Featured Research

from universities, journals, and other organizations

Behavioral therapy program reduces incontinence following radical prostatectomy

Date:
January 11, 2011
Source:
JAMA and Archives Journals
Summary:
For men with incontinence for at least one year following radical prostatectomy, participation in a behavioral training program that included pelvic floor muscle training, bladder control strategies and fluid management, resulted in a significant reduction in the number of incontinence episodes, according to a new study. The researchers also found that the addition of biofeedback and pelvic floor electrical stimulation provided no additional benefit.

For men with incontinence for at least one year following radical prostatectomy, participation in a behavioral training program that included pelvic floor muscle training, bladder control strategies and fluid management, resulted in a significant reduction in the number of incontinence episodes, according to a study in the January 12 issue of JAMA. The researchers also found that the addition of biofeedback and pelvic floor electrical stimulation provided no additional benefit.

"Men in the United States have a 1 in 6 lifetime prevalence of prostate cancer. Although survival is excellent, urinary incontinence is a significant morbidity following radical prostatectomy, often the treatment of choice for localized prostate cancer. Patient surveys indicate that as many as 65 percent of men continue to experience incontinence up to 5 years after surgery. Loss of bladder control can be a physical, emotional, psychosocial, and economic burden for men who experience it," according the background information in the article. "Although behavioral therapy has been shown to improve postoperative recovery of continence, there have been no controlled trials of behavioral therapy for postprostatectomy incontinence persisting more than 1 year." Also, biofeedback, which assists patients to properly contract pelvic floor muscles, and pelvic floor electrical stimulation, which produces a maximal pelvic floor contraction and improves urethral closure pressure, are often used together in practice and are thought to enhance the effectiveness of behavioral therapy, but empirical evidence of a benefit is lacking.

Patricia S. Goode, M.S.N., M.D., of the University of Alabama at Birmingham, and colleagues conducted a study to evaluate the effectiveness of behavioral therapy for reducing persistent postprostatectomy incontinence and to determine whether the technologies of biofeedback and electrical stimulation enhance its effectiveness. The randomized controlled trial, which involved 208 community-dwelling men ages 51 through 84 years with incontinence persisting 1 to 17 years after radical prostatectomy, was conducted from 2003 -- 2008 and included a 1-year follow-up after active treatment. Twenty-four percent of the men were African American; 75 percent, white.

After stratification by type and frequency of incontinence, participants were randomized to 1 of 3 groups: 8 weeks of behavioral therapy (pelvic floor muscle training and bladder control strategies); behavioral therapy plus in-office, dual-channel electromyograph biofeedback and daily home pelvic floor electrical stimulation (behavior plus); or delayed treatment, which served as the control group. Participants completed 7-day bladder diaries.

The researchers found that at 8 weeks, those in the behavioral therapy group had an average reduction of incontinence episodes of 55 percent (from 28 to 13 episodes per week), which was a significantly greater percent reduction than that reported by the control group (average reduction of 24 percent; from 25 to 21 episodes per week). Those in the behavior-plus group experienced an average reduction of 51 percent (from 26 to 12 episodes per week), indicating that the addition of biofeedback and electrical stimulation did not improve 8-week results compared with behavioral therapy alone.

"Improvements were durable to 12 months in the active treatment groups: 50 percent reduction (13.5 episodes per week) in the behavioral group and 59 percent reduction (9.1 episodes per week) in the behavior plus group," the authors write.

At the end of the 8-week treatment period, 15.7 percent of men in the behavior therapy group, 17.1 percent in the behavior-plus group, and 5.9 percent in the control group achieved complete continence, reporting no incontinence episodes in their 7-day bladder diaries.

Behavioral therapy also improved the effects of incontinence on daily activities and condition-specific quality of life.

"Based on the significant decrease in incontinence frequency and the small number needed to treat (n=10) to achieve complete continence with behavioral therapy, these findings have important implications for urologists, primary care providers, and their patients," the researchers write. "Behavioral therapy should be offered to men with persistent postprostatectomy incontinence because it can yield significant, durable improvement in incontinence and quality of life, even years after radical prostatectomy."

Editorial: Treatment for Postprostatectomy Incontinence -- Is This as Good as It Gets?

David F. Penson, M.D., M.P.H., of Vanderbilt University and VA Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC), Nash­ville, Tenn., writes that questions remain regarding the optimal way to address postprostatectomy uri­nary incontinence.

"Is it behavioral therapy, which likely re­quires considerable patient and clinician time and effort to implement and is associated with limited benefit? Is it sur­gical implantation of an artificial urinary sphincter [a structure, or a circular muscle, that relaxes or tightens to open or close a passage or opening in the body] that works, but requires another surgical procedure? Or is it applica­tion of new technologies at the time of prostatectomy that purport to result in better patient-reported outcomes but still appear to be associated with a significant incidence of postprostatectomy urinary incontinence? Perhaps none of these is ideal. A better strategy would be primary preven­tion: increased utilization of active surveillance among pa­tients with lower-risk disease and selective application of aggressive interventions in patients with worse prognostic variables."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal Reference:

  1. P. S. Goode, K. L. Burgio, T. M. Johnson, O. J. Clay, D. L. Roth, A. D. Markland, J. H. Burkhardt, M. M. Issa, L. K. Lloyd. Behavioral Therapy With or Without Biofeedback and Pelvic Floor Electrical Stimulation for Persistent Postprostatectomy Incontinence: A Randomized Controlled Trial. JAMA: The Journal of the American Medical Association, 2011; 305 (2): 151 DOI: 10.1001/jama.2010.1972

Cite This Page:

JAMA and Archives Journals. "Behavioral therapy program reduces incontinence following radical prostatectomy." ScienceDaily. ScienceDaily, 11 January 2011. <www.sciencedaily.com/releases/2011/01/110111165004.htm>.
JAMA and Archives Journals. (2011, January 11). Behavioral therapy program reduces incontinence following radical prostatectomy. ScienceDaily. Retrieved April 24, 2014 from www.sciencedaily.com/releases/2011/01/110111165004.htm
JAMA and Archives Journals. "Behavioral therapy program reduces incontinence following radical prostatectomy." ScienceDaily. www.sciencedaily.com/releases/2011/01/110111165004.htm (accessed April 24, 2014).

Share This



More Health & Medicine News

Thursday, April 24, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Deadly Fungus Killing Bats, Spreading in US

Deadly Fungus Killing Bats, Spreading in US

AP (Apr. 24, 2014) — A disease that has killed more than six million cave-dwelling bats in the United States is on the move and wildlife biologists are worried. White Nose Syndrome, discovered in New York in 2006, has now spread to 25 states. (April 24) Video provided by AP
Powered by NewsLook.com
Companies Ramp Up Wellness to Lower Health Costs

Companies Ramp Up Wellness to Lower Health Costs

AP (Apr. 24, 2014) — That little voice telling you to exercise, get in shape and get healthy is probably coming from your boss. More companies are beefing up wellness programs to try and cut down their health care costs. (April 24) Video provided by AP
Powered by NewsLook.com
FDA Wants To Ban Sales Of E-Cigarettes To Minors

FDA Wants To Ban Sales Of E-Cigarettes To Minors

Newsy (Apr. 24, 2014) — The Food and Drug Administration wants to crack down on the use of e-cigarettes, banning the sale of the product to minors. Video provided by Newsy
Powered by NewsLook.com
Michigan Man Sees Thanks to 'bionic Eye'

Michigan Man Sees Thanks to 'bionic Eye'

AP (Apr. 23, 2014) — A legally blind Michigan man is 'seeing something new every day' thanks to a high-tech retinal implant procedure. He's one of the first in the country to receive a 'bionic eye' since the federal government approved the surgery. (April 23) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins