Perez Fabiana S B, Rosa Nathalia C, da Rocha Adson F, Peixoto Luciana R T, Miosso Cristiano J
Medical Sciences Graduate Program, University of Brasilia, Brasilia, Brazil.
Department of Physiotherapy, Alfredo Nasser College, Aparecida de Goiania, Brazil.
Front Oncol. 2018 Feb 26;8:20. doi: 10.3389/fonc.2018.00020. eCollection 2018.
In this study, we present a biofeedback method for the strengthening of perineal muscles during the preoperative procedures for radical prostatectomy, and we evaluate this technique as a prevention measure against complications such as urinary incontinence (UI) and erectile dysfunction (ED), which affect prostatectomy patients after surgery. In the experimental protocol, the patients performed specific exercises with the help of a device that provided the patient with visual biofeedback, based on a plot of the anal pressure. For the experimental protocol, we selected 20 male patients, with an average age of 64.0 years, and submitted them to ten therapeutic sessions each. A control group consisting of 32 men with an average age of 66.3 years, who were treated with the same surgical procedure but not with the preoperative procedures, also took part in the experiment. To evaluate UI and ED after the surgery in both control and experimental groups, we used two validated questionnaires-to assess UI, we used the King's Health Questionnaire (KHQ) and, for ED, we used the International Index of Erectile Function (IIEF-5) Questionnaire. We compared the variables associated with UI and ED after the surgery for the control and experimental groups. The occurrence of UI after radical prostatectomy in the control group (100% of the patients) was higher than that for the experimental group (5% of the patients), with < 0.0001. Likewise, the occurrence of erectile dysfunction after prostatectomy in the control group (48.6% of the patients) was higher than that for the experimental group (5% of the patients), with < 0.0001. The number of nocturia events also decreased as a consequence of the intervention ( < 0.0001), as did the number of disposable underwear units for urinary incontinence ( < 0.0001). Furthermore, we compared, only for the experimental group, the anal pressure before the biofeedback intervention and after the surgery, and we verified that the anal pressure after surgery was significantly higher ( < 0.0001). The results strongly suggest that the preoperative biofeedback procedure was effective in decreasing urinary incontinence and erectile dysfunction after radical prostatectomy. As future work, we intend to extend this analysis for larger samples and considering a broader age range.
在本研究中，我们提出了一种在根治性前列腺切除术术前程序中加强会阴肌肉的生物反馈方法，并将该技术评估为一种预防措施，以应对诸如尿失禁（UI）和勃起功能障碍（ED）等影响前列腺切除术后患者的并发症。在实验方案中，患者借助一种基于肛门压力图为患者提供视觉生物反馈的设备进行特定锻炼。对于实验方案，我们选择了20名男性患者，平均年龄为64.0岁，每位患者接受十次治疗疗程。一个由32名平均年龄为66.3岁的男性组成的对照组也参与了实验，他们接受了相同的手术程序，但未进行术前程序。为了评估对照组和实验组术后的UI和ED情况，我们使用了两份经过验证的问卷——为评估UI，我们使用了国王健康问卷（KHQ），为评估ED，我们使用了国际勃起功能指数（IIEF - 5）问卷。我们比较了对照组和实验组术后与UI和ED相关的变量。对照组根治性前列腺切除术后尿失禁的发生率（100%的患者）高于实验组（5%的患者），P < 0.0001。同样，对照组前列腺切除术后勃起功能障碍的发生率（48.6%的患者）高于实验组（5%的患者），P < 0.0001。夜尿事件的数量也因干预而减少（P < 0.0001），尿失禁一次性内裤的使用数量也减少了（P < 0.0001）。此外，我们仅对实验组比较了生物反馈干预前和术后的肛门压力，并且我们证实术后肛门压力显著更高（P < 0.0001）。结果强烈表明，术前生物反馈程序在降低根治性前列腺切除术后的尿失禁和勃起功能障碍方面有效。作为未来的工作，我们打算对更大样本并考虑更广泛年龄范围进行扩展分析。
