Pre-operative training induces changes in the histomorphometry and muscle function of the pelvic floor in patients with indication of radical prostatectomy.
OBJECTIVE
To evaluate the efficacy of preoperative pelvic floor muscle training (PFMT) on histomorphometry, muscle function, urinary continence and quality of life of patients undergoing radical prostatectomy (RP).


METHODS
A prospective intervention clinical study was designed in 16 patients with indication of RP who were randomized into two groups. The Control Group received routine pre-surgical education (hygienic-dietary measures). The intervention group received a training session with supervised PFMT, three times a day, for four weeks, 30 days before the PR. Muscle function of the external urethral sphincter, contraction pressure of the levator ani, urinary continence and quality of life related to health (HRQoL) were evaluated before and after the intervention. At the end of the intervention and day of the surgery, samples of residual muscle tissue were obtained from the external sphincter muscle of the urethra for histomorphometric analysis.


RESULTS
After the intervention, those participants who carried out PFMT showed an increase in the cross-sectional area of the muscle fibers of the external urethral sphincter (1,313 ± 1,075 μm(2)vs. 1,056 ± 844 μm(2), P=.03) and higher pressure contraction of the levator ani (F=9.188; P=.010). After catheter removal, 62% of patients in the experimental group and 37% in the control group showed no incontinence. After removal of the catheter, 75% of the experimental group did not require any pad compared to 25% in the control group (p=NS). There were no significant differences between the two groups in any of the HRQoL domains studied.


CONCLUSIONS
Pre-surgical PFMT in patients with RP indication induces changes in the histology and function of the pelvic floor muscles, without changes in urogenital function and HRQoL. These results provide new evidence regarding the benefit of PFMT in preventing RP associated complications.
Servicio de Urología, Hospital Universitario del Valle, Santiago de Cali, Colombia; Programa de fortalecimiento de piso pélvico, Centro Médico Imbanaco, Santiago de Cali, Colombia.
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Ocampo-Trujillo
Servicio de Urología, Hospital Universitario del Valle, Santiago de Cali, Colombia.
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Carbonell-González
Servicio de Urología, Hospital Universitario del Valle, Santiago de Cali, Colombia; Instituto de Investigaciones, Centro Médico Imbanaco, Santiago de Cali, Colombia.
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Martínez-Blanco
Servicio de Urología, Hospital Universitario del Valle, Santiago de Cali, Colombia.
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Díaz-Hung
Facultad de Salud, Programa de Medicina, Universidad del Valle, Santiago de Cali, Colombia.
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Muñoz
Grupo GICAEDS, Universidad Santo Tomás, Facultad de Cultura Física, Deporte y Recreación, Bogotá, D.C., Colombia. Electronic address: robin640@hotmail.com.
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Ramírez-Vélez
D000368:Aged; D005081:Exercise Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017773:Pelvic Floor / Q000033:anatomy & histology / Q000502:physiology; D057234:Preoperative Period; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery*; D011788:Quality of Life; D016037:Single-Blind Method; D014549:Urinary Incontinence / Q000517:prevention & control
Entrenamiento de músculos del suelo pélvico; Incontinencia urinaria; Pelvic floor muscle training; Prostatectomía radical; Radical prostatectomy; Urinary incontinence