Background
Urinary incontinence is common after radical prostatectomy and can also occur in some circumstances after transurethral resection of the prostate (TURP). Conservative management includes pelvic floor muscle training with or without biofeedback, electrical stimulation, extra-corporeal magnetic innervation (ExMI), compression devices (penile clamps), lifestyle changes, or a combination of methods.

Objectives
To determine the effectiveness of conservative management for urinary incontinence up to 12 months after transurethral, suprapubic, laparoscopic, radical retropubic or perineal prostatectomy, including any single conservative therapy or any combination of conservative therapies.

Search methods
We searched the Cochrane Incontinence Group Specialised Register (5 February 2014), CENTRAL (2014, Issue 1), EMBASE (January 2010 to Week 3 2014), CINAHL (January 1982 to 18 January 2014), ClinicalTrials.gov and World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (both searched 29 January 2014), and the reference lists of relevant articles.

Selection criteria
Randomised or quasi-randomised controlled trials evaluating conservative interventions for urinary continence in men after prostatectomy.

Data collection and analysis
Two or more review authors assessed the methodological quality of the trials and abstracted data. We tried to contact several authors of included studies to obtain extra information.

Main results
Fifty trials met the inclusion criteria, 45 in men after radical prostatectomy, four trials after TURP and one trial after either operation. The trials included 4717 men of whom 2736 had an active conservative intervention. There was considerable variation in the interventions, populations and outcome measures. Data were not available for many of the pre-stated outcomes. Men's symptoms improved over time irrespective of management.

There was no evidence from eight trials that pelvic floor muscle training with or without biofeedback was better than control for men who had urinary incontinence up to 12 months after radical prostatectomy; the quality of the evidence was judged to be moderate (for example 57% with urinary incontinence in the intervention group versus 62% in the control group, risk ratio (RR) for incontinence after 12 months 0.85, 95% confidence interval (CI) 0.60 to 1.22). One large multi-centre trial of one-to-one therapy showed no difference in any urinary or quality of life outcome measures and had narrow CIs. It seems unlikely that men benefit from one-to-one PFMT therapy after TURP. Individual small trials provided data to suggest that electrical stimulation, external magnetic innervation, or combinations of treatments might be beneficial but the evidence was limited. 

Amongst trials of conservative treatment for all men after radical prostatectomy, aimed at both treatment and prevention, there was moderate evidence of an overall benefit from pelvic floor muscle training versus control management in terms of reduction of urinary incontinence (for example 10% with urinary incontinence after one year in the intervention groups versus 32% in the control groups, RR for urinary incontinence 0.32, 95% CI 0.20 to 0.51). However, this finding was not supported by other data from pad tests. The findings should be treated with caution because the risk of bias assessment showed methodological limitations. 

Men in one trial were more satisfied with one type of external compression device, which had the lowest urine loss, compared to two others or no treatment. The effect of other conservative interventions such as lifestyle changes remained undetermined as no trials involving these interventions were identified.

Authors' conclusions
The value of the various approaches to conservative management of postprostatectomy incontinence after radical prostatectomy remains uncertain. The evidence is conflicting and therefore rigorous, adequately powered randomised controlled trials (RCTs) which abide by the principles and recommendations of the CONSORT statement are still needed to obtain a definitive answer. The trials should be robustly designed to answer specific well constructed research questions and include outcomes which are important from the patient's perspective in decision making and are also relevant to the healthcare professionals. Long-term incontinence may be managed by an external penile clamp, but there are safety problems.

/pdf/conservative-management-for-postprostatectomy-urinary-xc5p0yf9ye.pdf

Conservative management for postprostatectomy urinary incontinence

Perceptions and experiences after radical prostatectomy in Turkish men: a descriptive qualitative study.

Prostate cancer is one of the most prevalent malignancies diagnosed in North American men. Typically, men diagnosed with localized prostate cancer have two options for curative treatment: radiation therapy or radical prostatectomy (RP). Many men choose RP to remove the cancer; however, the intervention has two possible side effects that patients dread: erectile dysfunction and urinary incontinence (UI). At least 50% of men who undergo RP suffer from UI, which can lead to embarrassment, loss of a sense of control, depression, and decreased social interactions. The Human Response to Illness Model provides a framework to gain a comprehensive understanding of the physiologic, pathophysiologic, behavioral, and experiential perspectives as well as personal and environmental factors related to UI following RP. Knowledge gained from these perspectives will help nurses design strategies that facilitate coping and improve outcomes in men with UI following RP.

Understanding Urinary Incontinence After Radical Prostatectomy: A Nursing Framework

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Nursing: Research and Reviews 2014:4 77–89 Nursing: Research and Reviews Dovepress

pdf/the-role-of-the-clinical-nurse-specialist-in-caring-for-47tylcxxfw.pdf

The role of the clinical nurse specialist in caring for patients with prostate cancer: a narrative review

Urinary incontinence (UI) after a radical prostatectomy (RP) is a common but devastating condition that can have a significant negative impact on quality of life (QoL). This article reviews the current literature on pelvic floor muscle training (PFMT) for the management of UI following a RP. A comprehensive literature search was carried out that identified 14 randomized controlled trials (RCTs) and seven systematic reviews. It is difficult to draw definitive conclusions from the RCTs because of their heterogenous methodology, particularly the diverse regimes of pelvic floor exercises that were prescribed. At present, there appears to be weak to moderate evidence for the use of PFMT for UI after RP. Spontaneous recovery from symptoms undoubtedly occurs in the first year after surgery, irrespective of management; however, the current evidence demonstrates that recovery time can be shortened with specific interventions. It is essential that further good-quality RCTs are carried out, specifically trials including QoL outcome measures.

Pelvic floor muscle training for the management of urinary incontinence following radical prostatectomy

Introduction The impact of a urology oncology nurse specialist in the practice environment to assist with both pre and postoperative education needs of men undergoing genitourinary surgery for cancer was evaluated. Objective This study aimed to improve the preoperative process and teaching for men planning surgery for genitourinary cancers, including the delivery of pathology results. A secondary aim was to decrease the incidence of postoperative incontinence. Methods Male patients undergoing a radical prostatectomy were recruited. Patients who underwent surgery were evaluated both before and after the urology oncology nurse specialist role was established. Followup was via phone call interview and International Prostate Symptom Score questionnaire. Results Men who received the personalized education from the urology oncology nurse specialist had a higher return of continence postoperatively, as well as higher satisfaction scores with the outcome of their surgery, including higher quality of life scores. Conclusion The urology oncology nurse specialist role had a significant impact on the postoperative incontinence rate and provided a missing patient education piece that improved the overall patient satisfaction rate with oncology-related care.

Management of urinary incontinence following radical prostatectomy.

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Management of urinary incontinence following radical prostatectomy.