Feasibility Testing of Transpelvic Magnetic Stimulation as a Novel Intervention toImprove Urogenital Function in Prostate Cancer Survivors

该SPIRE项目的总体目的是评估一种新干预措施的可行性和可接受性 为未来的泌尿生殖系统康复随机临床试验收集初步数据 前列腺癌幸存者的功能。前列腺癌在50岁以上的男性中最常见，这种癌症 VA患者的发病率尤其高(29%)。有了早期诊断，患者可以潜在地追求 包括手术在内的根治性干预措施(根治性耻骨后前列腺切除术)。然而，这些 手术治疗会导致大小便失禁(尿失禁)和性功能(勃起)问题 性功能障碍-性功能障碍的主要形式)在这些癌症幸存者中多达30%-70%。 尽管人们认识到大小便失禁和性功能是影响生活质量的关键问题， 对于预防这些形式的功能障碍的方法，只有有限的研究。这些错乱 进一步受到年龄相关性海绵体、尿道括约肌萎缩和纤维化以及 支持盆底肌肉(坐骨海绵体-ICM和耻骨直肠肌-PRM)。因此，迫切需要 用于非侵入性尿失禁和性功能康复的创新方法以预防这种情况 癌症幸存者的问题。这项拟议的可行性研究采用了一种新的干预方法，使用 重复经盆腔磁刺激方法(RTPMS)，以防止纤维化和加强PFM。 我们建议招募计划接受前列腺癌手术的VA患者并进行 随机干预研究以确定rTPMS康复潜力的可行性。我们会 估计潜在符合条件的患者数量、符合条件的患者的同意率、同意率、总体摄取率 比率(与潜在符合资格的人数有关)、保留率、问卷的随访率和 遵守干预措施和成像方案。我们将首先评估所有的基线生理指标 以及阴茎、尿路和盆腔肌的形态参数。主要成果衡量标准 对用户界面的评估将是用户界面症状分数的减少程度(%)。用于评估 ED，根据国际勃起功能指数(IIEF-5)衡量的勃起功能改善，a 将使用经过验证的5项症状评分。次要结果测量将是垫片重量和PFM 将由MRI测量的变化(UTE用于纤维化)。对于ED，阴茎血流和PFM的变化 分别用多普勒血流仪、激光散斑造影术和磁共振成像(UTE)进行测量。 除了这些治疗干预措施外，我们还建议测试新的诊断工具来监测血液供应 阴茎组织(通过激光多普勒成像)和这些肌肉的疤痕(通过一种新的MRI技术， 称为超短回波计时)。接下来，我们将测试TPMS是否会增强血液流动和增加骨盆肌肉 这些人的体力大约有6个月。患者将进一步接受3个月的监测，并接受 所有上述评估以确定大小便和性功能的恢复。使用rtpms来 促进大小便失禁和性功能康复仍未得到探索。因此，我们未来的随机临床 试验将有可能确定恢复大小便失禁和性功能的新策略 前列腺癌幸存者的外科治疗。所有提出的新的无创成像技术，如 AS-UTE(监测纤维化)和新的血流动力学技术监测阴茎微血管 该功能具有很高的临床应用潜力。此外，建议的rtpms协议具有 临床翻译的巨大潜力。如果这种干预在未来被证明是有效的，随机 这将对今后的康复工作产生重要的影响。因此，为 未来的转化性试验对退伍军人管理局的医疗保健用户至关重要。

The overall purpose of this SPiRE project is to assess the feasibility and acceptability of a novel intervention approach and to collect preliminary data for a future randomized clinical trial to rehabilitate urogenital function in prostate cancer survivors. Prostate cancer is most common in men over 50 years and this cancer incidence is especially high (29%) in the VA patients. With early diagnosis, patients can pursue potentially curative interventions that include surgical procedures (radical retropubic prostatectomy). However, these surgical treatments lead to problems with continence (urinary incontinence: UI) and sexual function (erectile dysfunction- ED, a major form of sexual dysfunction) in as many as 30-70% of these cancer survivors. Although it is recognized that the continence and sexual functions are critical issues affecting quality of life, there has been only limited research into methods to prevent these forms of dysfunction. These derangements are further impacted by age-related atrophy and fibrosis of corpus cavernosum, urethral sphincters, and that of supporting pelvic floor muscles (ischiocavernosus-ICM and puborectalis-PRM). Hence, there is an urgent need for non-invasive innovative approaches for urinary continence and sexual function rehabilitation to prevent this problem in cancer survivors. This proposed feasibility study takes a novel interventional approach, using repetitive Transpelvic Magnetic Stimulation approach (rTPMS) to prevent fibrosis and strengthen the PFM. We propose to recruit VA patients that are scheduled to undergo prostate cancer surgery and perform a randomized interventional study to determine the feasibility of rehabilitation potential of rTPMS. We will estimate number of potentially eligible patients, rate of consent of eligible patients consent rate, overall uptake rate (in relation to the number potentially eligible), retention rate, follow-up rates for questionnaires and adherence to the interventions and imaging protocols. We will first evaluate all the baseline physiological as well as morphological parameters of penis, urethra and pelvic muscles. Primary outcome measures for assessment of UI will be the extent of reduction (%) in the number of UI symptom scores. For assessment of ED, improvement in erectile function as measured by the International Index of Erectile Function (IIEF-5), a validated, 5-item symptom score, will be used. Secondary outcome measures will be pad weight and PFM changes that will be measured by MRI (UTE for fibrosis). For ED, penile blood flow and PFM changes measured by Doppler blood flow, laser speckle contrast imaging and MRI (UTE for fibrosis), respectively. Besides these therapeutic interventions, we also propose to test novel diagnostic tools to monitor blood supply to the penile tissues (by Laser Doppler imaging) and scarring of these muscles (by a new MRI technique, called ultrashort echo time-UTE). Next, we will test if TPMS will enhance blood flow and increase pelvic muscle strength in these men for about 6 months. Patients will be further monitored for 3 more months and subjected to all the described evaluations to determine recovery of continence and sexual functions. Use of rTPMS to promote continence and sexual function rehabilitation remains unexplored. Thus, our future randomized clinical trials will have the potential to identify novel strategies for restoring continence and sexual function after the surgical treatment in prostate cancer survivors. All the proposed novel non-invasive imaging techniques such as MR-UTE (to monitor fibrosis) and the novel hemodynamic technique to monitor penile microvascular function have high potential for future clinical applications. In addition, the proposed rTPMS protocol has significant potential for clinical translation. If this intervention is proven to be efficacious in a future randomized trial, it will have important implications for rehabilitation in the future. Thus, establishing the foundation for a future translational trial is of utmost importance to VA healthcare users.