Physiotherapy Assessment and Management of Post- Prostatectomy Urinary Incontinence

Abstract

Aim: To determine the reliability of scoring real-time ultrasound (RTUS) record during an exercise protocol aimed at developing pelvic floor motor control in men with prostate cancer, and to determine predictors of acquiring control. Methods: 91 men diagnosed with prostate cancer attending physiotherapy for pelvic floor exercises. Detailed pelvic floor motor control exercises were taught by a physiotherapist to participants using trans-abdominal RTUS for biofeedback. A new protocol to measure skill attainment was developed. Three independent physiotherapists assessed skill attainment by viewing RTUS videos of the exercise. Reliability was evaluated using intraclass correlation coefficients. Logistic regression analysis was conducted to identify predictors of successful skill attainment. Acquisition of the skill was compared between pre and post-operative participants using an independent-groups t-test. Results: There was good reliability for scoring the outcome method (ICC 0.73 (95%CI 0.59 - 0.82)) for experienced therapists. Having low BMI and being seen pre- operatively predicted motor skill attainment, accounting for 46.3% of the variance. Significantly more patients trained pre-operatively acquired the skill of pelvic floor control compared with patients initially seen post-operatively (OR 11.87 95%CI 1.4 to 99.5 p = 0.02). Conclusions: A new protocol to evaluate attainment of pelvic floor control in men with prostate cancer can be scored reliably from RTUS record, and is most effective delivered pre-operatively. Future Studies: Based on the above research a proposed RCT has been developed comparing current standard pelvic floor training protocols with a motor control led training protocol. This protocol is followed by development into a progressive resistance program that utilises progressively incremental intra- abdominal pressures as a resistance tool. Further discussion is made to evaluate optimal pelvic floor rehabilitative strategies.