Urinary Incontinence Clinical Trial
Official title:
A Randomized Controlled Trial Study of the Efficacy of Intensive Preoperative Pelvic Floor Muscle Training to Decrease Post-prostatectomy Urinary Incontinence
Urinary incontinence after radical prostatectomy is a significant clinical problem despite
advances in surgical techniques. In the literature, the incidence of post prostatectomy
urinary incontinence varies widely from 0.5 to 87% (Parekh et al, 2003). Various reasons are
held responsible for this wide discrepancy, including surgical technique, definition of
incontinence, time of evaluation, pathological stage, and patient age. The etiology of post
prostatectomy urinary incontinence has been attributed to sphincteric deficiency, either
from injury of striated muscle fibres or the innervating nerve fibres (Koelbl et al 2002).
The effect of urinary incontinence on the quality of life in these patients has been subject
to debate (Litwin et al, 1995; Braslis et al, 1995). For many patients, however, early
recovery from urinary incontinence has been a major concern (Moore et al, 1999), especially
in younger patients.
Various treatment modalities for post prostatectomy urinary incontinence have been
introduced, including conservative managemnt such as pelvic floor muscle training,
pharmacological treatment and surgical treatment. However, surgery is an invasive procedure
and it's usually be the last resort. Although the Cochrane Incontinence Group (2007)
commented on the need for ongoing research to clarify the role of pelvic floor muscle
training, it is still the first-line treatment used to restore pelvic floor or bladder
function after radical prostatectomy (MacDonald et. al., 2007). Currently, patients learned
pelvic floor muscle training on the day of admission for surgery by ward staff in HA
hospitals of Hong Kong. Subsequently, after removal of urethral catheter, patients will
attend the nurse-led clinic for reassessment and reinforcement of pelvic floor muscle
training. The continence rates which defined as zero pad were 69%, 78.7% and 88.9% at 3
months, 6 months and 12 months respectively (Tam and Ho et al., 2010). In order to determine
the efficacy of intensive preoperative pelvic floor muscle training to decrease
post-prostatectomy urinary incontinence, a randomized controlled trial will be conducted.
Participants in the intervention group would start the pelvic floor muscle training 3 weeks
before surgery provided by an urology nurse specialist whereas the control group would start
the pelvic floor muscle training on the day of admission for surgery provided by ward staff.
Measurement on the grams of urine loss, sense of self control in urination and quality of
life are collected on 4, 8, 12 and 24 weeks after surgery for comparison between the two
groups.
Status | Recruiting |
Enrollment | 84 |
Est. completion date | October 2015 |
Est. primary completion date | September 2015 |
Accepts healthy volunteers | No |
Gender | Male |
Age group | N/A and older |
Eligibility |
Inclusion Criteria: - Chinese; - Physically able to complete the pad test Exclusion Criteria: - Prior bladder surgery; - Prior urinary incontinence; - Neurogenic dysfunction of the lower urinary tract; - Pre-operative history of overactive bladder; - Impaired mental status; - Allergic to latex. |
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Health Services Research
Country | Name | City | State |
---|---|---|---|
Hong Kong | NG Sau-loi | Hong Kong | Heng Fa Chuen |
Lead Sponsor | Collaborator |
---|---|
Queen Mary Hospital, Hong Kong | The University of Hong Kong |
Hong Kong,
Hunter KF, Moore KN, Glazener CM. Pelvic floor muscle training to improve urinary incontinence after radical prostatectomy: a systematic review of effectiveness. BJU Int. 2007 Nov;100(5):1191; author reply 1191-2. — View Citation
Novara G. Editorial comment on: does physiotherapist-guided pelvic floor muscle training reduce urinary incontinence after radical prostatectomy? A randomised clinical trial. Eur Urol. 2008 Aug;54(2):447. doi: 10.1016/j.eururo.2008.04.023. Epub 2008 Apr 18. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Change in grams of urine loss at different intervals post surgery | To determine the benefit of starting intensive PFMT before radical prostatectomy and continuing PFMT postoperatively in order to promote (1) early regaining of urinary continence in the intervention group by weighted pad after pad test and (2) any positive improvement in quality of life in the intervention group. | 4, 8, 12, and 24 weeks post surgery | No |
Secondary | Change in patients' sense of self control in urination and quality of life at different intervals post surgery | The intervention group will significantly regain bladder control by decreasing urine leakage as measured by pad test than the control group by the end of three months post surgery. The intervention group will report better quality of life as measured by the Functional Assessment of Cancer Therapy-Prostate (FACT-P), Incontinence Impact on Quality (IIQ-7) and Health-related Quality of Life (SF 12) |
4, 8, 12, and 24 weeks post surgery | No |
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