Post-Op UI Therapy Sessions Not Better

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Four one-on-one sessions between men who have undergone prostate surgery and a therapist who provides pelvic-floor-muscle-exercise and bladder training do not improve urinary incontinence (UI) compared with self-teaching, a randomized study has revealed.

“You don't need to spend expensive resources upon a trained therapist. These resources can be used in some more useful way,” lead investigator Cathryn Glazener, MD, told colleagues.

Study results were reported here at the International Continence Society-International Urogynecological Association Joint Annual Meeting, where researchers won a prize for the best clinical abstract.

Dr. Glazener and her colleagues randomized 411 men who had undergone radical prostatectomy (RP) and another 442 who had received transurethral resection of the prostate (TURP) in the Men After Prostate Surgery (MAPS) trials. Ninety-eight percent of the men who had undergone RP and approximately 80% of the men who had undergone TURP had already received some information about pelvic-floor-muscle training from several sources including continence advisors, leaflets or books, physicians, friends or family, the Internet, or a physiotherapist.

The men who had post-operative UI were randomized to either four sessions with a trained therapist over four months or continuation of standard management. The therapist sessions involved pelvic-floor-muscle-exercise and bladder training. There was no difference in prevalence of UI prior to randomization according to either the route of operation or whether nerve-bundle-sparing had been done.

Ninety-two percent of the RP subjects in the intervention group had attended at least one therapy session. They were significantly more likely to be carrying out any pelvic-floor-muscle training at 12 months than those in the standard management (control) group (67% vs. 20%). However, the UI rates in the two groups did not differ significantly at 12 months (75.5% and 77.4%, respectively), according to Dr. Glazener, a professor in the Health Services Research Unit at the University of Aberdeen, Scotland. These results did not change when the investigators adjusted for age and pre-existing incontinence. The results also were not different for men who had received nerve-bundle sparing.

More than 85% of TURP patients in the intervention group had attended at least one therapist session. As with the RP patients, the TURP patients in the intervention and control arms showed no significant difference in UI rates at 12 months (65% and 62%, respectively).

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