[Description and results of a prospective study on a new physiotherapy method in the management of postprostatectomy urinary incontinence].
OBJECTIVE
Prospective evaluation of the short-, medium- and long-term efficacy of the "ABDO-MG concept" technique in the rehabilitation of urinary incontinence following radical prostatectomy (abdominal or laparoscopic approach).


METHODS
Fifty-three patients suffering from clinical urinary stress or triple incontinence (pure stress incontinence, incontinence due to bladder instability or sphincteric insufficiency) took part in the study. Rehabilitation treatment, begun six weeks before the operation, continued during the immediate postoperative period, at home and at the physiotherapist's office for three to 12 months until the urinary incontinence had disappeared or was considered to be minimal and acceptable, therefore tolerated. The exercises were performed according to a strict protocol defined by the inventor of the concept, involving expiration into a specific end-piece (called "sound end-piece") and connection with an abdominal neurostimulator for which the current is triggered and maintained by the sound of the patient's breathing into the sound end-piece. The efficacy of this concept was confirmed by a comparative trial before and during rehabilitation and then at the end of treatment. There was triple monitoring: evaluation by LFT noting, for each breath, the flowrate/volume curve and FEV1/s, clinical abdominal testing with monitoring of abdominal movement both vertically and horizontally during coughing and a "pad test" at home, assessing the quantity of nocturnal and diurnal urinary leakage relative to each patient's activity.


RESULTS
The results were meaningful and significant. The improvement of the flowrate/volume curve and FEV1/s varied between 1.4436 and 1.1209 L. Abdominal testing showed constant positive evolution in the correction of abdominal incompetence under stress (test improved by one point on a negative graduation of -1 to -3). The home "pad test" confirmed a highly significant result with leakage virtually disappearing, sometimes falling from nearly 800 cc to just a few drops at the end of treatment. The subjective results were marked by the improvement in various dysfunctions within the context of abdominal incompetence increased by the abdominal surgery.


CONCLUSIONS
This prospective study was the first to provide an evaluation of the abdominal motor score and the relationship between expiration thrust and pelviperitoneal protection.
Cheminal
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Service d'urologie, clinique Sainte-Marie, 4, allée de Saint-Jean-des-Vignes, 71100 Chalon-sur-Saône, France. guillarme.luc@neuf.fr
Hotton
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C
Delorme
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E
Trackoen
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G
Pasquale
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J
Mege
J-L
JL
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects*; D014549:Urinary Incontinence / Q000209:etiology / Q000534:rehabilitation*