Trial Study of the Efficacy of Intensive Preoperative Pelvic Floor Muscle Training to Decrease Post-prostatectomy Urinary Incontinence
Trial Study of the Efficacy of Intensive Preoperative Pelvic Floor Muscle Training to Decrease Post-prostatectomy Urinary Incontinence
Urinary incontinence after radical prostatectomy is a significant clinical problem despite
 advances in surgical techniques. In the literature, the incidence of post prostatectomy
 urinary incontinence varies widely from 0.5 to 87% (Parekh et al, 2003). Various reasons are
 held responsible for this wide discrepancy, including surgical technique, definition of
 incontinence, time of evaluation, pathological stage, and patient age. The etiology of post
 prostatectomy urinary incontinence has been attributed to sphincteric deficiency, either from
 injury of striated muscle fibres or the innervating nerve fibres (Koelbl et al 2002). The
 effect of urinary incontinence on the quality of life in these patients has been subject to
 debate (Litwin et al, 1995; Braslis et al, 1995). For many patients, however, early recovery
 from urinary incontinence has been a major concern (Moore et al, 1999), especially in younger
 patients.

 Various treatment modalities for post prostatectomy urinary incontinence have been
 introduced, including conservative managemnt such as pelvic floor muscle training,
 pharmacological treatment and surgical treatment. However, surgery is an invasive procedure
 and it's usually be the last resort. Although the Cochrane Incontinence Group (2007)
 commented on the need for ongoing research to clarify the role of pelvic floor muscle
 training, it is still the first-line treatment used to restore pelvic floor or bladder
 function after radical prostatectomy (MacDonald et. al., 2007). Currently, patients learned
 pelvic floor muscle training on the day of admission for surgery by ward staff in HA
 hospitals of Hong Kong. Subsequently, after removal of urethral catheter, patients will
 attend the nurse-led clinic for reassessment and reinforcement of pelvic floor muscle
 training. The continence rates which defined as zero pad were 69%, 78.7% and 88.9% at 3
 months, 6 months and 12 months respectively (Tam and Ho et al., 2010). In order to determine
 the efficacy of intensive preoperative pelvic floor muscle training to decrease
 post-prostatectomy urinary incontinence, a randomized controlled trial will be conducted.
 Participants in the intervention group would start the pelvic floor muscle training 3 weeks
 before surgery provided by an urology nurse specialist whereas the control group would start
 the pelvic floor muscle training on the day of admission for surgery provided by ward staff.
 Measurement on the grams of urine loss, sense of self control in urination and quality of
 life are collected on 4, 8, 12 and 24 weeks after surgery for comparison between the two
 groups.
Prostate cancer is one of the most important health problems in men. According to the
 information from Centre of Health Promotion (CHP) in January 2010, prostate cancer recorded
 the largest increase in incidence rate among the common male cancers in Hong Kong during the
 past two decades. In 2007, prostate cancer was the fourth most common cancer in men and there
 were 1 205 newly diagnosed cases of prostate cancer. It accounted for 9.2% of all new cancer
 cases in males. It is the fifth leading cause of male cancer deaths in Hong Kong. In 2008, a
 total of 282 men died from this cancer, accounting for 3.8% of male cancer deaths.

 For patients with disease confined to the prostate, several treatment alternatives are now
 available. However, radical prostatectomy remains the standard for long-term cure (Guidelines
 of American Urological Association, 2010). The incidence of incontinence and erectile
 dysfunction is higher after operation than other therapies for localized prostate cancer
 (Alivizatos, et al, 2005). Based on the literature review, the post prostatectomy urinary
 incontinence (PPUI) rates were ranging from 0.5-87% (Parekh, et al, 2003) and potency rates
 ranging from 11-87% (Alivizatos, et al, 2005). Various reasons are held responsible for this
 wide discrepancy, including surgical technique, definition of incontinence, time of
 evaluation, pathological stage, and patient age (Pannek & Konig, 2005). However, the majority
 of the patients undergoing radical prostatectomy would vote for the operation again as they
 put tumour free on their first priority (Alivizatos, et al., 2005). The cause of urinary
 incontinence after radical prostatectomy is not completely understood, but leakage is thought
 to result primarily from sphincteric insufficiency, resulting from sphincteric injury or
 detrusor overactivity and effects on the bladder detrusor muscle (Leach, 1995). Men afflicted
 with urinary incontinence must contend with shame, embarrassment, depression, avoidance of
 social activities and altered life style (Braslis et al., 1995; Herr, 1994). So, early and
 appropriate management of urinary incontinence can improve one's quality of life and reduce
 the adverse consequences of urinary incontinence such as lowering of the physical health
 causing disability and dependence, affecting the psychological well-being and social
 functioning; as well as escalating health care costs (White & Getliffe, 2003; Wyman, 2003).

 Sueppel et al. (2001) found that pelvic floor muscle training (PFMT) taught pre operatively
 helped patients achieve continence quicker than if only taught post operatively. There was
 significant improvement in the intervention group objectively by weighting the pad in every
 visit (pad weight: 2.8 g in intervention group whereas 33.3 g in control group). Previously,
 Bales et al. (2000) recruited 100 men scheduled to undergo radical prostatectomy were
 randomized to receive PFMT with biofeedback 2-4 weeks before surgery by a nurse pre and post
 operatively or to a group only receive briefly verbal instruction on PFMT without
 biofeedback. Six months following surgery, the continence rates, as defined by the use of one
 pad or less per day were 96% (44 of 47) and 96% (48 of 50) in the biofeedback and control
 groups respectively. The authors concluded that pre operative formal PFMT and biofeedback
 training did not improve the outcome of PFMT on overall continence as measured by number of
 pads used or the rate of return of urinary control in men undergoing radical prostatectomy at
 6 months (p=0.596).

 Among all studies reviewed, the efficacy of pre operative PFMT in early regaining of urinary
 control after radical prostatectomy is still inconclusive. Thus, further studies on PFMT for
 PPUI are needed (Centemero & Rigatti, et al., 2010).
Inclusion Criteria:

 -  Chinese;

 -  Physically able to complete the pad test

 Exclusion Criteria:

 -  Prior bladder surgery;

 -  Prior urinary incontinence;

 -  Neurogenic dysfunction of the lower urinary tract;

 -  Pre-operative history of overactive bladder;

 -  Impaired mental status;

 -  Allergic to latex.