Physical therapy after prostate surgery fails to reduce incontinence
MedWire News: Formal, one-on-one pelvic-floor training following prostate surgery does not reduce urinary incontinence, a study shows.
Given the failure of physical therapy to improve short- and medium-term continence rates and quality of life, the researchers say the formalized training program is not a cost-effective treatment option.
"The high rates of persisting incontinence after 12 months suggest a substantial unrecognized and unmet need for management in these men," write Cathryn Glazener (University of Aberdeen, UK) and colleagues in The Lancet.
Men undergoing radical prostatectomy or transurethral resection of the prostate (TURP) are advised to do pelvic-floor exercises following prostate surgery to reduce urinary incontinence.
With prostatectomy, the rate of incontinence at 12 months is 16%, whereas it is only about 1% at 12 months with TURP; however, resection is performed more frequently, so incontinence with the procedure is still a health burden.
To formally test the effectiveness of pelvic-floor exercises following surgery, Glazener and colleagues performed two trials of UK men who were severely incontinent 6 weeks after prostatectomy and TURP.
The men underwent four sessions with a physical therapist over 3 months, while controls received standard care and lifestyle advice only.
In the radical prostatectomy study, the rate of urinary incontinence at 12 months was 76% in 196 patients who received formalized physical therapy, a rate not significantly different from the 77% observed in 195 controls.
Among the TURP-treated patients, the rate of incontinence was 62% in the 203 patients who received physical therapy. Again, this rate was not significantly different from the 65% reported by the 194 control patients.
Although there were no adverse events reported, the one-to-one training did not improve quality of life.
In addition, the training also cost £ 181 (US$ 297, € 205) per patient among the radical prostatectomy patients and £ 209 (US$ 342, € 237) per TURP-treated patient.
As a result, the formal pelvic-floor muscle training did not result in an economically important difference in the quality-adjusted life years gained.
In settings where information about pelvic-floor exercises is available, including doctor's office pamphlets and the internet, the resources for one-to-one training "might be better used elsewhere," according to Glazener and colleagues.
More research is needed to identify the best management for the large numbers of men with persistent severe incontinence after radical prostatectomy, and those with persistent incontinence after TURP, they add.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
Lancet 2011; 378: 328–337