Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinence: a randomized, controlled trial.
OBJECTIVE
We tested the effectiveness of preoperative biofeedback assisted behavioral training for decreasing the duration and severity of incontinence, and improving quality of life in the 6 months following radical prostatectomy.


METHODS
We performed a prospective, randomized, controlled trial comparing preoperative behavioral training to usual care. The volunteer sample included 125 men 53 to 68 years old who elected radical prostatectomy for prostate cancer. Patients were stratified according to age and tumor differentiation, and randomized to 1 preoperative session of biofeedback assisted behavioral training plus daily home exercise or a usual care control condition, consisting of simple postoperative instructions to interrupt the urinary stream. The main outcome measurements were duration of incontinence (time to continence), as derived from bladder diaries, incontinence severity (the proportion with severe/continual leakage), pad use, Incontinence Impact Questionnaire, psychological distress (Hopkins Symptom Checklist) and health related quality of life (Medical Outcomes Study Short Form Health Survey).


RESULTS
Preoperative behavioral training significantly decreased time to continence (p = 0.03) and the proportion of patients with severe/continual leakage at the 6-month end point (5.9% vs 19.6%, p = 0.04). There were also significant differences between the groups for self-reported urine loss with coughing (22.0% vs 51.1%, p = 0.003), sneezing (26.0% vs 48.9%, p = 0.02) and getting up from lying down (14.0% vs 31.9%, p = 0.04). No differences were found on return to work and usual activities or quality of life measures.


CONCLUSIONS
Preoperative behavioral training can hasten the recovery of urine control and decrease the severity of incontinence following radical prostatectomy.
Burgio
Kathryn L
KL
Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Birmingham, Alabama, USA. kburgio@aging.uab.edu
Goode
Patricia S
PS
Urban
Donald A
DA
Umlauf
Mary G
MG
Locher
Julie L
JL
Bueschen
Anton
A
Redden
David T
DT
D000368:Aged; D001676:Biofeedback, Psychology; D006801:Humans; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects*; D014549:Urinary Incontinence / Q000209:etiology* / Q000517:prevention & control*