Preoperative pelvic floor muscle exercise for early continence after holmium laser enucleation of the prostate: a randomized controlled study
Preoperative pelvic floor muscle exercise for early continence after holmium laser enucleation of the prostate: a randomized controlled study
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DOI：
10.1186/s12894-019-0570-5
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发表时间：
2020-01-23
期刊：
影响因子：
2
通讯作者：
Sato, Makoto
中科院分区：
文献类型：
--
作者：
Anan, Go;Kaiho, Yasuhiro;Sato, Makoto
背景：暂时性术后尿失禁是钬激光前列腺剜除术（HoLEP）的一个令人烦恼的并发症。术前骨盆底肌肉锻炼（PFME）对HoLEP术后早期恢复的影响尚未阐明。本研究的目的是确定术前开始PFME对HoLEP术后早期恢复腰椎的益处。方法将患者随机分为两组：A组术前开始PFME，术后继续PFME; B组术后不开始PFME。主要结局是达到完全控尿的时间，定义为不使用尿垫。次要结局采用国际营养咨询简表（ICIQ-SF）评分进行测量。进行单变量和多变量分析，以确定与HoLEP后恢复相关的参数。结果70例患者随机分为A组（n = 35）和B组（n = 35）。A组和B组患者的特征无差异。术后3个月A组尿失禁发生率明显低于B组[3% vs. 26%（P = 0.01）]。然而，A组和B组在术后3天[40% vs. 54%（P = 0.34）]、1个月[37% vs. 51%（P = 0.34）]和6个月[0% vs. 3%（P = 1.00）]时无显著差异。术后任何时间点，A组和B组的术后ICIQ-SF评分均无显著差异。在单变量分析中，行术前PFME的患者在HoLEP后1个月的尿失禁风险降低0.56倍，在HoLEP后3个月的尿失禁风险降低0.08倍。结论术前开始PFME有助于改善HoLEP术后早期尿潴留。
Background Transient postoperative urinary incontinence is a bothersome complication of holmium laser enucleation of the prostate (HoLEP). The effects of preoperative pelvic floor muscle exercise (PFME) for early recovery of continence after HoLEP have never been elucidated. The aim of this study was to determine the benefit of preoperatively started PFME for early recovery of continence after HoLEP. Methods We randomly assigned patients to start PFME preoperatively and continue postoperatively (group A) or start PFME no earlier than the postoperative period (group B). The primary outcome was time to complete urinary control, defined as no pad usage. The secondary outcome was measured using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score. Univariate and multivariate analyses were performed to identify parameters associated with recovery of continence after HoLEP. Results Seventy patients were randomized across groups A (n = 35) and B (n = 35). Patients' characteristics were not different between groups A and B. The postoperative urinary incontinence rate significantly decreased in group A compared with that in group B at 3 months postoperatively [3% vs. 26% (P = 0.01)]. However, there were no significant differences between groups A and B at 3 days [40% vs. 54% (P = 0.34)], 1 month [37% vs. 51% (P = 0.34)], and 6 months [0% vs. 3% (P = 1.00)] postoperatively, respectively. The postoperative ICIQ-SF score was not significantly different between groups A and B at any time point postoperatively. In univariate analysis, patients who performed preoperative PFME had a 0.56-fold lower risk of urinary incontinence 1 month after HoLEP and a 0.08-fold lower risk of urinary incontinence 3 months after HoLEP. Conclusions Preoperatively started PFME appears to facilitate improvement of early urinary continence after HoLEP.