Physiotherapy Assessment and Management of Post- Prostatectomy Urinary Incontinence

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

Reconsideration of pelvic floor muscle training to prevent and treat incontinence after radical prostatectomy

Urinary incontinence is common after radical prostatectomy. Pelvic floor muscle training provides a plausible solution. Although early trials provided promising results, systematic reviews have questioned the efficacy of this intervention. A major consideration is that most clinical trials in men have applied principles developed for pelvic floor muscle training for stress urinary incontinence in women, despite differences in anatomy between sexes and differences in the mechanisms for continence/incontinence. Literature regarding continence control in men has been conflicting and often based on erroneous anatomy. New understanding of continence mechanisms in men, including the complex contribution of multiple layers of striated pelvic floor muscles, and detailed consideration of the impact of radical prostatectomy on continence anatomy and physiology, have provided foundations for a new approach to pelvic floor muscle training to prevent and treat incontinence after prostatectomy. An approach to training can be designed to target the pathophysiology of incontinence. This approach relies on principles of motor learning and exercise physiology, in a manner that is tailored to the individual patient. The aims of this review are to consider new understanding of continence control in men, the mechanisms for incontinence after radical prostatectomy, and to review the characteristics of a pelvic floor muscle training program designed to specifically target recovery of continence after prostatectomy

Ultrasound-based motor control training for the pelvic floor pre- and post-prostatectomy: Scoring reliability and skill acquisition

Aim: This study documents a protocol designed to evaluate pelvic floor motor control in men with prostate cancer. It also aims to evaluate the reliability of therapists in rating motor control of pelvic floor muscles (PFMs) using real time ultrasound imaging (RUSI) video clips. We further determine predictors of acquiring motor control. Methods: Ninety-one men diagnosed with prostate cancer attending a physiotherapy clinic for pelvic floor exercises were taught detailed pelvic floor motor control exercises by a physiotherapist using trans-abdominal RUSI for biofeedback. A new protocol to rate motor control skill acquisition was developed. Three independent physiotherapists assessed motor control skill attainment by viewing RUSI videos of the contractions. Inter-rater reliability was evaluated using intra-class 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-group t-test. Results: There was good reliability for rating the RUSI video clips (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 assessed reliably from RUSI images, and is most effectively delivered pre-operatively.</p