How to Predict Outcomes from a Biofeedback and Pelvic Floor Muscle Electric Stimulation Program in Patients with Urinary Incontinence after Radical Prostatectomy.

Stefano Salciccia,Giulio Bevilacqua,Martina Maggi,Alessandro Gentilucci,Gianna Mariotti,Giovanni Battista Di Pierro,Davide Rosati,Vittorio Canale,Martina Moriconi,Alessandro Sciarra,Marco Frisenda,Gianluca Nesi,Pietro Viscuso,Susanna Cattarino,Francesco Del Giudice

doi:10.3390/jcm11010127

Stefano Salciccia, Giulio Bevilacqua + Show 13 more

Open Access

https://doi.org/10.3390/jcm11010127

Copy DOI

Abstract

Objectives: The objective of this study was to analyze the pre-operative and intra-operative variables that can condition urinary incontinence (UI) after radical prostatectomy (RP), as well as continence rate recovery during a pelvic floor rehabilitation program. Materials and Methods: A total of 72 cases with UI after RP were prospectively examined. All cases were homogeneously treated by the same surgeon, using the same RP technique. A combination of biofeedback (BF) and pelvic floor electric stimulation (PFES) performed by the same clinician and using the same protocol was used. Clinical, pathologic and surgical variables were analyzed in terms of 24 h pad test results (pad weight and pad-free status). Results: Prostate volume (PV) strongly varied from 24 to 127 cc (mean ± SD 46.39 ± 18.65 cc), and the baseline pad weight varied from 10 to 1500 cc (mean ± SD 354.29 ± 404.15 cc). PV strongly and positively correlated with the baseline pad weight (r = 0.4215; p = 0.0269) and inversely with the three-month pad weight (r = − 0.4763; p = 0.0213) and pad-free status (r =− 0.3010; p = 0.0429). The risk of a residual pad weight >10 g after the rehabilitative program significantly increased according to PV (p = 0.001) and the baseline pad weight (p = 0.002 and < 0.0001). In particular, PV > 40 cc and a baseline pad weight >400 g significantly (p = 0.010 and p < 0.0001, respectively) and independently predicted a 5.7 and a 35.4 times increase in the risk of a residual pad weight at the three-month follow-up, respectively. Conclusion: This is the first prospective trial whose primary objective is to verify the possible predictors, such as PV, that are able to condition the response to a pelvic floor rehabilitation program for UI after RP.

Highlights

IntroductionThere have been improvements in radical prostatectomy (RP) for prostate cancer (PC), this surgical procedure remains significantly associated with the development of urinary incontinence (UI)
Inclusion criteria were the following: histological diagnosis of adenocarcinoma, no distant metastases at clinical staging, radical prostatectomy (RP) chosen as primary treatment option, estimated life expectancy of ≥10 years, persistent urinary incontinence (UI) at 30 days after catheter removal and referred by the patient as able to influence his quality of life
To the best of our knowledge, this is the first prospective clinical trial whose primary objective was to verify the possible predictors able to condition the response to a pelvic floor rehabilitation program for UI after RP

Summary

Introduction

There have been improvements in radical prostatectomy (RP) for prostate cancer (PC), this surgical procedure remains significantly associated with the development of urinary incontinence (UI). The rates of UI after RP significantly vary from 5 to 40% in different trials, depending on the characteristics of the populations and on the methods used [1,2,3]. UI is a relevant side effect after RP, and it can develop early after catheter removal and influence the quality of life of men. Non-invasive therapies are often prescribed first, and pelvic floor muscle exercises (PFMEs) can be used to improve the strength of the pelvic floor [1]. The European Association of Urology (EAU) guidelines [1] underline that

Objectives

Methods

Results

Conclusion