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Conservative management for postprostatectomy urinary incontinence

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  • Background Urinary incontinence is common after both radical prostatectomy and transurethral resection. Conservative management includes pelvic floor muscle training, biofeedback, electrical stimulation, compression devices (penile clamps), lifestyle changes, extra-corporeal magnetic innervation or a combination of methods. Objectives To assess the effects of conservative managements for urinary incontinence prostatectomy. Search strategy We searched the Cochrane Incontinence Group trials register (searched 2 July 2003), MEDLINE (January 1966 to January 2004), EMBASE (January 1988 to January 2004), CINAHL (January 1982 to January 2004), PsycLIT (January 1984 to January 2004), ERIC (January 1984 to January 2004), the reference lists of relevant articles, handsearched conference proceedings and contacted investigators to locate studies. Selection criteria Randomised controlled trials evaluating conservative interventions for urinary continence after prostatectomy. Data collection and analysis At least two reviewers assessed the methodological quality of trials and abstracted data. Main results Ten trials met the inclusion criteria, eight trials amongst men after radical prostatectomy, one trial after transurethral resection of prostate and one after either operation. There was considerable variation in the interventions, populations and outcome measures. The trials were of moderate quality and data were not available for many of the pre-stated outcomes. Confidence intervals were wide: it was not possible to reliably identify or rule out a useful effect. There was some support from five trials for pelvic floor muscle training with biofeedback being better than no treatment or sham treatment in the short term for men after radical prostatectomy: relative risk for incontinence with pelvic floor muscle training and biofeedback versus no treatment: 0.74 (95% confidence interval 0.60 to 0.93). Analysis of other conservative interventions such as pelvic floor muscle training alone, transcutaneous electrical nerve stimulation and rectal electrical stimulation, or combinations of these interventions were inconclusive. There were too few data to determine effects on incontinence after transurethral resection of the prostate. The findings should be treated with caution as there were few studies, all of moderate quality. Men in one trial reported a preference for one type of external compression device compared to two others or no treatment. The effect of other conservative interventions such as lifestyle changes remains undetermined as no trials involving these interventions were identified.Men’s symptoms tended to improve over time, irrespective of management. Authors’ conclusions The value of the various approaches to conservative management of postprostatectomy incontinence remains uncertain. There may be some benefit of offering pelvic floor muscle training with biofeedback early in the postoperative period immediately following removal of the catheter as it may promote an earlier return to continence. Long-term incontinence may be managed by external penile clamp, but there are safety problems. P L A I N L A N G U A G E S U M M A R Y Overall effectiveness of conservative management of postprostatectomy urinary incontinence remains unclear. The prostate is a male sex gland that surrounds the outlet of the bladder. Two main diseases of the prostate can be treated by surgery but some men suffer leakage of urine (urinary incontinence) afterwards. Conservative treatment such as pelvic floor muscle training, biofeedback and rectal electrical stimulation are thought to help men control this leakage. The review of trials found that pelvic floor muscle training and biofeedback might help soon after prostate removal (radical) surgery for cancer, but there was not enough information about the longer-term effects, nor the effect in men who had had surgery for benign (non cancerous) enlargement of the prostate (endoscopic resection). Of three external compression devices tested, one type seemed to be better than the others but needs to be used cautiously because of safety risks. More research of better quality is needed to assess conservative managements.

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    © 2004 The Cochrane Collaboration for John Wiley & Sons, Ltd. This version of this article is open access and can be downloaded and shared. The original author(s) and source must be cited.
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    • Hunter KF, Moore KN, Cody DJ, Glazener CMA. (2004). Conservative management for postprostatectomy urinary incontinence. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD001843. DOI: 10.1002/14651858.CD001843.pub2.