Baumann Freerk T, Reimer Nadine, Gockeln Theresa, Reike Alexandra, Hallek Michael, Ricci Christian, Zopf Eva M, Schmid Daniela, Taaffe Dennis, Newton Robert U, Galvao Daniel A, Leitzmann Michael
Department I of Internal Medicine, University of Cologne, Cologne, Germany.
Centre of Excellence for Nutrition, Nutritional Epidemiology and Biostatistics, North West University South Africa, Potchefstroom, South Africa.
Disabil Rehabil. 2022 Sep;44(19):5374-5385. doi: 10.1080/09638288.2021.1937717. Epub 2021 Sep 22.
Urinary incontinence is one of the most clinically relevant side effects in the treatment of prostate cancer patients. The aim of this systematic review and meta-analysis was to analyze the specific exercise effects of supervised versus unsupervised pelvic floor muscle exercise (PFME) and exercise volume on urinary incontinence status after radical prostatectomy.
A systematic data search was performed for studies published from January 2000 to December 2020 using the following databases: PubMed, Embase, SciSearch, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews and Effects. The review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A random-effects meta-analysis of urinary incontinence remission was performed. The relation between time since surgery and urinary incontinence remission was analyzed using a non-linear dose-response meta-analysis.
The meta-analysis included 20 randomized controlled trials involving 2188 men ( = 1105 in intervention groups; = 1083 in control groups). PFME versus no PFME had a beneficial effect on urinary incontinence remission at 3 months, 3-6 months, and more than 6 months post-surgery, with risk differences ranging from 12 to 25%. These effects were particularly evident for higher volume, supervised PFME in the first 6 months post-surgery. Additional biofeedback therapy appeared to be beneficial but only during the first 3 months post-surgery.
There is good evidence that the supervised PFME causes a decrease in short-term urinary incontinence rates. Unsupervised PFME has similar effects as no PFME in postoperative urinary incontinence. PFME programs should be implemented as an early rehabilitative measure to improve postoperative short-term urinary incontinence in patients with prostate cancer.IMPLICATIONS FOR REHABILITATIONProstate cancer, surgery, and urinary incontinenceThe surgical treatment of prostate cancer often leads to urinary incontinence.Pelvic floor training leads to a significant improvement of this situation.Exercise therapy support is very important in this context and is even more effective than unsupported training.
尿失禁是前列腺癌患者治疗中最具临床相关性的副作用之一。本系统评价和荟萃分析的目的是分析有监督与无监督盆底肌肉锻炼（PFME）以及锻炼量对根治性前列腺切除术后尿失禁状况的具体锻炼效果。
使用以下数据库对2000年1月至2020年12月发表的研究进行系统数据检索：PubMed、Embase、SciSearch、Cochrane对照试验中央注册库、Cochrane系统评价数据库以及综述与效应摘要数据库。本综述按照系统评价和荟萃分析的首选报告项目（PRISMA）声明进行。对尿失禁缓解情况进行随机效应荟萃分析。采用非线性剂量反应荟萃分析来分析术后时间与尿失禁缓解之间的关系。
荟萃分析纳入了20项随机对照试验，涉及2188名男性（干预组=1105名；对照组=1083名）。PFME与不进行PFME相比，在术后3个月、3至6个月以及6个月以上对尿失禁缓解有有益效果，风险差异在12%至25%之间。这些效果在术后前6个月进行更高强度、有监督的PFME时尤为明显。额外的生物反馈疗法似乎有益，但仅在术后前3个月。
有充分证据表明，有监督的PFME可降低短期尿失禁发生率。无监督的PFME在术后尿失禁方面与不进行PFME有相似效果。PFME方案应作为一种早期康复措施来实施，以改善前列腺癌患者术后短期尿失禁情况。
康复启示
前列腺癌、手术与尿失禁
前列腺癌的手术治疗常导致尿失禁。
盆底训练可显著改善这种情况。
在这种情况下，运动疗法支持非常重要，甚至比无支持训练更有效。
