Pelvic floor muscle training before radical prostatectomy
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Transcript of Pelvic floor muscle training before radical prostatectomy
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Anaïs Bassas Parga
PHYSIOTHERAPY
BEFORE RADICAL PROSTATECTOMY
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Do you recommend PFMT before RP?
Benefits:- Less worries- Less anxiety- Starting exercises quickly- Hypertrophy and increase local blood
supply
Why not??
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Patient information. Basic issues
1. Information about pelvic floor:a. Where PF isb. PF functionc. Why patient must do PFMT
2. Oral & written information / instructions about exercises
3. To teach awareness of their muscle and how it worksTo locate and Feel the PF
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Patient information. Basic issues
4. The “Knack” technique
5. Practise of PFM contractions with or without BFB
6. Urethrocavernosus reflex or Post void milking mechanism.
Routine at home
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Not all the patients are referred to physiotherapy...
Connection
Doctor Patient Physiotherapist
Knowledge
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Communication
Urology visit: prostate CANCER diagnosis.
Patients feel shocked & disoriented. They forgot oral information. Urge to be treated
+ visit physiotherapist: written information, and images...
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Accessing physiotherapy
Barriers:
- where?- How much?- Perception “they might be lucky”- Embarrassment/Shame- No info about PFM - Focus on cancer
Hirschhorn et al. BJU Int 2014
Hirschhorn et al. BMC 2013
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Sounds reasonable, but….
Evidence?
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Hirschhorn et al. BJU Int 2014
Public hospital (n=32) & Private hospital (n=107) providers of PFMTICIQ-UI done to assess UI at 3 months after RP
ConclusionPrivate hospital provides preoperative PFMT more than public hospital.
Patients receiving preop PFMT had significantly better self-report UI at 3 months after RP that those who didn’t received it.(Mean ICIQ-UI 6.2 vs 9.2).
Additional strategies are needed to improve PFMT treatment among patients undergoing RP in the public system.
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Geraerts et al. Eur Urol 2013
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Collado et al. Abstract 28th EAU meeting 2013.
Methods 179 males- Treatment group (n=87):
3 weeks before RP: weekly assisted BFB session and hypopressive + daily home PFMT & written instructions
- Control group (n=92): Oral instructions on Kegel exercises after RP
Structured programme starts after 3 weeks after RP.
Degree of incontinence assessed with: 24 hours pad-test / ICIQ-UI SF
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Conclusions Intensive preoperatory PFMT considerably REDUCES DURATION AND SEVERITY of SUI after RP.
Collado et al. Abstract 28th EAU meeting 2013, contd.
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Patel et al. Int J Urol 2013
24h pad-test incontinence severity (>50g)
6w 3 months 6w 3 months
Treatment g 9g no sign diff 8/152 no sign diff
Control g 17g no sign diff 33/132 no sign diff
RESULTS
Preop physiotherapist-guided PFMT reduces time to continence by 28% (it reduces the duration and severity of early incontinence after RRP)
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SUMMARY
- Preop PFMT is better than: - Nothing.- Oral & written instructions
- Preop PFMT cannot ensure complete continence after surgery
- Preop PFMT reduces duration and severity of early SUI.
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SUMMARY
We recommend to teach PFM exercises before surgery because:
- patient is pain-free and with a normal sensation (anatomicly intact)
- have time to practise PFM exercises and become confident with the exercises
- Evidence: reduces severity and duration of SUI
- Better quality of life and better satisfaction with the treatment
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SUMMARY
We encourage all physiotherapists to:
- Promote their services to healthcare professionals and general public.- Do more studies. We need more evidence!
Bernad et al J Cancer Surviv 2015 (systematic review)There is some evidence that RT has detrimental impacts on both PFMs’ structure and function.
But we also need more studies in radiotherapy
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Thank you very much