Abstract
Objective to investigate the response of the pelvic floor muscles (PFM), and urinary incontinence (UI), in patients having undergone a prostatectomy, after treatment using electrical stimulation. Materials and methods this observational study was conducted in an outpatient urogynecologic physical therapy clinic of Hospital dos Servidores in Rio de Janeiro, Brazil from August to September 2012. Ten patients (aged, 64 ± 7 years) with urinary incontinence resulting from radical prostatectomy, having received surgery within six months of study entry, without urinary infection, and without metallic implants underwent electrical stimulation of the PFM, while in lateral decubitus position with knees and hips flexed. The parameters used were 65 Hz frequency, pulse width of 500 µs, biphasic current, intensity according to the tolerance level reported by the patient, perineal contraction time of four seconds, and rest time of eight seconds for 20 minutes twice a week, totaling 16 sessions of electrical stimulation with active-assisted contraction. Patients were evaluated before and after electrical stimulation through physical therapy evaluation of urinary incontinence, by being asked about the number of disposable guards used daily, using a visual analogue scale (VAS) to measure how the UI interfered with activities of daily living, and by electromyographic biofeedback to measure the work of the PFM. Data were analyzed using Student’s paired t-tests and a significance level of 0.05. Results after 16 sessions of electrical stimulation, the electromyographic biofeedback evaluation showed a significant increase in muscle strength of 10.73 ± 8.64 to 17.16 ± 9.00 µV (t = -3.39, P = 0.008), a significant decrease in the number of diapers used before and after treatment (3.9 ± 1.2 to 1.8 ± 1.5, respectively; t = 5.16, P = 0.0006), and a significant decrease in the interference of urinary incontinence on daily activities of 9.6 ± 0.5 to 4.0 ± 3.8 (t = 5.15, P = 0.0006). Conclusion electrical stimulation may represent a novel way to strengthen the pelvic floor muscles and decrease urinary incontinence resulting from radical prostatectomy.
Highlights
The prevalence of prostate cancer has been steadily increasing in the recent years, and is a concern for both medical professionals and men in general
The aim of this study was to determine the response of the pelvic floor muscles and potential changes in urinary incontinence status in prostatectomized men submitted to electric stimulation
Ten patients, who were evaluated for urinary incontinence post-radical prostatectomy who were within six months of their surgery, and who did not suffer urinary infection or had metallic implants, were enrolled in the study and followed at the outpatient Urogynecologic Physical Therapy Clinic of Hospital dos Servidores in the State of Rio de Janeiro (HFSE), Brazil from August to September 2012
Summary
The prevalence of prostate cancer has been steadily increasing in the recent years, and is a concern for both medical professionals and men in general. There are two main forms of prostate cancer, which may be benign, and are most commonly affecting men aged 50 and above [1]. In Brazil, prostate cancer is one of the most common malignancies affecting men, with an estimated 60,180 new cases of prostate cancer diagnosed in 2012, according to the Brazilian National Institute of Cancer (INCA). In 2009, prostate cancer was responsible for 12,274 deaths [2]. Radical prostatectomy is a common treatment option for localized prostate cancer. The procedure is associated with a number of issues such as bladder, intestinal, and sexual dysfunction due to complications of the surgery [3]
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