Developing a rehabilitation programme for male urinary incontinence: detailed schemes and results on 122 patients

Abstract

Urinary incontinence (UI) is a common complication of prostatectomy. International guidelines suggest using pelvic floor muscle training (PFMT) as a first‐line intervention (grade A) to help patients reduce the involuntary urine leakages. In the literature it is hard to find a complete exercise scheme, with full details (e.g. body position during PFMT, how to avoid antagonist synergies), information on how to make exercises progressively more difficult, and data showing the efficacy of the whole programme. This study presents a complete PFMT programme, with full details and outcomes. A scheme of five progressive exercises was built, each with precise characteristics and times. Totally 131 patients with stress UI after radical retropubic prostatectomy were enrolled and followed a written scheme of PFMT with the five exercises. Leakages were quantified using the 24‐h pad test. Rehabilitation ended when patients had leakages less than 10 g/d. Nine patients could not achieve results and decided to exit the programme after a median of five sessions (InterQuartile Range, IQR = [4;7]). Out of the 122 patients, 90 patients who followed the full programme achieved the rehabilitation (70.3%); they had median leakages of 150 g, IQR = [90;300]. Those who did not reach the result had higher leakages [540 g/d, IQR = (300;840)] but obtained clinically significant reduction and reached a median of 90 g/d, IQR = [90;157] after comparable rehabilitation times (median of 6 or 7 sessions, corresponding to 8 or 10 weeks, for rehabilitated and non‐rehabilitated patients, respectively). Future studies will investigate the long‐term results of this programme.

Intervenções de enfermagem para incontinência urinária e disfunção sexual após prostatectomia radical

“…Of the 18 articles included, (5)(6)(7)(8)11,12,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) 17 were found in the electronic databases and one in the references of the selected studies. In the reference lists of the excluded reviews, no study was found that complied with the inclusion criteria set.…”

“…In the reference lists of the excluded reviews, no study was found that complied with the inclusion criteria set. As for the language of the articles, 16 were published in English, (5,6,8,11,12,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) one in Spanish (7) and one in Portuguese. (23) As for the country where the study was developed, three were developed in Spain, followed by the United States, United Kingdom, Italy, Australia and China, with two studies each, and Brazil, Denmark, Sweden, Norway and The Netherlands, with one study in each country.…”

“…Concerning the year of publication, one study was published in 2018, (11) one in 2017, (17) five in 2016, (18)(19)(20)(21)(22) five in 2015 (5,(23)(24)(25)(26) and six in 2014. (6)(7)(8)12,27,28) As for the evidence level (EL), five studies presented level II, (5,11,12,21,27) ten level VI (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)28) and three level VII. (6)(7)(8) What the strategies for the implementation of the interventions are concerned, Nursing interventions for UI and SD, Nursing interventions for UI and Nursing interventions for SD were the categories created after analyzing the studies.…”

“…When analyzing the nursing interventions identified in this study, we understand that all of them refer to the education and support that nurses should offer to prostatectomized patients. In this sense, the communication between patient and nurse stands out, (11,12,25) considered a key instrument to promote health education. Authors point to the need for prostatectomized patients to be followed before (22) and after the surgery (29) and for nurses to seek alternative patient education methods, which are not limited to leaflets and consultations.…”

“…Advise him to contract the muscles before and during activities that cause urine leakage, such as coughing and sneezing. (6,21,24,25,27) II, VI, VII Engage the family and teach them the PFME so that they can encourage the patient to perform them. (11) II Provide the patient with written material, containing pictures and details about the execution of the PFME.…”