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Training limits incontinence following radical prostatectomy.

SEATTLE -- Behavioral training is an excellent method for helping men with urinary incontinence after radical prostatectomy, Dr. Patricia S. Goode said at the annual meeting of the American Geriatrics Society.

Research suggests that simple training to help the men learn to control their pelvic floor muscles--which can be taught briefly--can reduce stress incontinence by 78%, Dr. Goode said.

"There are urology practices themselves that have developed wonderful expertise at behavioral training," said Dr. Goode, medical director of the continence program at the University of Alabama, Birmingham. "Referral doesn't necessarily have to be to a continence center."

Large surveys show that 1 year after prostatectomy, 65%-90% of men have either stress or urge urinary incontinence, she said. Remedies for the problem generally have been surgical, and some practitioners have begun trying collagen injections more recently, with fair results.

But, behavior training produces good results, Dr. Goode said. And, she and her colleagues have shown it works both when it is given before prostatectomy, and after in patients with the problem.

In a recent published study, she and her group randomly assigned 125 men aged 53-68 years before prostatectomy to a single training session with biofeedback to allow them to learn to contract their pelvic floor muscles at will, or to a usual care control group.

After surgery, it took the men who received training a median of 3.5 months to stop leaking, versus 6 months in the control group. At 6 months, only 32% of the trained men were wearing pads, versus 52% of the control group. And, they calculated that the number of individuals who needed to be treated to stop one man from having to wear a pad was five.

In a study of 20 men aged 55-87 years who had been incontinent after prostatectomy for a mean of 2.5 years, Dr. Goode found that four sessions of training reduced incontinence accidents by 78%, and three of the subjects had no accidents after training. "That's not bad for something that is not surgery," she said.

In describing the training, Dr. Goode said that they use biofeedback to teach the men to contract their pelvic floor muscles, but one can also do it during a digital rectal exam, since one can feel when there is proper contraction.

Then the patients are sent home and told to do exercises at home, three times daily, contracting and then relaxing 15 times in a row. At first, she has them contract for 3 seconds and then relax for the same amount of time in each repetition, adding a few seconds a week until they get to hold the contractions for 10-15 seconds.

She tells patients to incorporate the exercises into their daily activities and routine, such as using certain television commercials as a cue. "Before they brush their teeth at night is another good time" to do the exercises, she said.

Patients also are told to contract the muscles before they sneeze or cough or are about to lift something or exert themselves. "The most important thing is to use the muscles when you need them," Dr. Goode said.

Patients who have urge incontinence also are taught to stop when they feel the urge, instead of rushing to the bathroom. They then are instructed to squeeze their pelvic floor until the urge eases. Then, they can walk calmly to the bathroom, stopping again if necessary.

Dr. Goode said she also recommends that men avoid caffeine. In women, caffeine avoidance often helps ease stress and urge incontinence, and one study suggests it helps men as well. "I tell my patients that they should at least try to eliminate caffeine to see if that makes a difference," she said.

BY TIMOTHY F. KIRN

Sacramento Bureau
Men Wearing Pads for Incontinence 6 Months After Prostatectomy

Pelvic floor training group 32%
Control group 52%

Note: Based on a study of 125 men aged 53-68 years.
Source: Dr. Goode
ELSEVIER GLOBAL MEDICAL NEWS

Note: Table made from bar graph.
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Title Annotation:Urology
Author:Kirn, Timothy F.
Publication:Internal Medicine News
Geographic Code:1USA
Date:Jul 15, 2007
Words:664
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