Anaïs Bassas Parga

PHYSIOTHERAPY

BEFORE RADICAL PROSTATECTOMY

Do you recommend PFMT before RP?

Benefits:- Less worries- Less anxiety- Starting exercises quickly- Hypertrophy and increase local blood

supply

Why not??

Patient information. Basic issues

1. Information about pelvic floor:a. Where PF isb. PF functionc. Why patient must do PFMT

2. Oral & written information / instructions about exercises

3. To teach awareness of their muscle and how it worksTo locate and Feel the PF

Patient information. Basic issues

4. The “Knack” technique

5. Practise of PFM contractions with or without BFB

6. Urethrocavernosus reflex or Post void milking mechanism.

Routine at home

Not all the patients are referred to physiotherapy...

Connection

Doctor Patient Physiotherapist

Knowledge

Communication

Urology visit: prostate CANCER diagnosis.

Patients feel shocked & disoriented. They forgot oral information. Urge to be treated

+ visit physiotherapist: written information, and images...

Accessing physiotherapy

Barriers:

- where?- How much?- Perception “they might be lucky”- Embarrassment/Shame- No info about PFM - Focus on cancer

Hirschhorn et al. BJU Int 2014

Hirschhorn et al. BMC 2013

Sounds reasonable, but….

Evidence?

Hirschhorn et al. BJU Int 2014

Public hospital (n=32) & Private hospital (n=107) providers of PFMTICIQ-UI done to assess UI at 3 months after RP

ConclusionPrivate hospital provides preoperative PFMT more than public hospital.

Patients receiving preop PFMT had significantly better self-report UI at 3 months after RP that those who didn’t received it.(Mean ICIQ-UI 6.2 vs 9.2).

Additional strategies are needed to improve PFMT treatment among patients undergoing RP in the public system.

Geraerts et al. Eur Urol 2013

Collado et al. Abstract 28th EAU meeting 2013.

Methods 179 males- Treatment group (n=87):

3 weeks before RP: weekly assisted BFB session and hypopressive + daily home PFMT & written instructions

- Control group (n=92): Oral instructions on Kegel exercises after RP

Structured programme starts after 3 weeks after RP.

Degree of incontinence assessed with: 24 hours pad-test / ICIQ-UI SF

Conclusions Intensive preoperatory PFMT considerably REDUCES DURATION AND SEVERITY of SUI after RP.

Collado et al. Abstract 28th EAU meeting 2013, contd.

Patel et al. Int J Urol 2013

24h pad-test incontinence severity (>50g)

6w 3 months 6w 3 months

Treatment g 9g no sign diff 8/152 no sign diff

Control g 17g no sign diff 33/132 no sign diff

RESULTS

Preop physiotherapist-guided PFMT reduces time to continence by 28% (it reduces the duration and severity of early incontinence after RRP)

SUMMARY

- Preop PFMT is better than: - Nothing.- Oral & written instructions

- Preop PFMT cannot ensure complete continence after surgery

- Preop PFMT reduces duration and severity of early SUI.

SUMMARY

We recommend to teach PFM exercises before surgery because:

- patient is pain-free and with a normal sensation (anatomicly intact)

- have time to practise PFM exercises and become confident with the exercises

- Evidence: reduces severity and duration of SUI

- Better quality of life and better satisfaction with the treatment

SUMMARY

We encourage all physiotherapists to:

- Promote their services to healthcare professionals and general public.- Do more studies. We need more evidence!

Bernad et al J Cancer Surviv 2015 (systematic review)There is some evidence that RT has detrimental impacts on both PFMs’ structure and function.

But we also need more studies in radiotherapy

Thank you very much