Effects of Patient Centered Interventions on Persistent Urinary Incontinence after Prostate Cancer Treatment: A Randomized, Controlled Trial

• Published in: The Journal of urology Vol. 194; no. 6; pp. 1675 - 1681
• Main Authors: Zhang, Amy Y, Bodner, Donald R, Fu, Alex Z, Gunzler, Douglas D, Klein, Eric, Kresevic, Denise, Moore, Shirley, Ponsky, Lee, Purdum, Michael, Strauss, Gerald, Zhu, Hui
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2015
• Subjects: Aged; Biofeedback, Psychology; Combined Modality Therapy; exercise; Exercise Therapy; Humans; Longitudinal Studies; Male; Middle Aged; Patient-Centered Care; pelvic floor; Pelvic Floor Disorders - therapy; Problem Solving; prostatic neoplasms; Prostatic Neoplasms - therapy; Psychotherapy; Quality of Life; Referral and Consultation; Self Care; Self-Help Groups; Telephone; urinary incontinence; Urinary Incontinence - therapy; Urology; biofeedback; BF; body mass index; problem solving therapy; exercise; VAS; PFME; pelvic floor; visual analog scale; urinary incontinence; UC; QOL; PST; usual care without intervention; I-PSS; prostatic neoplasms; quality of life; pelvic floor muscle exercise; BMI; International Prostate Symptom Score
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1016/j.juro.2015.07.090

Purpose We examined whether an intervention combining pelvic floor muscle exercise and symptom self-management would improve urinary continence and quality of life in patients with prostate cancer. Materials and Methods In a randomized, controlled, longitudinal clinical trial 279 patients with prostate cancer with persistent urinary incontinence were randomized to 1 of 3 groups, including biofeedback pelvic floor muscle exercise plus a support group, the biofeedback exercise plus telephone contact and usual care without intervention. The biofeedback plus support and plus telephone groups received 1 session of biofeedback assisted exercise and 6 biweekly sessions of problem solving therapy. This delivered symptom management skills through a peer support group or telephone contacts for 3 months. All subjects were assessed in blinded fashion at baseline, and 3 and 6 months for urinary leakage frequency, leakage amount and disease specific quality of life. Results A total of 244 subjects completed the study. The biofeedback plus support and biofeedback plus telephone groups had a lower frequency of daily urinary leakage than the group with usual care without intervention at 3 months (p = 0.019 and p ≤0.001, respectively) but not at 6 months. The biofeedback plus support group but not the biofeedback plus telephone group had 13.3 gm lower leakage at 6 months than the usual care group (p = 0.003). Overall the biofeedback plus support and plus telephone groups reported less symptom severity (p ≤0.001) and fewer incontinence problems (p ≤ 0.01) than the usual care group at 6 months. Conclusions Study findings show that pelvic floor muscle exercise practice plus symptom self-management in a peer support setting can significantly improve urinary continence and quality of life in patients with prostate cancer.