Effects of Biofeedback in Preventing Urinary Incontinence and Erectile Dysfunction after Radical Prostatectomy

Abstract

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.

Physiotherapy as an Effective Method to Support the Treatment of Male Urinary Incontinence: A Systematic Review

“…Evaluating the effectiveness of PFMT combined with BF in the treatment of PPI was the aim of many articles [ 17 , 22 , 24 , 25 , 36 , 38 , 41 , 44 , 45 , 51 ]. Most authors conducted training with BF once a week [ 25 , 36 , 44 , 45 , 51 ], which lasted between 20 [ 51 ] and 30 min [ 17 , 24 , 25 , 44 , 45 ].…”

“…Most authors conducted training with BF once a week [ 25 , 36 , 44 , 45 , 51 ], which lasted between 20 [ 51 ] and 30 min [ 17 , 24 , 25 , 44 , 45 ]. PFMT with BF is used in patients both before [ 17 , 22 , 41 ] and after radical prostatectomy [ 17 , 25 , 45 , 51 ]. Perez et al [ 41 ] noted that preoperative PFMT with BF may be effective in reducing the symptoms of UI and erectile dysfunction as compared to no therapy after prostate removal [ 41 ].…”

Atuação Da Fisioterapia Pélvica No Tratamento Das Disfunções Miccionais E Sexuais Em Pacientes Prostatectomizados: Revisão Integrativa

“…A associação de técnicas utilizadas pelos autores enriqueceu ainda mais os efeitos citados acima, contribuindo para uma melhora significativa da IU, da DE e climatúria. Prota et al (2010) avaliaram os efeitos do BFB em 52 pacientes submetidos à PR, tendo como conclusão efeitos positivos sobre à função erétil (FE) e IU; porém Perez et al (2018) compararam os efeitos do BFB quando utilizado no pré e pós-operatório, mostrando que, apenas uma parte dos indivíduos submetidos à cirurgia, apresentaram melhora no seu quadro, àqueles pacientes que iniciaram o tratamento no pré-operatório preveniram maiores sequelas, pois a hipertrofia dos MAP auxiliou no procedimento cirúrgico contribuindo para menores lesões após a retirada da próstata.…”

Preventing Erectile Dysfunction after Radical Prostatectomy: Nerve-Sparing Techniques, Penile Rehabilitation, and Novel Regenerative Therapies

“…With regard to prostatectomy, the timing is such physical therapy is also interesting to consider and there is no established consensus of whether pre-and postoperative physical therapy is superior to postoperative therapy alone. Perez et al examined the use of biofeedback preoperatively to strengthen the levator muscles prior to radical prostatectomy [135]. Their methods employed a device that provided visual feedback based on intra-anal pressures.…”