NEW YORK (Reuters Health) – Assessment of pelvic-floor strength before radical prostatectomy may allow for more accurate prediction of early return of continence after surgery, new research indicates.
Urinary incontinence is a common short-term complication of radical prostatectomy (RP). While continence is eventually achieved in most patients, predicting when patients will become continent is challenging. Prior studies aiming to predict return of continence after the surgery have not evaluated patient-specific parameters of pelvic-floor strength, the study team explains in a paper in Urology.
Dr. Peter Chang with Beth Israel Deaconess Medical Center in Boston and colleagues studied 144 men who underwent RP and underwent assessment of pelvic-floor strength by a trained physical therapist prior to surgery. As part of the assessment, the men were given a home exercise program to improve their pelvic-floor-muscle strength. All of the men completed three-month patient-reported quality of life evaluation.
Three months after RP, 90 of the men (62.5%) were continent (defined as using zero or one pad per day). On multivariate analysis, preoperative pelvic-floor endurance was significantly associated with being continent at three months (odds ratio, 2.71; 95% confidence interval, 1.23 to 6.17).
Nearly three-quarters of men (74%) with good pelvic-floor endurance were continent, compared with 50% of men with poor endurance.
Higher prostate volume was associated with slightly lower rates of continence at three months on multivariable analysis (OR, 0.98; 95% CI, 0.96 to 1.00; P=0.036).
“To our knowledge this is the first study to assess the link between objective preoperative measures of pelvic floor muscle strength and timing of continence after RP,” Dr. Chang and colleagues say.
“Our study suggests that preoperative assessment by a trained pelvic floor physical therapist (PFPT) with electromyography (EMG) pelvic floor muscle measurements can aid in patient counseling regarding timing of return of continence after RP,” they write.
“EMG pelvic floor muscle measurements are easily obtained during a preoperative physical therapy visit and can be used in conjunction with biofeedback for preoperative assessment. When counseling a patient prior to RP it is critical to discuss the known risks of incontinence and erectile dysfunction,” they say.
“Using PFPT assessment to augment education and improve the accuracy of preoperative counseling is likely to improve quality of life and decrease the potential for decision regret for a patient choosing among potential treatments for prostate cancer,” they conclude.
Current guidelines recommend offering PFPT to patients after RP to reduce time to regain continence.
SOURCE: https://bit.ly/33C1S9i Urology, online May 7, 2021.
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