Conservative management for postprostatectomy urinary incontinence

Anderson, Coral A; Omar, Muhammad Imran; Campbell, Susan; Hunter, Kathleen F.; Cody, June D; Glazener, Cathryn

doi:10.1002/14651858.cd001843.pub5

Cited by 190 publications

(140 citation statements)

References 117 publications

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“…When assessing prevention of PPUI with PFME with/without biofeedback vs no treatment, or sham or verbal instruction, eight trials reported on continence status in this systematic review. No differences were seen at 3 months; however, the number of men with UI between 6 and 12 months was 24% vs 52% and after 1 year was 10% vs 32%, respectively . The quality of evidence was judged to be moderate.…”

Section: Postoperative Strategiesmentioning

confidence: 98%

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How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence‐Research Society 2018

Averbeck

Marcelissen

Anding

et al. 2019

Neurourology and Urodynamics

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Aims: To review current prevention strategies for urinary incontinence among patients undergoing radical prostatectomy (RP). Methods: This is a consensus report of the proceedings of a research proposal from the annual International Consultation on Incontinence-Research Society (ICI-RS), 14 to 16 June 2018 (Bristol, UK): "How can we prevent postprostatectomy incontinence by patient selection, and by preoperative, peroperative, and postoperative measures?" Results: Several baseline parameters were proposed as predicting factors for postprostatectomy urinary incontinence (PPUI), including age, tumor stage, prostate volume, preoperative lower urinary tract symptoms, maximum urethral closure pressure, and previous transurethral resection of the prostate.More recently, magnetic resonance imaging has been used to measure the membranous urethral length and sphincter volume. Peroperative techniques include preservative and reconstructive approaches. Bladder neck preservation improved early (6 months), as well as long-term (>12 months) continence rates.Several prospective studies have reported earlier return of continence following preservation of puboprostatic ligaments, although no long-term data are available. Preservation of the urethral length yielded controversial outcomes.Concerning postoperative strategies, it is probably optimal to remove the catheter in a window between 4 and 7 days if clinically appropriate; however, more research in this regard is still required. Postoperative PFME (preoperative pelvic floor muscle exercise) appears to speed up the recovery of continence after RP.Conclusions: Conservative strategies to prevent PPUI include proper patient selection and PFME. Peroperative techniques have largely shown benefit in the short term. Postoperative complications and timing of trial without catheter can influence continence status. Future research initiatives must assess peroperative and postoperative measures, with longer-term follow-up.

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Section: Postoperative Strategiesmentioning

confidence: 98%

“…A recent Cochrane review assessed the use of conservative measures in managing and preventing PPUI . When assessing prevention of PPUI with PFME with/without biofeedback vs no treatment, or sham or verbal instruction, eight trials reported on continence status in this systematic review.…”

Section: Postoperative Strategiesmentioning

confidence: 99%

How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence‐Research Society 2018

Averbeck

Marcelissen

Anding

et al. 2019

Neurourology and Urodynamics

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“…In een recente Cochrane review werden de resultaten van 50 studies gecombineerd met in totaal 4.717 mannen [13]. In 45 studies ondergingen mannen een prostatectomie, in vier een transurethrale resectie van de prostaat (TURP) en in één studie TURP of prostatectomie.…”

Section: Bekkenfysiotherapieunclassified

Mictieklachten bij mannen – meer dan een vergrote prostaat

Blanker¹,

Dekker²

2015

Bijblijven

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Plasklachten zijn bij mannen decennialang ten onrechte toegeschreven aan prostaatvergroting en daardoor ontstane urine-uitstroombelemmering. In deze bijdrage wordt de multifactoriële oorzaak van plasklachten toegelicht, met specifieke aandacht voor de rol van de bekkenbodem. Uitleg over het onschuldige karakter en het gunstig beloop van plasklachten zijn naast leefstijladviezen de eerste stap in het behandelplan. De onderbouwing daarvan is beperkt. Dat geldt ook voor het effect van bekkenfysiotherapie bij mannen met plasklachten. InleidingPlasklachten komen vaak voor bij de ouder wordende man en werden voorheen toegeschreven aan goedaardige prostaatvergroting. In de afgelopen decennia zijn de inzichten rond het ontstaan van plasklachten bij mannen veranderd. Prostaatvergroting speelt daarin een veel kleinere rol. In deze bijdrage worden hypothesen over de pathofysiologie van plasklachten bij mannen toegelicht, gevolgd door de fysiologie van de mictie op bekkenniveau, met bijzondere aandacht voor de rol van de bekkenbodemspieren. Er wordt kort stilgestaan bij de diagnostiek door de huisarts. Daarna worden het natuurlijk beloop en de niet-medicamenteuze behandeling besproken, gevolgd door de overige therapeutische opties die de huisarts voor deze grote patiëntengroep heeft.

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“…PFMT is considered a first‐line treatment for PPI, yet systematic reviews provide conflicting conclusions. A Cochrane review 15 concluded there was insufficient evidence to demonstrate effectiveness of PFMT or PFMT with BFB (PFMT + BFB) to treat or prevent PPI. Yet, other systematic reviews conclude that PFMT is more effective than no PFMT 16–19 .…”

Section: Introductionmentioning

confidence: 99%

Do features of randomized controlled trials of pelvic floor muscle training for postprostatectomy urinary incontinence differentiate successful from unsuccessful patient outcomes? A systematic review with a series of meta‐analyses

Hall

Neumann

Hodges

2020

Neurourology and Urodynamics

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Aims: Efficacy of pelvic floor muscle training (PFMT) for postprostatectomy incontinence (PPI) differs between randomized clinical trials (RCT). This might be explained by variation in content/delivery of PFMT (eg, biofeedback, muscles targeted, and time of commencement of training). This review investigated whether outcome of meta-analysis differs based on presence or not of specific RCT features. Methods: PubMed, CINAHL, EMBASE, Physiotherapy Evidence Database (PEDro), and Cochrane were searched for RCTs that investigated efficacy of PFMT on PPI. PFMT details and outcomes were extracted. Methodological quality and comprehensiveness of PFMT reporting was assessed using the PEDro scale and Consensus on Reporting Template, respectively. Effect size and 95% confidence intervals were calculated for incontinence rate at 3 months. To identify features that influenced efficacy, separate meta-analyses were performed for studies with and without specific features. Results: Twenty-two trials were included, and 15 were used for meta-analysis of 3-month outcomes. Overall, meta-analysis showed reduced incontinence with PFMT (risk ratio [RR] = 0.85; I 2 = 55%; P = .005). Meta-analyses showed better outcomes for PFMT than control groups when the study included preoperative PFMT (RR = 0.76; I 2 = 30%; P = .006), biofeedback (RR = 0.73; I 2 = 58%; P = .006), instruction to contract around the urethra (RR = 0.9; I 2 = 43%; P = .009), a control group without PFMT instruction (RR = 0.85; I 2 = 69%; P = .05), inclusion of all men irrespective of continence status (RR = 0.84; I 2 = 30%; P = .003) and continence defined as no leakage (RR = 0.85; I 2 = 48%; P = .05). Conclusions: Preoperative PFMT, biofeedback, urethral instructions, no PFMT instruction for controls, inclusion of all men, and continence defined as no leakage are features associated with successful patient outcomes. Future studies should consider these features in design of interventions and pooling data for meta-analysis. K E Y W O R D Smeta-analysis, pelvic floor muscle training, prostatectomy, systematic review, urinary incontinence | 543 | CONCLUSIONSThis systematic review is the first to deconstruct the details of PFMT program design and implementation in an attempt to explain variation in efficacy of PFMT in men with PPI in RCTs, systematic reviews, and metaanalyses. The multiple meta-analyses provide preliminary evidence for important candidate features.This study was developed in accordance with the PRISMA statement and registered with PROSPERO (CRD42017059589).

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Conservative management for postprostatectomy urinary incontinence

Abstract: Conservative management for postprostatectomy urinary incontinence.

Cited by 190 publications

References 117 publications

How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence‐Research Society 2018

How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence‐Research Society 2018

Mictieklachten bij mannen – meer dan een vergrote prostaat

Do features of randomized controlled trials of pelvic floor muscle training for postprostatectomy urinary incontinence differentiate successful from unsuccessful patient outcomes? A systematic review with a series of meta‐analyses

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