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Urodynamic quantification of decrease in sphincter function after radical prostatectomy: relation to postoperative continence status and the effect of intensive pelvic floor muscle exercises.
Neurourol Urodyn. 2012 Jun; 31(5):646-51.NU

Abstract

AIMS

We analyzed the impact of radical retropubic prostatectomy (RRP) on the urethral sphincter function as assessed by urethral pressure profilometry (UPP) and its relation to post-radical prostatectomy continence status. Furthermore, we analyzed the effect of intensive pelvic floor muscle exercises (PFME) on the urethral sphincter function.

METHODS

Sixty-six patients were included in the study. UPP was performed before RRP and 26 weeks after catheter removal. All patients were instructed in PFME, however, the intensity of PFME varied between instructions based on an information folder only (F-PFME) and intensive guidance by a physiotherapist, in addition to the folder (PG-PFME).

RESULTS

In 66 patients, pre- as well as postoperative UPP was evaluable. After surgery, the functional profile length and the maximum urethral closure pressure (MUCP) showed a median decrease of 64% and 41%, respectively. For men who had regained continence after 6 months the median MUCP was significantly higher both before and after operation as compared to men who were still incontinent. In multivariate analysis, non-nerve sparing approach was a prognostic factors for a higher relative decrease of the MUCP after RRP. Comparing the PG-PFME group with the F-PFME group there were no significant differences in changes in UPP parameters.

CONCLUSIONS

A poor preoperative MUCP seems to be an important prognostic factor for persistent incontinence after RRP. Non-nerve sparing approach seems to be an important prognostic factor for impairment of the urethral sphincter function as measured by UPP. More intensive physiotherapy seems to have no additional effect on the postoperative urethral sphincter function as measured by UPP.

Authors+Show Affiliations

Department of Urology, St. Elisabeth Hospital, Tilburg, The Netherlands. y.dubbelman@elisabeth.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

22488800

Citation

Dubbelman, Yvette D., et al. "Urodynamic Quantification of Decrease in Sphincter Function After Radical Prostatectomy: Relation to Postoperative Continence Status and the Effect of Intensive Pelvic Floor Muscle Exercises." Neurourology and Urodynamics, vol. 31, no. 5, 2012, pp. 646-51.
Dubbelman YD, Groen J, Wildhagen MF, et al. Urodynamic quantification of decrease in sphincter function after radical prostatectomy: relation to postoperative continence status and the effect of intensive pelvic floor muscle exercises. Neurourol Urodyn. 2012;31(5):646-51.
Dubbelman, Y. D., Groen, J., Wildhagen, M. F., Rikken, B., & Bosch, J. L. (2012). Urodynamic quantification of decrease in sphincter function after radical prostatectomy: relation to postoperative continence status and the effect of intensive pelvic floor muscle exercises. Neurourology and Urodynamics, 31(5), 646-51. https://doi.org/10.1002/nau.21243
Dubbelman YD, et al. Urodynamic Quantification of Decrease in Sphincter Function After Radical Prostatectomy: Relation to Postoperative Continence Status and the Effect of Intensive Pelvic Floor Muscle Exercises. Neurourol Urodyn. 2012;31(5):646-51. PubMed PMID: 22488800.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urodynamic quantification of decrease in sphincter function after radical prostatectomy: relation to postoperative continence status and the effect of intensive pelvic floor muscle exercises. AU - Dubbelman,Yvette D, AU - Groen,Jan, AU - Wildhagen,Mark F, AU - Rikken,Berend, AU - Bosch,J L H Ruud, Y1 - 2012/04/06/ PY - 2011/08/24/received PY - 2011/11/02/accepted PY - 2012/4/11/entrez PY - 2012/4/11/pubmed PY - 2012/10/24/medline SP - 646 EP - 51 JF - Neurourology and urodynamics JO - Neurourol Urodyn VL - 31 IS - 5 N2 - AIMS: We analyzed the impact of radical retropubic prostatectomy (RRP) on the urethral sphincter function as assessed by urethral pressure profilometry (UPP) and its relation to post-radical prostatectomy continence status. Furthermore, we analyzed the effect of intensive pelvic floor muscle exercises (PFME) on the urethral sphincter function. METHODS: Sixty-six patients were included in the study. UPP was performed before RRP and 26 weeks after catheter removal. All patients were instructed in PFME, however, the intensity of PFME varied between instructions based on an information folder only (F-PFME) and intensive guidance by a physiotherapist, in addition to the folder (PG-PFME). RESULTS: In 66 patients, pre- as well as postoperative UPP was evaluable. After surgery, the functional profile length and the maximum urethral closure pressure (MUCP) showed a median decrease of 64% and 41%, respectively. For men who had regained continence after 6 months the median MUCP was significantly higher both before and after operation as compared to men who were still incontinent. In multivariate analysis, non-nerve sparing approach was a prognostic factors for a higher relative decrease of the MUCP after RRP. Comparing the PG-PFME group with the F-PFME group there were no significant differences in changes in UPP parameters. CONCLUSIONS: A poor preoperative MUCP seems to be an important prognostic factor for persistent incontinence after RRP. Non-nerve sparing approach seems to be an important prognostic factor for impairment of the urethral sphincter function as measured by UPP. More intensive physiotherapy seems to have no additional effect on the postoperative urethral sphincter function as measured by UPP. SN - 1520-6777 UR - https://www.unboundmedicine.com/medline/citation/22488800/Urodynamic_quantification_of_decrease_in_sphincter_function_after_radical_prostatectomy:_relation_to_postoperative_continence_status_and_the_effect_of_intensive_pelvic_floor_muscle_exercises_ L2 - https://doi.org/10.1002/nau.21243 DB - PRIME DP - Unbound Medicine ER -