Urinary incontinence after radical prostatectomy: A randomized controlled trial comparing pelvic muscle exercises with or without electrical stimulation.
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1999
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Abstract
Objectives. To assess the effectiveness of intensive conservative treatment on and the impact of urinary incontinence after radical retropubic prostatectomy. Patients and methods. Sixty-three men with urinary incontinence ≥8 weeks after radical prostatectomy were randomized to one of three groups: group 1, standard treatment (control); group 2, intensive pelvic muscle exercises (PME, or group 3, PME plus electrical stimulation (PME + ES). Group 1 received verbal and written instructions about postoperatioe PME from their urologist and from the nurses at the preadmission clinic. Groups 2 and 3 were treated by a physiotherapist for 30 min twice a week for 12 weeks and carried out home exercises three times a day on the days when they were not treated. Outcome was assessed using the 24-h pad test, two validated quality-of-life questionnaires and a urine symptom inventory, all obtained at baseline, 17, 16 acid 24 weeks after enrolment, The final pad test- was carried out ≃8 months after surgery. Results. Fifty-eight patients completed the study, 21 in group 1, 18 in group 2 and 19 in group 3: five discontinued, three with bladder neck contractures requiring dilatation, one with rectal pain when doing the exercises and one unable to complete therapy while on vacation. The mean (median) time elapsed from surgery to entry into the study was 19 (8) weeks. At 12 weeks from baseline, the mean overall urine loss had decreased from 463 g to 115 g but there were no differences among groups, nor were there significant differences in urine loss at 16 and 24 weeks (F = 0.16, P = O.69), There was a significant impact on quality of life during the early recovery. Despite preoperative instructions, many patients revealed little or no knowledge about catheter care, bladder spasms, rectal pain, incontinence and erectile dysfunction. Little of the preoperative education was retained because of the overwhelming nature of the diagnosis. Conclusions. From the initial assessment to the final pad test at ≃8 months after surgery, incontinence improved greatly in all three groups, This rapid improvement may have masked any treatment benefit. Further research should address incontinence in men whose urine loss has stabilized and who underwent surgery >8 months previously. Moreover, a telephone-based follow-up soon after discharge may alleviate many of the concerns expressed.
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Keywords
Incontinence; Quality of life; Radical prostatectomy, EMTREE medical terms: adult; aged; article; bladder neck; clinical trial; conservative treatment; controlled clinical trial; controlled study; electrostimulation; erectile dysfunction; home care; human; major clinical study; male; muscle contracture; muscle exercise; muscle spasm; pain; patient education; pelvis; physiotherapist; priority journal; prostatectomy; quality of life; questionnaire; randomized controlled trial; rectum; urine catheter; urine incontinence, MeSH: Aged; Electric Stimulation Therapy; Exercise Therapy; Humans; Male; Middle Aged; Pain, Postoperative; Pelvic Floor; Prostatectomy; Prostatic Diseases; Quality of Life; Urinary Catheterization; Urinary Incontinence
Citation
Moore, K. N., Griffiths, D., & Hughton, A. (1999). Urinary incontinence after radical prostatectomy: A randomized controlled trial comparing pelvic muscle exercises with or without electrical stimulation. BJU International, 83(1), 57-65.