Hypothesis / aims of study
Prostate carcinoma is the main cancer that affects men, and the second cause of death after lung cancer. His treatment of choice is radical prostatectomy, which consists of removing the entire prostate, as well as seminal vesicles. Its main complications are urinary incontinence and erectile dysfunction. Various studies show that performing exercises that work the pelvic floor muscles help improve these complications. Although sometimes, the execution of these exercises is not performed correctly because the patient is not able to assimilate the information received and performs the exercises with the help of auxiliary muscles such as the abdominal muscles, gluteal muscles or abductors, so the work It is not effective. To avoid this circumstance, a study is designed comparing a group with biofeedback-guided learning by a nurse expert in the technique versus another without this learning method.
Study design, materials and methods
Randomized clinical trial with two arms, with a control group and a study group. The study group has undergone two biofeedback sessions prior to surgery for the identification of the muscles to be worked guided by a trained professional compared to another group where prior learning of the muscles to be worked is not carried out. These fifteen-minute sessions consisted of the placement of electromyography sensors to detect muscle contractions that were visible on the monitor along with the explanations of the nurse who, through palpation, detects the possible contraction or not of the auxiliary muscles.
On the hospitalization ward, both groups followed the same care process led by the urology unit staff, where the teaching protocol for strengthening the perineal muscles after removing the urinary catheter fifteen days after surgery was explained. surgery. The data has been collected through validated questionnaires.
Interpretation of results
The main concern before prostate surgery is facing the tumor and its possible consequences. Once this phase is over, erectile dysfunction and urinary incontinence is a new reality that was not expected, hence the importance of health education prior to surgery, not only to recover the perineal muscles as soon as possible, but also to that the patient also knows from the first moment the real possibility of suffering from these complications. Knowing that this possibility exists and knowing that you have a series of professionals who advise you on the best techniques and treatments to alleviate and solve these complications is part of the work of urological nursing.
We can conclude from the work presented that our patients have felt satisfied with the care received regardless of whether or not they suffer from incontinence and/or erectile dysfunction.
The degree of adherence obtained in our series is relevant, if we take as reference the work of Morris et al., where they estimate the lack of adherence to a treatment to be between 30% and 50% regardless of the disease, prognosis or treatment, in our series we achieved 70% adherence in performing perineal rehabilitation at a anus.
The World Health Organization places this adherence in long-term therapies at around 50%. Perhaps the success in terms of our patients' adherence is the strict monitoring we have carried out and the intentions for improvement they have presented. Although there is no difference in terms of adherence by group, it is notable that patients who have presented urinary incontinence have 10% greater adherence to treatment.
Like Girotti et al., in a prospective cohort study in 60 patients who performed intermittent catheterization where the adherence rate at 6 months (61.7%) was similar to that at one year (58%), in our series no differences were observed either. significant in terms of adherence at 4 months and one year.
There are several factors that impact urinary continence and erectile dysfunction after prostatectomy, some of them non-modifiable such as age or tumor location, and other modifiable . Depending on these factors, there are rates of erectile dysfunction in the literature that vary between 3-51% for robotic surgery. Other authors speak of erectile dysfunction rates of 30% while others speak of recovery to pre-surgery states of only 33%.
In our series we observed moderate/severe dysfunction rates of 42% for the study group compared to 58% for the control group, which indicates an improvement in the rates in the study group. This improvement is observed equally in all subdivisions, including patients who do not present erectile dysfunction, who are up to 5 times more numerous in the study group. Twice as many patients in the control group presented severe dysfunction than patients in the study group.
Regarding urinary incontinence, the literature speaks of rates of up to 80%. In our work, we observed incontinence rates that doubled in the case of the control group, maintaining an incontinence rate in the study group of 39%.
Coinciding our work with other works such as the LF Hsu study, time is essential for the recovery of continence, so in our series for the study group we went from incontinence rates of 66% at 4 months to rates incontinence of 39% one year after surgery. It is different in the control group where this considerable improvement is not reflected.
Concluding message
The use of biofeedback as a support element in the prevention of urinary incontinence and erectile dysfunction in patients who are going to undergo robotic radical prostatectomy is a safe technique that can provide advantages when it comes to the patient learning more simpler and more rigorous exercises to strengthen the perineal muscles.
With the use of biofeedback we have improved the incidence of urinary incontinence and erectile dysfunction in patients undergoing robotic prostatectomy at the San Carlos Clinical Hospital in Madrid. Improving the rates of urinary incontinence and severe erectile dysfunction by 50%.
Although the distribution of the sample is very homogeneous between the two groups, and observing an evident improvement in the incidence of urinary incontinence and erectile dysfunction in patients where the biofeedback sessions have been performed, a proportion is not achieved. significant between its use and the improvement of the variables under study. We can attribute the possible cause to an insufficient sample, despite observing a favorable trend, not obtaining a statistically significant relationship.
Finally, we would like to emphasize the importance of continuing with studies related to the role of nursing in radical prostatectomy, where it can be seen that the work of nursing in teaching pelvic floor exercises, as well as in-patient care of hospitalization, help improve UI and ED, as well as the quality of life of patients undergoing this type of intervention.
Research is necessary to continue learning, training, and discovering new methods that help us grow as a profession and improve patient care and their quality of life.
This clinical trial opens up the need for more studies in this area in which we can see how nursing can play an important and decisive role in the perioperative period of these patients, directly influencing an improvement in their quality of life.