In this study, we present a biofeedback method for the strengthening of perineal muscles during the preoperative procedures for radical prostatectomy, and we evaluate this technique as a prevention measure against complications such as urinary incontinence (UI) and erectile dysfunction (ED), which affect prostatectomy patients after surgery. In the experimental protocol, the patients performed specific exercises with the help of a device that provided the patient with visual biofeedback, based on a plot of the anal pressure. For the experimental protocol, we selected 20 male patients, with an average age of 64.0 years, and submitted them to ten therapeutic sessions each. A control group consisting of 32 men with an average age of 66.3 years, who were treated with the same surgical procedure but not with the preoperative procedures, also took part in the experiment. To evaluate UI and ED after the surgery in both control and experimental groups, we used two validated questionnaires—to assess UI, we used the King’s Health Questionnaire (KHQ) and, for ED, we used the International Index of Erectile Function (IIEF-5) Questionnaire. We compared the variables associated with UI and ED after the surgery for the control and experimental groups. The occurrence of UI after radical prostatectomy in the control group (100% of the patients) was higher than that for the experimental group (5% of the patients), with p < 0.0001. Likewise, the occurrence of erectile dysfunction after prostatectomy in the control group (48.6% of the patients) was higher than that for the experimental group (5% of the patients), with p < 0.0001. The number of nocturia events also decreased as a consequence of the intervention (p < 0.0001), as did the number of disposable underwear units for urinary incontinence (p < 0.0001). Furthermore, we compared, only for the experimental group, the anal pressure before the biofeedback intervention and after the surgery, and we verified that the anal pressure after surgery was significantly higher (p < 0.0001). The results strongly suggest that the preoperative biofeedback procedure was effective in decreasing urinary incontinence and erectile dysfunction after radical prostatectomy. As future work, we intend to extend this analysis for larger samples and considering a broader age range.
This study evaluates the therapeutic effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) of the posterior tibial nerve, for treating urinary incontinence (UI) due to detrusor overactivity (DO) in patients with multiple sclerosis (MS). Five volunteers having positive cutaneous plantar reflexes and intact innervation of the anterior tibial participated in the study. Individuals with a positive Babinski reflex were excluded. We applied 10 sessions of TENS currents (20 Hz, 200 milliseconds, tetrapolar), over a period of 5 weeks (2 sessions per week). The treatment was monitored through a Urogynecology Physiotherapeutic Assessment Questionnaire and by a Voiding Log. We observed a reduction in the average frequency of miction, as well as decreased nocturia; also, the urge incontinence symptoms in the treated patients were cleared up.
This case study evaluates the therapeutic use of Transcutaneous Electrical Nerve Stimulation (TENS) of the posterior tibial nerve for treating one patient with multiple sclerosis (MS) showing signs of urinary incontinence (UI) due to detrusor overactivity (DO). Patient: MS with UI and sensory loss. Method: Using the current therapy twice a week for 20 minutes in 10 sessions and monitoring electrodes during electrical stimulation. Results: We observed an improvement in urge incontinence with reduced trips to the bathroom during the day and night. Both the post voiding sense of desire and pain during urination disappeared. Conclusions: This study shows an indication that the use of TENS in the current technique of posterior tibial nerve can reduce the uninhibited detrusor contractions and improve the quality of life of patients with MS due to a reduction of urinary incontinence and also reduce the number of times that the patient's urinates, thus providing better quality of sleep, humor, personal relationship, less embarrassment and reduction of stress. In this way, this study justifies a wide investigation with multiple subjects.
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