Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: a randomised controlled trial

doi:10.1016/S0140-6736(99)03473-X

The Lancet

Volume 355, Issue 9198, 8 January 2000, Pages 98-102

https://doi.org/10.1016/S0140-6736(99)03473-X Get rights and content

Summary

Background

Urinary incontinence is a common long-term complication after radical prostatectomy. Spontaneous recovery of normal urinary control after surgery can take 1–2 years. We aimed to investigate whether there was any beneficial effect of pelvic-floor re-education for patients with urinary incontinence as a result of radical prostatectomy.

Methods

102 consecutive incontinent patients who had had radical retropubic prostatectomy for clinically localised prostate cancer and who could comply with the ambulatory treatment schedule in our hospital were randomised, after catheter removal, into a treatment group (n=50) and a control group (n=52). Patients in the treatment group took part in a pelvic-floor re-education programme for as long as they were incontinent, and for a maximum of 1 year. The control group received placebo therapy. The primary endpoint was continence rate at 3 months. Incontinence was assessed objectively with the 1 h and 24 h pad tests and subjectively by the visual analogue scale. The groups were analysed on an intention-to-treat basis by ANOVA and χ² -test.

Findlngs

In the treatment group continence was achieved after 3 months in 43 (88%) of 48 patients. In the control group, continence returned after 3 months in 29 (56%) of 52 patients. At 1 year, the difference in proportion between treatment and control group was 14% (95% CI 2–27). In the treatment group improvement in both duration (log-rank test, p=0·0001) and degree of incontinence (Wald test, p=0·0010) was significantly better than in the control group.

Interpretation

Pelvic-floor re-education should be considered as a first-line option in curing incontinence after radical prostatectomy.

Introduction

Localised prostate cancer can be cured by surgery or radiotherapy. Radical prostatectomy is commonly thought to be the most effective treatment.1, 2, 3, 4 Removal of the prostate and surrounding tissue can lead to leakage of urine, one of the most distressing sequelae of prostate surgery and a major cause of urinary incontinence in men.4, 5, 6, 7 In previous studies, the rate of incontinence after radical prostatectomy varied from 8% to 87% at 6 months and from 5%–44·5% 1 year after the operation.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 Some investigators defined incontinence strictly to include all patients with any lack of control, whereas others reported only severe incontinence. Most studies used subjective assessments.5, 10, 16 A few prospective studies that used an objective assessment, such as a 1 h¹⁸ or 24 h pad test and urodynamic investigation,9, 16 provided more reliable information.

Postprostatectomy incontinence may be caused by bladder dysfunction or sphincter incompetence. Most patients present with sphincter insufficiency with or without detrusor instability.7, 9, 11, 17 Previous transurethral resection, age, operative technique, preservation of the neurovascular bundles, urodynamic measurements, and clinical and pathological stage of the tumour were found to be risk factors for incontinence after radical prostatectomy.12, 14, 15, 19, 20

The spontaneous recovery of urinary control may take up to 1 or 2 years after surgery. Pelvic-floor re-education is an effective non-invasive method of treating urinary incontinence in women.21, 22, 23, 24, 25 Physiotherapy is not mentioned in most studies about incontinence after radical prostatectomy. In only a few studies were rehabilitation programmes initiated to treat incontinence after prostate surgery.26, 27, 28, 29 These studies suggested beneficial effects of re-education programmes, but the effect of spontaneous recovery was not taken into account.

We aimed to find out whether pelvic-floor re-education decreases the duration and degree of urinary incontinence after radical prostatectomy in a randomised controlled study.

Section snippets

Patients

From January, 1995, to June, 1996, all patients who had a radical retropubic prostatectomy for clinically localised prostate cancer at our hospital were screened. Patients were included if they were seen to be incontinent on day 15 after surgery after removal of the catheter, and if the patient could regularly attend hospital appointments. All patients included in the study gave written informed consent.

Procedures

The radical retropubic prostatectomies were done by two surgeons (HVP and LB). The same

Results

181 patients who had had a radical retropubic prostatectomy for clinically localised prostate cancer were screened (figure 1). 16 patients were excluded because they were continent and did not need any further treatment and 63 patients with incontinence were excluded since they were not able to come regularly to the hospital, mostly because of the distance or problems of access. They were referred to private community physiotherapists who specialised in pelvic-floor re-education. 102 patients

Discussion

We found that pelvic-floor re-education was significantly more effective than placebo treatment in decreasing both the duration and degree of incontinence after radical prostatectomy. Differences between the two groups in the percentage of incontinent patients remaining were highest in the first 4 months and decreased from 31% at 1 month to 14·4% at 1 year. This study shows that therapy should start as soon as possible after the operation. 1 year after radical prostatectomy, severe incontinence

References (32)

RE Hautmann et al.
Radical retropubic prostatectomy: morbidity and urinary continence in 418 consecutive cases
Urology
(1994)
F Haab et al.
Postprostatectomy incontinence
Urol Clin North Am
(1996)
ET Goluboff et al.
Urinary continence after radical prostatectomy: the Columbia experience
J Urol
(1998)
DC Rudy et al.
Urodynamic evaluation of incontinence in patients undergoing modified Campbell radical retropubic prostatectomy: a prospective study
J Urol
(1984)
R Chao et al.
Incontinence after radical prostatectomy: detrusor or sphincter causes
J Urol
(1995)
MR Gudziak et al.
Urodynamic assessment of urethral sphincter function in post-prostatectomy incontinence
J Urol
(1996)
GE Leach et al.
Post-prostatectomy incontinence: urodynamic findings and treatment outcomes
J Urol
(1996)
JA Eastham et al.
Risk factors for urinary incontinence after radical prostatectomy
J Urol
(1996)
P Hammerer et al.
Urodynamic evaluation of changes in urinary control after radical retropubic prostatectomy
J Urol
(1997)
SM Donnellan et al.
Prospective assessment of incontinence after radical retropubic prostatectomy: objective and subjective analysis
Urology
(1997)

MA Ficazzola et al.

The etiology of post-radical prostatectomy incontinence and correlation of symptoms with urodynamic findings

J Urol

(1998)

JS Elder et al.

Morbidity and radical perineal prostatectomy following transurethral resection of the prostate

J Urol

(1984)

K Bo et al.

Long-term effect of pelvic floor muscle exercise 5 years after cessation of organized training

Obstet Gynecol

(1996)

KL Burgio et al.

Behavioural training for postprostatectomy urinary incontinence

J Urol

(1989)

JP Meaglia et al.

Post-prostatectomy urinary incontinence: response to behavioural training

J Urol

(1990)

MJ Barry et al.

The American Urological Assocation symptom index for benign prostatic hyperplasia: the measurement committee of the Americal urological association

J Urol

(1992)

Cited by (260)

Association between Presurgical Weight Status and Urinary and Sexual Function in Prostate Cancer Patients Treated by Radical Prostatectomy: A Prospective Cohort Study
2023, Urology
To prospectively examine the influence of weight status on urinary and sexual function in clinically localized prostate cancer patients treated by radical prostatectomy (RP).
The Prostatectomy, Incontinence and Erectile dysfunction study recruited patients at 2 US institutions between 2011 and 2014. At baseline, height and weight were measured, and urinary and sexual function were collected by the modified Expanded Prostate Cancer Index Composite-50. This index was repeated at the 5-week, 6-month, and 12-month postsurgical assessments and compared to baseline using linear generalized estimating equations. Logistic equations were used to evaluate the likelihood of functional recovery at the 6- and 12-month assessments.
Presurgery, nonobese patients (68.8% of 407 patients) had similar urinary function as those with obesity (P = .217), but better sexual function (P = .006). One year after surgery, 50.5% and 28.9% patients had recovered to baseline levels for urinary and sexual function, respectively. Recovery was not, however, uniform by obesity. Compared to those with obesity, nonobese patients had better urinary function at the 6- (P < .001) and 12-month postsurgical assessments (P = .011) and were more likely to recover their function by the 6-month assessment (OR = 2.55, 95% CI = 1.36-4.76). For sexual function, nonobese patients had better function at the 6- (P = .028) and 12-month (P = .051) assessments, but a similar likelihood of recovery 1-year postsurgery.
Nonobese prostate cancer patients had better and likely earlier recovery in urinary function postsurgery, and better sexual function both pre- and postsurgery. These findings support the potential for tailored presurgical counseling about RP side-effects and prehabilitation to improve these side-effects.
Effects of Biofeedback Combined With Pilates Training on Post-prostatectomy Incontinence
2021, Urology
To verify the effect of Pilates training combined with biofeedback training, Kegel training combined with biofeedback training, and Kegel training alone on post-prostatectomy incontinence in male patients.
Forty-two patients were randomly divided into 3 groups. The changes occurring to the 3 groups before and after treatment and the differences between the 3 groups were assessed using a 1-hour pad test, number of incontinent episodes, the ICIQ questionnaire, and the Oxford Grading Scale. The 3 groups were required to undergo daily training for an 8-week period.
At 8 weeks, groups A, B and C experienced a 34.3%, 61.9%, and 67% improvement in the 1-hour pad test, respectively, and 32.1%, 52.9%, and 58.8% reduction in the number of urinary incontinence episodes, respectively, and a 29.4%, 50%, and 64.7% reduction in the ICIQ Scale, respectively, and a 33.3%, 50%, and 50% in Oxford Grading Scale improvement, respectively. The graph results showed that the effect was noted after 3 weeks of treatment and a significant effect occurred by the eighth week of treatment.
Three methods were shown to optimize urinary continence and pelvic floor muscle strength of patients with post-prostatectomy incontinence. The treatment effect of group C was better than group B, but there was no statistically significant difference in the 1-hour pad tests. It is particularly important to understand the time sensitivity for patient training.
Acupuncture for postprostatectomy incontinence: A systematic review
2023, BMJ Supportive and Palliative Care
Effects of surgery versus radiotherapy in patients with localized prostate cancer in terms of urinary, bowel, and sexual domains
2023, Cancer Medicine
Non-pharmacological and nonsurgical interventions in male urinary incontinence: A scoping review
2023, Journal of Clinical Nursing
Pelvic floor muscle exercise with or without duloxetine for postprostatectomy urinary incontinence: A retrospective single-center study
2023, Medicine (United States)

View all citing articles on Scopus

View full text

ArticlesEffect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: a randomised controlled trial

Summary

Background

Methods

Findlngs

Interpretation

Introduction

Section snippets

Patients

Procedures

Results

Discussion

Urology

Urol Clin North Am

J Urol

J Urol

J Urol

J Urol

J Urol

J Urol

J Urol

Urology

J Urol

J Urol

Obstet Gynecol

J Urol

J Urol

J Urol

Articles
Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: a randomised controlled trial