'Pre-hab' reduces impact of incontinence after prostate surgery
Urinary incontinence is a common and expected problem experienced by approximately 80% of prostate cancer patients who undergo surgery, and can continue for months to years after surgery — in some cases, recovery can continue for as long as two years.
‘Prehabilitation’ — physical activity and pelvic floor muscle training before prostate cancer surgery — has been shown to positively influence the recovery of continence and, according to a recent article published in Nature Reviews Urology, Australian-developed ultrasound technology is helping to improve the quality of this training.
Studies have shown that men undertaking pre-hab training of specific pelvic floor muscles are 28–36% more likely to be continent by three months post-surgery.
“It is clear that a structured and coordinated program of exercise initiated prior to prostate cancer surgery is a key component to the successful management of urinary incontinence and quality of life,” said men’s health physiotherapist and study co-author Sean Mungovan.
“We are finding that establishing a regular and consistent program of correctly prescribed pelvic floor exercises works well to prepare men for what they are required to do after surgery.”
Training through technology
Physiotherapists in Australia are using an ultrasound technique developed at the University of Queensland to help men train their pelvic floor.
“While we know that pelvic floor muscle exercise can assist in restoring continence, many men can struggle to correctly and effectively activate and train the pelvic floor muscles,” Mungovan said. “Verbal and written instructions have limitations and previously it was difficult to be certain that men were correctly activating the muscles that need to be trained.
“This new technology provides a non-invasive and accessible way for men and their physiotherapist to view their pelvic floor muscle contractions to ensure proper training in order to minimise the degree of incontinence after surgery.”
Comprehensive prehab training programs delivered by physiotherapists are not always the standard of care offered to all men undergoing prostate surgery in Australia and internationally.
“It is understandable that conversations between doctors and patients focus on cancer control and mortality,” Mungovan said. “We want to encourage more discussion with patients about risk management of post-surgery complications such as incontinence and building a culture of prehabilitation. It is important patients are aware that there are things they can do to try and optimise the outcomes of surgery and their quality of life.”
Professor Manish Patel, a urologist who specialises in prostate cancer surgery, said, “Incorporating a thorough pelvic floor education and training program that includes ultrasound gives me the confidence to know that my patients are doing everything they can to prepare well for surgery. A well-prepared patient goes into the operation already knowing what they will need to do after their operation. These patients are in the optimal position for the recovery of continence after surgery,” Professor Patel said.
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