Gerlegiz Ege Nur Atabey, Akbayrak Türkan, Gürşen Ceren, Yazici Mustafa Sertaç, Bolat Naşide Mangir, Akdoğan Bülent, Nakip Gülbala, Özgül Serap
Faculty of Physical Therapy and Rehabilitation, Department of Fundamental Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
School of Medicine, Department of Urology, Hacettepe University, Ankara, Turkey.
Support Care Cancer. 2025 Jan 31;33(2):132. doi: 10.1007/s00520-025-09197-z.
The aim of this study is to investigate the additional effects of the Knack maneuver and comprehensive lifestyle recommendations to pelvic floor muscle training (PFMT) in individuals with post-prostatectomy urinary incontinence (PP-UI).
Seventy-one individuals with symptom of PP-UI were included. Individuals were randomly assigned to study groups (Group I: PFMT + Knack + Comprehensive Lifestyle Recommendations, Group II: PFMT + Knack, Group III: PFMT alone). Assessments were performed at the baseline and at the end of the 8th week. The primary outcome was the subjective severity and impact of UI. Secondary outcomes were objective severity of UI, health-related quality of life (QoL) and patient global impression of severity and improvement. Descriptive and outcome measures were compared between study groups using the Kruskal-Wallis test. The Games-Howell post hoc test was also used to indicate which groups differ.
A total of 66 patients were included in the final analysis. Per protocol analysis in all three groups showed significant improvements in all primary and secondary outcomes in eight weeks. The group of patients who had the PFMT + Knack + Comprehensive Lifestyle Recommendations had the greatest improvement in all outcome measures (p < 0.001). In addition, while PFMT + Knack showed superiority in terms of subjective UI severity and effect of UI on daily life, compared to PFMT alone (p < 0.001), there was no inter-group differences for objective UI severity and other subdomains of QoL (p > 0.05).
Adding comprehensive lifestyle recommendations and/or Knack maneuver to traditional PFMT is more effective in the management of post-prostatectomy UI in the short term. Further long-term follow-up studies should be planned to investigate compliance and response to these combined interventions.
ClinicalTrials.gov NCT04804839. Date of registration: 03/17/2021.
本研究旨在探讨对前列腺切除术后尿失禁（PP-UI）患者进行盆底肌训练（PFMT）时，Knack手法及综合生活方式建议的附加效果。
纳入71例有PP-UI症状的患者。将患者随机分配至各研究组（第一组：PFMT + Knack手法 + 综合生活方式建议；第二组：PFMT + Knack手法；第三组：单纯PFMT）。在基线期和第8周结束时进行评估。主要结局指标为尿失禁的主观严重程度及影响。次要结局指标为尿失禁的客观严重程度、健康相关生活质量（QoL）以及患者对严重程度和改善情况的总体印象。使用Kruskal-Wallis检验比较各研究组间的描述性指标和结局指标。还采用Games-Howell事后检验来表明哪些组存在差异。
最终分析共纳入66例患者。所有三组的符合方案分析均显示，8周内所有主要和次要结局指标均有显著改善。接受PFMT + Knack手法 + 综合生活方式建议的患者组在所有结局指标上改善最大（p < 0.001）。此外，与单纯PFMT相比，PFMT + Knack手法在主观尿失禁严重程度及尿失禁对日常生活的影响方面显示出优势（p < 0.001），但在尿失禁客观严重程度及QoL的其他子领域方面，组间无差异（p > 0.05）。
在传统PFMT基础上增加综合生活方式建议和/或Knack手法，在短期内对前列腺切除术后尿失禁的管理更有效。应计划进一步的长期随访研究，以调查对这些联合干预措施的依从性和反应情况。
ClinicalTrials.gov NCT04804839。注册日期：2021年3月17日。
