Urinary incontinence is one of the most common complications of radical prostatectomy. Multiple prevention and treatment modalities have been proposed in the management of post prostatectomy urinary incontinence. This is a randomized controlled comparative study to evaluate the efficacy of extracorporeal magnetic stimulation alone and combined with pelvic floor muscle exercise versus pelvic floor muscle exercise alone in the management of post radical prostatectomy urinary incontinence. This study is expected to be performed over 7 years. The study population will be all male patients who are prepared for radical prostatectomy under urology department in HMC and were referred to voiding dysfunction for preoperative counselling and postoperative rehabilitation. Patients will be randomized into one of three treatment groups. The first group will receive sessions of extracorporeal magnetic field stimulation only. The second group will receive extracorporeal magnetic stimulation in addition to pelvic floor muscle exercise. The third group will receive pelvic floor muscle exercise only. The recruitment phase will take 3 years. Patients will be followed for 18 months for the course of urinary incontinence symptoms, severity of urinary incontinence on 1-hour pad test, urodynamic leak point pressure and the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the ICIQ quality of life (QOL) score. This study is proposed to reveal strong evidence on the efficacy of extracorporeal magnetic stimulation on the management of post radical prostatectomy urinary incontinence.
The study population will include all adult male patients 18 years of age and above, with localized prostate cancer of low or intermediate risk disease who chose definitive treatment with radical prostatectomy either through open radical retropubic prostatectomy (RRP) or through robotic assissted laparoscopic radical prostatectomy (RALP) as first line for treatment and had the surgery under Hamad General Hospital urology department care.
Patients with high risk , locally advanced or metastatic prostate cancer at time of diagnosis
Patients with low to intermediate risk prostate cancer who received chemo or radiotherapy then had salvage surgery
Patients with urinary incontinence or diagnosed overactive bladder before radical prostatectomy.
Patients with complicated surgery resulting in anastomotic leak, prolonged catheterisation more than 3 weeks, reinsertion of catheter due to retention of urine.
Parallel
Extracorporeal electromagnetic stimulation
DeviceElectromagnetic stimulation using Magneto STYM device, (Iskra medical d.o.o, Slovenia).
Pelvic floor exercises
BehavioralPelvic floor muscle training in serial training sessions with our therapist
One hour pad test
Measuring the weight of an incontinence pad used for one hour to detect the volume of urinary leakage in one hour assessed at 6 points of follow up
the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF)
Questionnaire administered at 6 points of follow up
Urodynamic leak point pressure.
Urodynamic study to evaluate the bladder dynamics and its response to radical prostatectomy and its response to rehabilitation
International Consultation on Incontinence Questionnaire quality of life score
Questionnaire administered at 6 points of follow up
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