Effect of early pelvic-floor biofeedback training on continence after radical prostatectomy: a prospective, controlled and randomized trial / Efeito da reabilitação precoce do assoalho pélvico com biofeedback sobre a continência urinária de pacientes submetidos à prostatectomia radical: estudo prospectivo, controlado e randomizado

AUTOR(ES)
DATA DE PUBLICAÇÃO

2010

RESUMO

INTRODUCTION: Urinary incontinence (UI) is a common complication after radical prostatectomy. Although recovery of continence is achieved by most patients, it can take one to two years. This study tested the effectiveness of pelvic floor biofeedback training (PFBT) on the severity and duration of UI up to 12 months following radical retropubic prostatectomy (RRP). METHODS: This study was a prospective, controlled, randomized trial comparing early postoperative PFBT to usual care. The sample included 73 men between 47 and 76 years old who elected RRP for treatment of clinically localized prostate cancer and could comply with the ambulatory treatment schedule. Patients were randomized into a treatment group (n=36) and a control group (n=37). After catheter removal, patients in the treatment group received PFBT once a week for as long as they were incontinent for a maximum of 12 weeks and practiced exercises at home. Patients in the control group received the usual instructions to contract the pelvic floor muscles. Both groups were evaluated before surgery and one, three, six and 12 months after RRP. Pelvic floor muscle strength (PFMS) was evaluated by the Oxford Scale. Incontinence symptoms were measured by the incontinence part of the International Continence Society Male Short Form Questionnaire (ICSmaleSF). The impact of incontinence on quality of life was measured by the Incontinence Impact Questionnaire (IIQ-7). Urinary continence was defined as the use of one or less pad per day. Incontinence was graduated by the 24h pad test in mild (less than 20g), moderate (between 21 and 74g) and severe (more than 75g). RESULTS: The preoperative assessment did not show differences in age, diabetes, body mass index, prostate weight, PFMS or voiding symptoms between the groups. At 12 months postoperatively, 25 (96.2%) patients in the treatment group and 20 (75.0%) in the control group were continent (p=0.028). The absolute risk reduction was 21.2% (95% CI: 3.4538.81%) and the relative risk of recovering continence was 1.28 (95% CI: 1.021.69). The number needed to treat was 5 (95% CI: 2.628.6). The percentage of severe incontinence was stronger for the control group at one month (p=0.015), three months (p=0.038), six months (p=0.012) and 12 months (p=0.021). Incontinence symptoms significantly decreased in the treatment group at one month (p=0.011), three months (p=0.002) and 12 months (p=0.04), but not at six months (p=0.063). PFMS was stronger after PFBT at one month (p=0.043), three months (p<0.001), six months (p=0.021) and 12 months (p=0.035). The impact of UI on quality of life was significantly improved for the treated group in the first month (p=0.025). CONCLUSIONS: Early pelvic floor biofeedback training decreased the severity and duration of urinary incontinence after radical retropubic prostatectomy

ASSUNTO(S)

biofeedback prostatectomia urinary incontinence neoplasias da próstata prostatic neoplasms qualidade de vida quality of life incontinência urinária prostatectomy biofeedback

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