Zellner M
Urologische Abteilung, Johannesbad-Fachklinik, Johannesstraße 2, 94072 Bad Füssing, Deutschland.
Urologe A. 2011 Apr;50(4):433-44. doi: 10.1007/s00120-010-2478-2.
In spite of improvements in nerve-sparing operation techniques in radical prostatectomies, a disturbance of (early) continence is subjectively perceived by a number of patients as burdensome, which can last for several months. Skilled physiotherapy is appreciated as causal therapy in the hands of the qualified therapist. In an open randomised controlled trial the efficacy of a standardised rehabilitation therapy with pelvic floor re-education instructed by a physiotherapist (n=25) as the control group in comparison to a group with additional combined electrostimulation and biofeedback device (Myo 420™; n=25) or whole body vibration therapy (FitVibe medical™; n=25). Pre- and post-therapeutic evaluation of the International Prostate Symptom Score (IPSS), the enclosed question about quality of life (IPSS-QL), pad test, pelvic floor strength, maximum uroflow, micturition volume, serum testosterone and blood glucose was done. Within the treatment duration of 3-4 weeks in all treatment groups a statistically significant improvement of IPSS and IPSS-QL was seen. Due to whole body vibration the reduction of urine loss (pad test), increase of voided volume and maximum uroflow were statistically significant. Whereas for isolated physiotherapy during the short therapy duration merely a trend for the improvement of pelvic floor muscle strength was seen, the difference was significant in the Myo 420 and the whole body vibration groups, respectively. It was shown that a continuous improvement in continence depends on the consistent continuation of the training also under domestic conditions. The controlled trial conditions also confirm the efficacy, acceptance and tolerance of a standardised pelvic floor re-education under the conditions of urological inpatient rehabilitation treatment. By additional use of a combined electro- and multichannel biofeedback device or a whole body vibration device, the treatment results could be further improved. Due to the different causal therapeutic approaches and effects, a further therapy optimisation by combination of all three components should be evaluated in an additional controlled trial.
尽管根治性前列腺切除术中保留神经的手术技术有所改进，但仍有许多患者主观上感觉到（早期）控尿障碍带来的负担，这种情况可能持续数月。熟练的物理治疗被认为是合格治疗师手中的因果疗法。在一项开放性随机对照试验中，将由物理治疗师指导进行盆底再教育的标准化康复治疗（n = 25）作为对照组，与使用额外的联合电刺激和生物反馈设备（Myo 420™；n = 25）或全身振动疗法（FitVibe medical™；n = 25）的组进行比较。对国际前列腺症状评分（IPSS）、附带的生活质量问题（IPSS-QL）、尿垫试验、盆底肌力、最大尿流率、排尿量、血清睾酮和血糖进行治疗前和治疗后的评估。在所有治疗组3至4周的治疗期间，IPSS和IPSS-QL均有统计学上的显著改善。由于全身振动，尿失禁（尿垫试验）的减少、排尿量和最大尿流率的增加具有统计学意义。而在短疗程的单纯物理治疗中，仅观察到盆底肌肉力量改善的趋势，在Myo 420组和全身振动组中差异分别具有显著性。结果表明，控尿的持续改善取决于在家庭条件下也持续进行训练。对照试验条件也证实了在泌尿外科住院康复治疗条件下标准化盆底再教育的有效性、可接受性和耐受性。通过额外使用联合电刺激和多通道生物反馈设备或全身振动设备，治疗结果可以进一步改善。由于不同的因果治疗方法和效果，应在另一项对照试验中评估将所有三种成分组合进行进一步治疗优化的效果。
