Conservative management for postprostatectomy urinary incontinence.
BACKGROUND
Urinary incontinence is common after both radical prostatectomy (RP) and transurethral resection of the prostate (TURP). Conservative management includes pelvic floor muscle training (PFMT) with or without biofeedback, electrical stimulation, compression devices (penile clamps), lifestyle changes, extra-corporeal magnetic innervation or a combination of methods.


OBJECTIVE
To assess the effects of conservative management for urinary incontinence after prostatectomy.


METHODS
We searched the Cochrane Incontinence Group Specialised Trials Register (searched 23 January 2006), MEDLINE (January 1966 to January 2006), EMBASE (January 1988 to January 2006), CINAHL (January 1982 to January 2006), PsycLIT (January 1984 to January 2006), ERIC (January 1984 to January 2006), the reference lists of relevant articles, handsearched conference proceedings and contacted investigators to locate studies.


METHODS
Randomised or quasi-randomised controlled trials evaluating conservative interventions for urinary continence after prostatectomy.


METHODS
At least two review authors assessed the methodological quality of trials and abstracted data.


RESULTS
Seventeen trials met the inclusion criteria, fifteen trials amongst men after radical prostatectomy (RP), one trial after transurethral resection of the prostate (TURP) and one trial after either operation. There was considerable variation in the interventions, populations and outcome measures. The majority of trials in this area continue to be of moderate quality, although more recent studies have been of higher quality in terms of both randomization and blinding. Data were not available in all the trials for many of the pre-stated outcomes. Confidence intervals have tended to be wide except for the more recent studies, and it continues to be difficult to reliably identify or rule out a useful effect. There were several important variations in the populations being studied. Therefore the decision was made by the review authors to separate in the analysis the men having the intervention as prevention (whether administered before or after operation, to all men having surgery) or as treatment (postoperatively to those men who did have urinary incontinence), as well as separating those treated with TURP or RP. Amongst seven treatment trials of postoperative PFMT for urinary incontinence after RP, one trial suggested benefits, whereas the estimates from the others were consistent with no effect. There was clinical and statistical heterogeneity, precluding meta-analysis. There was no clear reason for this heterogeneity. Trials of preventative PFMT started pre or post-operatively also showed heterogeneity: only one large trial favoured PFMT but the data from the others were conflicting. Analysis of other conservative interventions such as transcutaneous electrical nerve stimulation and anal electrical stimulation, or combinations of these interventions were inconclusive. There were too few data to determine treatment effects on incontinence after TURP. The findings should continue to be treated with caution, as most studies were of poor to moderate quality. With respect to other management, men in one trial reported a preference for one type of external compression device compared to two others or no treatment. The effect of other conservative interventions such as lifestyle changes remains undetermined as no trials involving these interventions were identified. Men's symptoms tended to improve over time, irrespective of management.


CONCLUSIONS
The value of the various approaches to conservative management of postprostatectomy incontinence remains uncertain. Long-term incontinence may be managed by external penile clamp, but there are safety problems.
Hunter
K F
KF
University of Alberta Faculty of Nursing, Edmonton, Alberta, Canada. Kathleen.Hunter@ualberta.ca
Glazener
C M A
CM
Moore
K N
KN
D001676:Biofeedback, Psychology; D005081:Exercise Therapy; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy*