Prostate Cancer After Radical Urinary Control

Objective1. There are many factors that may cause the post-prostatectomy incontinence. Objective clinical characteristics, surgical techniques, pelvic floor muscle therapy are the most important. Our aim was to identify the risk factors that might associate with urinary incontinence after radical retropubic prostatectomy (RRP).2. Up to now, for patients who has undergone radical prostatectomy, among the vast methods which can improve their urinary continence, pelvic floor muscle therapy (PFMT) is the only noninvasive therapy that has been validated by a large number of clinical studies. Whether electrical acupuncture stimulation combining with PFMT can improve the recovery of urinary continence is still lack of evidence. This investigation focused on the effectiveness and significance of electrical acupuncture stimulation for the recovery of urinary continence.Methods1. A total of 263 patients were enrolled in the study of multivariate analysis. Close follow-up was performed and a series of pre-, peri-and post-operative factors were recorded and examined.2. A total of 109 patients took part in the study of novel combination treatment for urinary continence. Patients were divided into two groups:study group,40 patients, one week after removal the catheter, they received electrical acupuncture stimulation therapy combined with PFMT; control group,69 patients, performed PFMT as the only treatment for post prostatectomy incontinence. We followed up closely, recorded clinical characteristics, filled up the questionnaires of ICI-Q-SF, and collected all the data for statistical analysis.Results1. Urinary continence after radical prostatectomy was 14.8% at 4 weeks, and 94.7% at 16 weeks. The most important recovery interval for urinary continence is 4 weeks to 16 weeks after the surgery. On multivariate analysis age (p=0.015), blood transfusion (0.017), previous TURP (p=0.006), surgical cases (p=0.002), and neoadjuvant hormonal therapy (p=0.005) were important risk factors for urinary incontinence.2. There was a significant difference between the study group and the control group in the urinary control curve, p=0.029. The difference of continence probability between these two groups became greater from 4 weeks after surgery, and at 6 weeks, the difference reached the peak, at which point, the study group was superior to the control group by 23.5%, p=0.023; then the difference become smaller, and at 16 weeks after surgery, there was no difference. ICI-Q-SF questionnaires gave us the same results.ConclusionsDuring the radical retropubic prostatectomy, optimizing preservation of urethral rhabdosphincter length, nerve sparing approach, pelvic floor muscle examination can improve the recovery of urinary continence. Age, blood transfusion, past TURP and surgical volume are independent prognostic factors. Neoadjuvant hormonal therapy might attribute to increasing the preoperative membranous urethral length in improving urinary continence.Electrical acupuncture stimulation therapy combining with pelvic floor muscle therapy can improve the recovery of patients'urinary continence after radical prostatectomy.