L'INCONTINENZA URINARIA POST-PROSTATECTOMIA RADICALE RETROPUBICA: QUALITÀ DI VITA DEI PAZIENTI ED EFFICACIA DI DUE TRATTAMENTI CONSERVATIVI GESTITI DALL'INFERMIERE.

Introduction Urinary incontinence is a common problem after radical retropubic prostatectomy (RRP). Management strategies include conservative management, a series of treatment that do not imply neither surgery nor drugs. Conservative management includes pelvic floor muscle exercises (PFMEs), based on voluntary muscular contractions similar to those proposed by Kegel. Another rehabilitation technique is called “extracorporeal magnetic innervations” (ExMI), a special armchair that induces muscular contractions by using a magnetic field (passive rehabilitation). Both treatments can be performed by nurses, but their efficacy is unclear in literature. Goals The study was aimed at evalutating the role of PFMEs vs. no treatment in decreasing prostatic symptoms; clarifying the effects of PFMEs in time; comparing PFMEs vs. ExMI in decreasing urine leakage; investigating quality of life in patients with post-RRP urinary incontinence; identifying which prostatic symptoms investigated by the IPSS are linked between each other, since many patients are unable to completely describe their clinical situation and give a full report of the symptoms. Methods Quasi – experimental, non-randomized study. Convenience sample: 153 patients, prostate-limited cancer (2003-2010), indwelling catheter for max 8 days, regular flow after removal. 22 people refused rehabilitation after their RRP, but accepted to enter the study (control group). 88 underwent home and outpatient treatments with PFMEs, 23 were enrolled in the ExMI group. Assessment at 1, 3, 6, 12 months: International Prostate Symptom Score (IPSS) in each group, 24-h pad test in treated patients. End of treatment: loss<10 grams/day during muscular effort. Comparison between the groups was performed statistically. The IPSS questionnaires were analyzed in order to identify clusters of questions. EORTC PR-25 questionnaire was administered to treated patients, in order to investigate quality of life. 6 Results The IPSS score had a very good internal consistency in PFMEs patients (Cronbach‟s =0.9685); together with literature findings, this data supported the choice of such questionnaire in these patients. No significant difference between the IPSS prostatic symptom scores was detected at 1 month (Wilcoxon test: 2(8)=6.33, p=0.6104). Between 1 and 3 months, IPSS decreased more quickly in the PFMEs patients, in comparison with the control group, notwithstanding BMI and age (ANCOVA after PROBIT transformation: p=0.0008, R2=0.8163, 2 in the sample=0.1465). No significant difference was found at 6 months (Wilcoxon test,2(3)=1.51, p=0.68). After 6 weeks of treatment (the equivalent of a full ExMI cycle), 32.73% patients in the PFMEs group had reached the 10 g/day cutoff, vs. 63.88% in the ExMI group (log-rank test: 2(1)=16.287, p<0.0001). PFMEs could achieve comparable results between 10 and 11 weeks (Kaplan-Meier analysis). The clusters identified through the analysis of the IPSS questionnaires were not clinically useful, being predictable through basic clinical considerations. The EORTC PR-25 questionnaire, according to the existing literature, pointed out that incontinence was perceived as a limitation to daily activities, as well as a source of virility loss. Conclusion / discussion PFMEs are effective in reducing prostatic symptoms, if compared with no treatmen, between 1 and 3 months after surgery. At 6 months, a physiological recovery seems to exist even in both the PFMEs and control group. ExMI is clearly quicker than PFMEs in leading patients to reach the 10 g/day cutoff; a long-term follow-up could be useful to evaluate the persistence of its benefits over time. Further studies could investigate the impact of ExMI on various types on incontinence with larger samples. The IPSS score includes questions that are strictly linked between each other, but using it as a whole seems the best choice for nursing anamnesis. According to literature, 7 quality of life is heavily influenced by incontinence in its sexual aspects. Nurses‟ collaboration with sexologists could lead to a further quality of life improvement. Practical relevance Conservative management, performed by nurses through PFMEs and ExMI, can be effectively used in rehabilitation. Nurses are autonomous in performing such treatments; their work improves quality of life in post-RRP patients with urinary incontinence.