Cardoso, Magda Aranchipe, Carmem Kretiska, Ernani Luis Rhoden

Abstract

Aims: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction (ED), which negatively impact quality of life (QoL). This study aimed to evaluate the effects of a perioperative pelvic floor muscle training (PFMT) program versus usual care on early recovery of urinary continence and erectile function after RP.

Materials and methods: Of 59 eligible men, 31 were randomly allocated into 2 groups: Group 1 (Control, N=15) received usual post-RP care; and Group 2 (Physical therapy, N=16) received two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were used to evaluate UI and ED, respectively.

Results: Demographic characteristics were similar in both groups. Three months after RP, the UI rate was 72.7% and 70.0% in Groups 1 and 2, respectively (P >0.05). The severity and frequency of UI and its impact on QoL were evaluated by the ICIQ-Short Form, with scores of 6.9±6.26 in Group 1 and 7.0±5.12 in Group 2 (P >0.05). The IIEF-5 scores were similar in Groups 1 and 2 (5.73±7.43 vs. 6.70±6.68, respectively) (P >0.05).

Conclusion: Our pre-RP protocol of two physical therapist-assisted sessions of PFMT plus instructions did not signifi cantly improve urinary continence or erectile function at 3 months after RP.

Keywords: Erectile Dysfunction; Prostatic Neoplasms; Urinary Incontinence.

Conflict of interest statement

None declared.

Copyright® by the International Brazilian Journal of Urology.

Figures

Figure 1. Consort flowchart.
Figure 1. Consort flowchart.

References

    1. Gannon K, Guerro-Blanco M, Patel A, Abel P. Re-constructing masculinity following radical prostatectomy for prostate cancer. Aging Male. 2010;13:258–264.
    2. 1. Gannon K, Guerro-Blanco M, Patel A, Abel P Re-constructing masculinity following radical prostatectomy for prostate cancer. Aging Male. 2010;13:258-64.
    1. Litwin MS, Hays RD, Fink A, Ganz PA, Leake B, Leach GE, et al. Quality-of-life outcomes in men treated for localized prostate cancer. JAMA. 1995;273:129–135.
    2. 2. Litwin MS, Hays RD, Fink A, Ganz PA, Leake B, Leach GE, et al. Quality-of-life outcomes in men treated for localized prostate cancer. JAMA. 1995;273:129-35.
    1. Jønler M, Madsen FA, Rhodes PR, Sall M, Messing EM, Bruskewitz RC. A prospective study of quantification of urinary incontinence and quality of life in patients undergoing radical retropubic prostatectomy. Urology. 1996;48:433–440.
    2. 3. Jønler M, Madsen FA, Rhodes PR, Sall M, Messing EM, Bruskewitz RC. A prospective study of quantification of urinary incontinence and quality of life in patients undergoing radical retropubic prostatectomy. Urology. 1996;48:433-40.
    1. Dubbelman YD, Dohle GR, Schröder FH. Sexual function before and after radical retropubic prostatectomy: A systematic review of prognostic indicators for a successful outcome. Eur Urol. 2006;50:711–718. discussion 718-20.
    2. 4. Dubbelman YD, Dohle GR, Schröder FH. Sexual function before and after radical retropubic prostatectomy: A systematic review of prognostic indicators for a successful outcome. Eur Urol. 2006;50:711-8; discussion 718-20.
    1. Kendirci M, Bejma J, Hellstrom WJ. Update on erectile dysfunction in prostate cancer patients. Curr Opin Urol. 2006;16:186–195.
    2. 5. Kendirci M, Bejma J, Hellstrom WJ. Update on erectile dysfunction in prostate cancer patients. Curr Opin Urol. 2006;16:186-95.
    1. Filocamo MT, Li Marzi V, Del Popolo G, Cecconi F, Marzocco M, Tosto A, et al. Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. Eur Urol. 2005;48:734–738.
    2. 6. Filocamo MT, Li Marzi V, Del Popolo G, Cecconi F, Marzocco M, Tosto A, et al. Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. Eur Urol. 2005;48:734-8.
    1. Burgio KL, Goode PS, Urban DA, Umlauf MG, Locher JL, Bueschen A, et al. Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinence: a randomized, controlled trial. J Urol. 2006;175:196–201. discussion 201.
    2. 7. Burgio KL, Goode PS, Urban DA, Umlauf MG, Locher JL, Bueschen A, et al. Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinence: a randomized, controlled trial. J Urol. 2006;175:196-201; discussion 201.
    1. Parekh AR, Feng MI, Kirages D, Bremner H, Kaswick J, Aboseif S. The role of pelvic floor exercises on postprostatectomy incontinence. J Urol. 2003;170:130–133.
    2. 8. Parekh AR, Feng MI, Kirages D, Bremner H, Kaswick J, Aboseif S. The role of pelvic floor exercises on postprostatectomy incontinence. J Urol. 2003;170:130-3.
    1. Van Kampen M, De Weerdt W, Van Poppel H, De Ridder D, Feys H, Baert L. Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: a randomised controlled trial. Lancet. 2000;355:98–102.
    2. 9. Van Kampen M, De Weerdt W, Van Poppel H, De Ridder D, Feys H, Baert L. Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: a randomised controlled trial. Lancet. 2000;355:98-102.
    1. Manassero F, Traversi C, Ales V, Pistolesi D, Panicucci E, Valent F, et al. Contribution of early intensive prolonged pelvic floor exercises on urinary continence recovery after bladder neck-sparing radical prostatectomy: results of a prospective controlled randomized trial. Neurourol Urodyn. 2007;26:985–989.
    2. 10. Manassero F, Traversi C, Ales V, Pistolesi D, Panicucci E, Valent F, et al. Contribution of early intensive prolonged pelvic floor exercises on urinary continence recovery after bladder neck-sparing radical prostatectomy: results of a prospective controlled randomized trial. Neurourol Urodyn. 2007;26:985-9.
    1. Moore KN, Valiquette L, Chetner MP, Byrniak S, Herbison GP. Return to continence after radical retropubic prostatectomy: a randomized trial of verbal and written instructions versus therapist-directed pelvic floor muscle therapy. Urology. 2008;72:1280–1286.
    2. 11. Moore KN, Valiquette L, Chetner MP, Byrniak S, Herbison GP. Return to continence after radical retropubic prostatectomy: a randomized trial of verbal and written instructions versus therapist-directed pelvic floor muscle therapy. Urology. 2008;72:1280-6.
    1. Tobía I, González MS, Martínez P, Tejerizo JC, Gueglio G, Damia O, et al. [Randomized study on urinary continence after radical prostatectomy with previous kinesic perineal physiotherapy] Arch Esp Urol. 2008;61:793–798.
    2. 12. Tobía I, González MS, Martínez P, Tejerizo JC, Gueglio G, Damia O, et al. [Randomized study on urinary continence after radical prostatectomy with previous kinesic perineal physiotherapy]. Arch Esp Urol. 2008;61:793-8.
    1. Floratos DL, Sonke GS, Rapidou CA, Alivizatos GJ, Deliveliotis C, Constantinides CA, et al. Biofeedback vs verbal feedback as learning tools for pelvic muscle exercises in the early management of urinary incontinence after radical prostatectomy. BJU Int. 2002;89:714–719.
    2. 13. Floratos DL, Sonke GS, Rapidou CA, Alivizatos GJ, Deliveliotis C, Constantinides CA, et al. Biofeedback vs verbal feedback as learning tools for pelvic muscle exercises in the early management of urinary incontinence after radical prostatectomy. BJU Int. 2002;89:714-9.
    1. Bales GT, Gerber GS, Minor TX, Mhoon DA, McFarland JM, Kim HL, et al. Effect of preoperative biofeedback/pelvic floor training on continence in men undergoing radical prostatectomy. Urology. 2000;56:627–630.
    2. 14. Bales GT, Gerber GS, Minor TX, Mhoon DA, McFarland JM, Kim HL, et al. Effect of preoperative biofeedback/pelvic floor training on continence in men undergoing radical prostatectomy. Urology. 2000;56:627-30.
    1. Lilli P, Mercuriali M, Fiori M, Hanitzsch H, Gunelli R, Bercovich E. Impact of preoperative biofeedback on incontinence in cancer patients undergoing radical prostatectomy. Arch Ital Urol Androl. 2006;78:92–96.
    2. 15. Lilli P, Mercuriali M, Fiori M, Hanitzsch H, Gunelli R, Bercovich E. Impact of preoperative biofeedback on incontinence in cancer patients undergoing radical prostatectomy. Arch Ital Urol Androl. 2006;78:92-6.
    1. Franke JJ, Gilbert WB, Grier J, Koch MO, Shyr Y, Smith JA., Jr Early post-prostatectomy pelvic floor biofeedback. J Urol. 2000;163:191–193.
    2. 16. Franke JJ, Gilbert WB, Grier J, Koch MO, Shyr Y, Smith JA Jr. Early post-prostatectomy pelvic floor biofeedback. J Urol. 2000;163:191-3.
    1. Chang JI, Lam V, Patel MI. Preoperative Pelvic Floor Muscle Exercise and Postprostatectomy Incontinence: A Systematic Review and Meta-analysis. Eur Urol. 2016;69:460–467.
    2. 17. Chang JI, Lam V, Patel MI. Preoperative Pelvic Floor Muscle Exercise and Postprostatectomy Incontinence: A Systematic Review and Meta-analysis. Eur Urol. 2016;69:460-7.
    1. Wang W, Huang QM, Liu FP, Mao QQ. Effectiveness of preoperative pelvic floor muscle training for urinary incontinence after radical prostatectomy: a metaanalysis. BMC Urol. 2014;14:99–99.
    2. 18. Wang W, Huang QM, Liu FP, Mao QQ. Effectiveness of preoperative pelvic floor muscle training for urinary incontinence after radical prostatectomy: a metaanalysis. BMC Urol. 2014;14:99.
    1. Nilssen SR, Mørkved S, Overgârd M, Lydersen S, Angelsen A. Does physiotherapist-guided pelvic floor muscle training increase the quality of life in patients after radical prostatectomy? A randomized clinical study. Scand J Urol Nephrol. 2012;46:397–404.
    2. 19. Nilssen SR, Mørkved S, Overgârd M, Lydersen S, Angelsen A. Does physiotherapist-guided pelvic floor muscle training increase the quality of life in patients after radical prostatectomy? A randomized clinical study. Scand J Urol Nephrol. 2012;46:397-404.
    1. Dorey G, Speakman M, Feneley R, Swinkels A, Dunn C, Ewings P. Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction. Br J Gen Pract. 2004;54:819–825.
    2. 20. Dorey G, Speakman M, Feneley R, Swinkels A, Dunn C, Ewings P Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction. Br J Gen Pract. 2004;54:819-25.
    1. Van Kampen M, De Weerdt W, Claes H, Feys H, De Maeyer M, Van Poppel H. Treatment of erectile dysfunction by perineal exercise, electromyographic biofeedback, and electrical stimulation. Phys Ther. 2003;83:536–543.
    2. 21. Van Kampen M, De Weerdt W, Claes H, Feys H, De Maeyer M, Van Poppel H. Treatment of erectile dysfunction by perineal exercise, electromyographic biofeedback, and electrical stimulation. Phys Ther. 2003;83:536-43.
    1. Prota C, Gomes CM, Ribeiro LH, de Bessa J, Jr, Nakano E, Dall'Oglio M, et al. Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, randomized, controlled trial. Int J Impot Res. 2012;24:174–178.
    2. 22. Prota C, Gomes CM, Ribeiro LH, de Bessa J Jr, Nakano E, Dall'Oglio M, et al. Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, randomized, controlled trial. Int J Impot Res. 2012;24:174-8.
    1. Zhang Q, Wang L, Zheng W. Surface electromyography of pelvic floor muscles in stress urinary incontinence. Int J Gynaecol Obstet. 2006;95:177–178.
    2. 23. Zhang Q, Wang L, Zheng W. Surface electromyography of pelvic floor muscles in stress urinary incontinence. Int J Gynaecol Obstet. 2006;95:177-8.
    1. Ronco M, Iona L, Fabbro C, Bulfone G, Palese A. Patient education outcomes in surgery: a systematic review from 2004 to 2010. Int J Evid Based Healthc. 2012;10:309–323.
    2. 24. Ronco M, Iona L, Fabbro C, Bulfone G, Palese A. Patient education outcomes in surgery: a systematic review from 2004 to 2010. Int J Evid Based Healthc. 2012;10:309-23.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅