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Strategy for Incontinence From Prostate Cancer Surgery

Study Shows Benefits of Behavioral Therapy in Reducing Incontinence Episodes
By
WebMD Health News
Reviewed by Laura J. Martin, MD

Jan. 11, 2011 -- Pelvic-floor-muscle exercises along with other bladder control strategies, such as keeping a diary and monitoring your daily fluid intake, can help halve weekly incontinence episodes among men with prostate cancer who have had surgery to remove their prostate gland (radical prostatectomy), a study shows.

The new findings appear in the Jan. 12 issue of The Journal of the American Medical Association.

Incontinence is a known risk of prostate removal surgery, and as many as 65% of men will still have some degree of incontinence up to five years after the surgery. Other options to treat incontinence after radical prostatectomy include follow-up surgeries.

“Behavioral therapy should be offered to men with persistent post-prostatectomy incontinence because it can yield significant, durable improvements in incontinence and quality of life, even years after radical prostacatetomy,” conclude researchers who were led by Patricia Goode, MD, a professor in the division of gerontology, geriatrics, and palliative care at the University of Alabama, Birmingham.

Decrease in Incontinence Episodes

In the new study involving 208 men aged 51 to 84 with incontinence from one year up to 17 years after their prostate removal surgery, those who took part in an eight-week behavioral therapy showed a 55% decrease in weekly incontinence episodes (from 28 episodes to 13 episodes per week), compared to men who were placed in a delayed treatment comparison group.

The behavioral intervention consisted of four visits scheduled two weeks apart. Men received education on their pelvic floor anatomy and learned how to do the pelvic-floor-muscle exercises. Homework included three pelvic floor exercise sessions per day done lying down, sitting, and standing. Each session encompassed 15 reps of 2- to 10- second contraction and release exercises. Men were also advised to hold their urine stream during voiding once a day for two weeks, keep a bladder diary, avoid caffeine, and to distribute their fluid throughout the day.

Biofeedback and electrical stimulation did not seem to increase the effectiveness of the behavioral therapy, the study shows. Study participants who used biofeedback and electrical stimulation of their pelvic muscles to augment the behavioral interventions showed a 51% decrease in incontinence episodes per week, compared with men in the delayed treatment comparison group, the study shows.

By the end of the eight-week study, almost 16% of men in the behavioral therapy group were completely dry, as were 17.1% in the group that also added biofeedback and electrical stimulation along with behavioral therapy and 5.9% of men in the comparison group.

Ninety percent of men in the behavior therapy group and 91% of men in the behavior therapy with biofeedback and electrical stimulation group said their leakage was “better” or “much better” when compared with 10% of men in the comparison group, the study shows.

Overall, 47% of men in the treatment groups said they were satisfied with the level of improvement.

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