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Abstract
We evaluated the efficacy of progressive resistance training of the pelvic floor muscle for post-prostatectomy incontinence. In this prospective study, 59 patients who underwent radical prostatectomy were evaluated preoperatively. Continence was sequentially assessed within 2 weeks postoperatively, and an exercise regimen was initiated at 6- and 12-weeks. The primary outcome was continent status and the secondary outcome was changes in muscle strength and endurance after the exercise intervention. Continence was defined as no urine loss in a 1h pad test. A total of 59 patients participated in this study. Six patients dropped out of the study because of non-compliance and orthopedic problems. Of the remaining 53 patients, 31 (58.5%) achieved pad-free continence at 12 weeks postoperatively. The patients were divided into two groups based on their continence status, and no statistically significant difference was observed in age, body mass index, prostate volume, prostate-specific antigen, pathological Gleason score sum, and pathological T stage. Meanwhile, preoperative maximal urethral closure pressure and change in hip extensor muscle strength and endurance during the 12-week exercise program were significantly higher in the continent group. In multivariate analysis, change in hip extensor muscle strength was the only significant parameter predicting achievement of continence status (Odds ratio, 1.039; p = 0.045). The changes in hip extensor muscle strength in the current exercise program was an independent predictor of continence status after radical prostatectomy. A large-scale prospective study on the relationship between extensor muscle strength and urinary incontinence should be explored in future.
Highlights
IntroductionIn South Korea, the number of prostate cancer patients has increased rapidly in recent decades, and the disease is one of the top five most frequent cancers occurring in men in that country [2]
Prostate cancer is one of the most common cancers in Western countries [1]
A recently published study protocol was planned using different times of exercise initiation, exercise durations, and combinations of exercise programs [15,16,17]. Centemero and his colleagues published the early starting of pelvic floor muscle exercise before radical prostatectomy could improve early continence
Summary
In South Korea, the number of prostate cancer patients has increased rapidly in recent decades, and the disease is one of the top five most frequent cancers occurring in men in that country [2]. These dramatic changes in prostate cancer frequency may be attributed to early diagnosis, which became possible following introduction of the prostate-specific antigen (PSA) test. Radical prostatectomy is recognized as a standard surgical treatment for early-stage localized prostate cancer [5]. Several surgical techniques have been developed and applied to reduce urinary incontinence especially after radical prostatectomy [8]
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