273 EFFECT OF PELVIC MUSCLE EXERCISES BIOFEEDBACK STIMULATION AND PROSTATECTOMY Wille Sebastian, Rainer Department
Axel, Varga Zoltan,
of Urology, Philipps-University
WITH ELECTRICAL AFTER RADICAL
of Marburg, Marbug.
INTRODUCTION & OBJECTIVES: To asses the effectiveness of pelvic muscle exercises (PME) and electrical stimulation (ES) and biofeedback (BFB) on urinary incontinence after radical retropubic prostatectomy (RRP). MATERIALS & METHODS: We randomised 139 patients who underwent RRP into 3 groups: Group I received verbal and written instruction about postoperative PME from a physiotherapist. Group 2 received same instructions and electrical stimulation for I5 minutes twice a day. Patients in group 3 were additionally treated with BFB for I5 minutes twice a day. Treatment was started immediately after catheter removal and performed for three months. Outcome was assessed using the 20 minutes pad test. a urine symptom inventory, all obtained preoperative and three months postoperative. Surgery was performed by two surgeons only. Results at three months were available for 120 (symptom inventory) and 79 patients (padtest) respectively.
CHU H Mondor.
CHU H Mondor,
margins after retropubic.
MATERIALS by retropubic
perineal and laparoscopic
& METHODS: approach.
I I9 by perineal
of radical prostatectomies
and 220 by laparoscopic
in terms of the location of positive surgical margins
and its rate.
Group I vs. 2
3 not simificant
Group 2 vs. 3 not sismficant
Overall subjective continence at 3 months (questionnaire)
Overall objective at 3 months (padtest)
For pT2 tumours, surgical positive margin rates were 18,8%, 15%
and 16%. Location
was at apex in 47.1%. 33% and 52%. at bladder neck in
41.2% 41.6% and 20% and posterolateral
margin rate was 54.98,
25% et 28%. For pT3
30.3% and 46%, Location
was at apex in 38.2%. 50% and 44%. at bladder neck in 44.1%, 25% and 22.2%, 76% (Il=L?S)
in 17.6%, 25% and 33.3%
CONCLUSION: CONCLUSION: A treatment program of electrical stimulation or biofeedback enhanced pelvic floor exercises began immediately after catheter removal did not significantly affect continence after three months in this study.
several approaches, the retropubic
whereas bladder neck involvement is mostly seen in perineal approach.
276 IMPROVED URINARY CONTINENCE IN RADICAL RETROPUBIC PROSTATECTOMY AFTER PREPARATION OF A LONG INTRAPROSTATIC URETERAL STUMP - RESULTS OF A QUESTIONNAIRE IN 575 CONSECUTIVE CASES van Randenboreh Hartung Rudolf
Urology, TU Munich, Munich, Germany Urologie, CHU H Mondor, Creteil. France
of these 3 approaches.
From 1988 to 2000,401
for localised prostate cancer,
by perineal approach, rate, medical
145 by retropubic
stay were noted
time was 197 mn, 178 mn and 285 mn, transfusion
15.9% and 2.9%, medical complications complications
rate was 26.2%,
rate was 8.3%. 5.9%. 5.1% and surgical
rate was 13.1%, 7.5%. 7.30/c, bladder catheterisation
days,] I .9 days, 6.9 days, hospital stay was13 days. X.7 days and 5.4 days.
with a decreasing
of the laparoscopic
rate. In spite of its higher identical
INTRODUCTION & OBJECTIVES: Urinary contmence is one of the most important factors of quality of life in patients after radical retropubic prostatectomy. In the literature the achieved continence rates are between 75% and 97% of all patients. To improve the rate of full continence in our patients we used a careful preparation of the intraprostatic part of the uretera to obtain a long ureteral stump for the vesico- urethral anastomosis since June 1997. Before this time, the urethra has been transsected at the apex of the prostate. This study was performed to compare the rate of urinary continence as well as positive surgical margins in these two groups. MATERIALS & METHODS: 156 patients with (group I) and 419 patients without (group 2) a long intraprostatic stump of the urethra were asked by a questionnaire about their continence status. All patients have been fully continent before the operation. The status was defined as continent, if the patient did not use any pads, as stress-incontinent I” (SIK) in the case of I pad. as SIK II” in the case of 2-3 pads and SIK III” if the patient needs more than 3 pads and/or more than I pad at night. The rate of positive surgical margins in the histopathological results was compared. The mean follow-up for group I is 2.5 years and for group 2 4.5 years. RESULTS: Full contmence (no pads) was achieved in 93% of all patients in group I and in 82% in group 2. Stress-incontinence (SIK) I” was found in 4.5% and 12.2% respectiveley. SIK II” was noted in 2.5% and S.6% and complete incontinence was seen in no patient in group I but in I .8% in group 2. This difference is statistically highly significant (p
No. 1, pp. 71