The Effect of Pelvic Floor Muscle Exercises After Radical Prostatectomy

Official title

The Effect of Pelvic Floor Muscle Exercises on Urinary Incontinence Management and Quality of Life in Patients Undergoing Radical Prostatectomy

Overview

Cancer, a major public health problem worldwide, was one of the leading causes of mortality in 2020, accounting for approximately 10 million deaths. With 1.41 million new cases reported in the same year, prostate cancer is the fourth most common cancer type globally (Ferlay et al., 2021). Prostate cancer is not only one of the most common types of cancer in men, but it also ranks second among cancer-related deaths in men worldwide (Rahnama'i et al., 2021). Radical prostatectomy (RP) is a treatment method that involves the surgical removal of the prostate gland and surrounding tissues, to stop the progression of the disease and improve the patient's quality of life (Göktas et al., 2015; Litwin and Tan, 2017). Following radical prostatectomy, a curative treatment method commonly used to prevent metastasis, mortality rates remain low; however, the procedure carries a relatively high risk of morbidity (Akarken et al., 2020; Evren and Taşcı, 2021). The most common complication encountered by patients after RP is urinary incontinence (Choiniere et al., 2022; Rahnama'i et al., 2021). Urinary incontinence (UI) arises due to factors such as damage to the internal sphincter, external rhabdosphincter, and supportive structures of the urethra during surgery, as well as the involvement of the neurovascular bundle and the development of postoperative fibrosis (Castellan et al., 2023). UI developing after radical prostatectomy significantly reduces patients' quality of life and negatively affects their social adaptation. Therefore, understanding the factors influencing the development of UI after radical prostatectomy is of great importance in determining appropriate treatment approaches and optimizing management (Bernardes et al., 2019; Storås et al., 2020). In the literature, the incidence rates of incontinence after radical prostatectomy range from 0.8% to 87%, and these differences are attributed to various factors such as surgical technique, patient characteristics, and evaluation methods (Boorjian et al., 2012; Hodges et al., 2019; Grise et al., 2017; Pastero et al., 2017). In the majority of patients, moderate to severe urinary incontinence is observed in the first few weeks after surgery. In some patients, this condition may persist for months or even years. Urinary incontinence can lead to various psychosocial effects such as shame, loss of self-esteem, impaired mental well-being, anxiety, relationship and sexual dysfunction, and social isolation (Kadono et al., 2016; Zachovajeviene et al., 2017). This condition has a significant impact on patients' physical, social, and emotional well-being, as well as their daily activities, and can contribute to social isolation by causing feelings of embarrassment (Castellan et al., 2023; Ouanes et al., 2022). Nurses play an important role in the management of urinary incontinence that develops after RP. Nurses can educate patients about urinary incontinence, teach conservative treatment methods such as pelvic floor muscle exercises (PFME), and provide psychological support to make the process more manageable (Milios et al., 2019; Tosunöz et al., 2018; Wang et al., 2018). PFME is an effective method that stands out in the rehabilitation of incontinence after RP, and it is one of the most common practices aimed at increasing the strength of the pelvic floor muscles to eliminate sphincter weakness (Castellan et al., 2023; Chitre and Kulkarni, 2023; Pratiwi et al., 2020). Studies on the effectiveness of PFME indicate that these exercises can improve patients' urinary control (Azal et al., 2022). Nurses play a significant role in promoting pelvic floor muscle health by providing information and implementing educational programs and practices to ensure that these exercises are taught and performed correctly (Jalalinia et al., 2020; Storås et al., 2020). This study aims to evaluate the effects of preoperative and postoperative nursing interventions on urinary incontinence management and quality of life in patients who have undergone RP. In this context, the effects of nursing interventions (education, pelvic floor muscle exercises, bladder training, etc.) on urinary incontinence severity, quality of life, and patient satisfaction will be examined comparatively. The study aims to identify the most effective nursing interventions in the management of urinary incontinence after RP and to integrate these interventions into clinical practice.

Interventions

• Behavioral Pelvic Floor Muscle Exercises.
  A structured pelvic floor muscle training (PFME) program provided by a nurse, based on EAU and AUA guidelines, consisting of 20-minute sessions delivered 3 times a week

Primary outcome measures

• Change in Urinary Incontinence Severity Assessed by ICIQ-SF [Time frame: Baseline (preoperative), 7 days after catheter removal, 1 month, and 3 months postoperatively]

Secondary outcome measures (1)

• Change in Quality of Life Assessed by King's Health Questionnaire (KHQ) [Time frame: Baseline (preoperative), 7 days after catheter removal, 1 month, and 3 months postoperatively]

Eligibility criteria

Inclusion criteria

• Being 40 years of age or older Not having urinary incontinence before surgery Having undergone Radical Prostatectomy surgery due to prostate cancer Patients who did not have urinary incontinence before surgery

Exclusion criteria

• Patients with congenital anomalies of the urinary system, serious organ dysfunctions (liver or kidney failure, advanced heart failure, coagulopathy), neuropsychiatric disorders, presence of active infection, and history of major abdominal or pelvic surgery will not be included in the study.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Triple blind

Primary purpose

Supportive care

Study locations

Turkey (Türkiye) · 1 center

• Konya City Hospital, Urology Clinic — Konya

Identifiers

NCT: NCT07045415 · E-41901325-200-109794

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗