SciELO - Scientific Electronic Library Online

 
vol.17 issue50Informal care in times of crisis. Analysis from the nursing perspectiveLiterature as a therapeutic instrument in the health-disease process in childhood author indexsubject indexarticles search
Home Pagealphabetic serial listing  

My SciELO

Services on Demand

Journal

Article

Indicators

Related links

  • On index processCited by Google
  • Have no similar articlesSimilars in SciELO
  • On index processSimilars in Google

Share


Enfermería Global

On-line version ISSN 1695-6141

Enferm. glob. vol.17 n.50 Murcia Apr. 2018  Epub Dec 14, 2020

https://dx.doi.org/10.6018/eglobal.17.2.285871 

Reviews

Alternative therapies for early recovery of post-prostatectomy urinary continence: systematic review

Magali Rezende de Carvalho1  , Francine Amaral Machado Nascimento da Silva2  , Isabelle Andrade Silveira3 

1 Enfermera Estomaterapeuta, Alumna de Máster del Programa de Mestrado Académico en Ciencias del Cuidado en Salud, Universidad Federal Fluminense/UFF Brasil.

2 Enfermera especialista em Neonatología. Posgraduanda en Enfermería Oncológica por la Universidad Estácio de Sá. Rio de Janeiro, Brasil

3 Máster en Enfermería. Enfermera del Hospital Universitario Antônio Pedro. Universidad Federal Fluminense, UFF. Niterói, Brasil.

ABSTRACT:

Aim

To conduct a systematic review of the evidence of the effectiveness of Pelvic Floor Muscle Training (PFMT) in the treatment of post-prostatectomy urinary incontinence.

Method

Systematic review conducted in Ovid MEDLINE, EMBASE and LILACS in Portuguese, English and Spanish, with the time limit: 2005-2015.

Results

9 studies analyzed the effectiveness of PFMT associated or not with biofeedback (BFB) and electrical stimulation (ES).

Conclusion

PFMT with or without the biofeedback and electrical stimulation may contribute to the early recovery of continence. Patients with initial difficulty of identifying the pelvic floor muscles can benefit from ES followed BFB sessions of structured PFMT. A greater participation of nurses in the care related to the early return of continence in post-prostatectomy patients is possible through the implementation of pelvic floor muscle exercises and behavioral therapy.

Keywords:  Urinary Incontinence; Post-Prostatectomy; Pelvic Floor Muscle exercises; Nursing care

INTRODUCTIÓN

The global incidence of prostate cancer (PC) reaches about 71.4 cases per 100,000 inhabitants and is considered the second most common type of cancer1.

There are several treatment options for men with prostate cancer; the choice depends on the degree of tumor malignancy, as well as other particularities of the patients. Radical prostatectomy leads to urinary incontinence in most cases, causing significant changes in the quality of life2. Several prognostic factors for failure in continence recovery have been reported in retrospective observational surveys, including advanced age, prostate size, stenosis of the anastomosis, preoperative urodynamic abnormalities, and details of the surgical technique3.

Urinary incontinence exerts a marked negative influence on the quality of life because of the disorders and discomforts triggered4. Involuntary urine leakage may cause embarrassment, resulting in reduced social interaction or isolation, besides expenses with diapers that can compromise the patient's income.

Firstly, it is necessary to clarify that involuntary urine leakage at any age, resulting from treatment or not, requires attention and care. Many people believe that an incontinent person is only the one who has large losses of urine on a day to day basis; this belief delays the diagnosis and consequent treatment.

Urinary incontinence is defined as any involuntary loss of urine, according to the International Continence Society (ICS)5. Involuntary loss of urine may affect to a lesser or greater extent the quality of life of any individual, especially prostatectomized patients who also deal with many other peculiarities arising from cancer therapy.

The treatment of Post-prostatectomy Urinary Incontinence (PPUI) is often undervalued, since the improvement of the incontinence is time-dependent. Only about 5% of PPUI patients will remain incontinent 1 year after surgery6.

Like any other type of urinary incontinence, PPUI may be associated with bladder dysfunction, sphincter dysfunction or a combination of both8. The main cause of PPUI is sphincter deficiency, affecting more than two thirds of patients; about 10% of patients present isolated bladder dysfunction and one third may present both6. The internal sphincter can undergo injury during surgery and its functionality can be compromised, causing great pressure under the external sphincter, which, in turn, depends on the smooth functioning of its striated muscle fibers. When le later are weakened, urinary losses happen7.

Conservative treatment includes behavioral therapy (lifestyle modifications such as reduction or elimination of irritating substances to the bladder), pelvic floor muscle training (PFMT), and pharmacotherapy, when appropriate8. Incontinence surgical interventions are quite effective, but are usually reserved for moderate to severe incontinence, and many prostate cancer survivors are reluctant to undergo further surgery9.

The success of PPUI treatment depends on a multidisciplinary approach involving physicians, psychologists, physical therapists/urology nurses and stoma therapists.

Although most of PPUI patients present significant improvement and/or solution of incontinence within a 12-month period without previous exercises to strengthen the pelvic floor muscles, previous studies have shown that the realization of exercises during the postoperative period contributes to regaining incontinence early10,11.

There is still no consensus among urologist physicians about whether to recommend conservative treatment before 12 months post-prostatectomy. Therefore, the search for scientific evidences that support or not this practice becomes necessary.

The research question that guided this review followed the P.I.O strategy and was thus established as: Do men with post-prostatectomy urinary incontinence submitted to pelvic floor muscle post-surgery training have an early improvement in incontinence?

In this context, the objective of this study is to conduct a systematic review of the evidence of the effectiveness of Pelvic Floor Muscle Training in the treatment of post-prostatectomy urinary incontinence.

METHODS

Systematic review of the literature carried out in 8 stages: (1) elaboration of the research question; (2) literature search; (3) selection of articles; (4) data extraction; (5) methodological quality assessment; (6) data synthesis; (7) evaluation of the quality of the evidence; and (8) writing and publishing the results12.

Inclusion criteria: Randomized clinical trials with secrecy of allocation addressing the application of PFMT for PPUI treatment; articles that evaluate the improvement or cure of PPUI as the main outcome.

Exclusion criteria: Studies that performed PFMT before surgery or after 1 year; case reports, case series, case control, cohort and expert opinion; research protocols; abstracts, unpublished theses and dissertations.

The search was performed on September 26, 2015, in the electronic databases MEDLINE/OVID (1946 to 2015 set week 3); EMBASE (1974 to 2015 set 25) and Latin American and Caribbean Literature in Health Sciences (Lilacs) and was limited to articles published in the period 2005-2015 in English, Portuguese and Spanish.

Descriptors (MeSH and DeCS) and keywords were used to construct search strategies in the databases. For the search in Medline and Embase, the Cochrane's high-sensitivity search strategy was used to identify randomized studies: ((((randomized controlled trial.pt.) or (controlled clinical trial.pt.) or (randomized.ab.) or (placebo.ab.) or (drug therapy.fs.) or (randomly.ab.) or (trial.ab.) or (groups.ab)) not ((animals.sh. not (humans.sh. and animals.sh.))) and ((urinary incontinence.mp) or (continence.tw.) or (incontinence.ab.)) and ((prostatectomy.mp.) or (prostatectomy.tw.) or (prostatectomy.ab.)) and ((biofeedback.tw.) or (biofeedback.ab.) or (electric Stimulation.ab.) or (electric stimulation therapy.tw.) or (electric stimulation.tw.) or (exercise therapy.tw.) or (pelvic floor exercise.mp.) or (pelvic floor.tw.) or (pelvic floor muscle exercise.ab.))). Where pt.(Publication Type term); .ab. (abstract); .fs.(‘floating’ subheading); sh.(MeSH); .ti.( title); mp. (search of title, abstract, name of substance and subject heading word).

For the search in the LILACS, we opted for a more simplified adaptation in the attempt to find more studies: (((urinary incontinence) or (continence) or (incontinence)) and (prostatectomy) and ((biofeedback) or (electrical stimulation) or (electrical stimulation therapy) or (exercice therapy) or (pelvic floor exercise) or (pelvic floor muscle exercise))).

The quality of the studies was evaluated according to Oxford Centre for Evidence-Based Medicine (EBMC) (2009)13 as to the level of evidence and degree of recommendation. The methodological evaluation was done through the Jadad scale (1996)14.

RESULTS

The search resulted in 236 studies; after removal of the duplicates, 158 studies were set apart for reading the titles and abstracts. After reading the titles and abstracts, 30 were pre-selected for reading in full-length. When applying the inclusion and exclusion criteria, 9 articles were selected for analysis, as shown in flowchart 1.

Figure 1 Flowchart of search and selection of articles included in this review 

The Table 1 describes the title of the study, the authors, year of publication and country of origin, as well as identification of the methodological design.

Table 1 Characterization of the Studies, Rio de Janeiro, 2017. 

Source: Authors' elaboration

The Table 2 describes the interventions performed as well as the sample size and follow-up time of each study.

The Table 3 presents the main results found in the analyzed studies as well as their conclusions.

Table 2 Interventions, sample size and follow-up time, Rio de Janeiro, 2017 

Source: Authors' elaboration

Legend: * There were 2 losses in the test group and 11 in the control group. To obtain 80% of study power, each arm of the study should have 96 participants. However, in 2 years of recruitment it was only possible to recruit 79 patients in total.

Table 3 Main results and conclusions of the authors, Rio de Janeiro, 2017. 

Source: Authors' elaboration

The fourth table shows the analysis of the quality of the studies that were classified as to the level of evidence, degree of recommendation, Jadad scale score and conflicts of interest.

Table 4 Level of evidence, degree of recommendation, Jadad scale scores and conflict of interest, Rio de Janeiro, 2017. 

Study Evidence level Degree of recomendation Jadad scale Conflict of interests
Filocamo et al, 200515 1b A 2 Not reported
Manassero et al, 200716 1b A 3 None
Moore et al, 200717 1b A 3 Not reported
Overgård et al, 200818 1b A 2 Not reported
Dubbelman et al, 20093 1b A 4 Not reported
Mariotti et al, 200919 1b A 1 Not reported
Ribeiro et al, 201020 1b A 2 Not reported
Glazener et al, 201121 1b A 5 None
Ahmed et al, 201222 1b A 3 None

Source: Authors' elaboration

DISCUSSION

Two studies evaluated the influence of periodic follow-up of a specialist during the period of PFMT versus the performance of home-based exercises without professional support (Overgård18 and Dubbelman3). Dubbelman analyzed 79 patients and concluded that the PFMT supervised by a therapist does not interfere with the time of return of the continence, in addition to considerably increasing the cost of the treatment3. Overgård analyzed 85 patients and achieved a significant result 12 months after surgery in the supervised PFMT group (p = 0.028)18.

Filocamo15, Manassero16, and Glazener21 evaluated the effectiveness of PFMT supervised by a therapist compared to no guidance; 300, 107 and 411 patients, respectively, were analyzed over 12 months. Two of them concluded that PFMT is able to reduce continence recovery time with positive results already in the first months of therapy15-16. Filocamo et al. obtained statistically significant results in their results in the 1st (P < 0.00001), third (p < 000001) and 6th month (0 < 0.00001) after prostatectomy 15. Manassero et al. observed a significant improvement from the 3rd month onwards (53.7% incontinent patients in the test group and 77.5% in the control group), the difference increases at the end of the study, with 12 months, where only 16.6% still remained incontinent in the test group and 60% in the control group16.

Glazener et al21, however, did not find significant differences between the two groups studied. They concluded that the supervised PFMT costs too much and does not have the expected return. However, it is worth mentioning that, although the initial proposal of the Glazener study was to compare the supervised PFMT effectiveness with no exercise, 170 patients from the 206 allocated in the control group sought help at their respective research center and started to perform PFMT in the beginning of the study. Furthermore, the adherence of the participants to the proposed therapy decreased at similar extent in both groups until the end of the 12 months (number of patients who periodically performed the pelvic floor strengthening exercises after 6 and 12 months: 96/188 in the test group and 64/190 in control group, and 67/192 in the test group and 51/190 in the control group, respectively). Considering the low adherence of the test and control groups to PFMT, a similar high incontinence rate is expected in both groups at the end of the study (148/196 ENT#091;75.5%ENT#093; test group and 151/195 ENT#091;77.4%ENT#093; in the control group were incontinent at the end of the 12 months - p = 0.637).

One study followed 114 men with PPUI for a period of 12 months, all of whom were instructed to follow a daily protocol for PFMT. Quality of life was assessed at the beginning and at the end of the follow-up23. The authors concluded that pelvic floor strengthening exercises promote early rehabilitation and have a positive impact on the patients' quality of life and social activities23.

In this review, four studies evaluated the effectiveness of PFMT associated with biofeedback (BFB) and/or electrical stimulation (ES)17,19,20,22. Two studies evaluated the use of biofeedback to better identify the muscles to be worked during PFM training plus home exercise performance compared to the control group where participants did not receive a structured PFMT program17,20.

Moore et al.17 analyzed 205 patients and obtained similar results between groups, concluding that weekly sessions with biofeedback are as effective as the practice of PFMT at home. Ribeiro et al.20 analyzed 73 patients and found positive results in the use of biofeedback, with a significant improvement in the reduction of incontinence severity in the test group (p = 0.017).

The other two studies evaluated the use of biofeedback and electrical stimulation.21,24 Mariotti et al19 analyzed the results of 60 patients where 30 received BFB and electrical stimulation sessions, in addition to performing the PFMT at home and 30 only performed the exercises at home. There was a significant improvement in the continence of patients in the test group in the first 3 months (p < 0.05), as well as better urinary loss rates from the 4th week of therapy (p < 0.05)19.

Ahmed et al22 compared the results of 90 patients distributed into 3 groups, one receiving only electrical stimulation (ES); the other, electrical stimulation (ES) + Biofeedback (BFB) and the third only performed PFMT at home. The authors observed that patients receiving combined therapy (ES + BFB) had statistically better results compared to the other groups (P < 0.05).

Electrical stimulation is a method that can increase the success of pelvic muscle exercise in patients with incontinence after radical prostatectomy (19)(20)(21)(22). The combination of ES with BFB can help patients perform better and continue the exercises at home, thereby improving voluntary pelvic floor control19.

Evidence on the performance of PFMT supervised by a therapist is contradictory; in the present review, two similar studies obtained opposite results. In a meta-analysis published in 2015, the authors reached similar conclusions. Thus, it is not possible to recommend supervised PFMT for the purpose of early recovery from incontinence24.

Some authors recommend that PFMT be initiated soon after the removal of the bladder catheter, which usually occurs ten to twenty days after surgery, because it is believed that the initiated exercises suddenly accelerate the recovery of urinary continence15-16,19 20 21 22 23-24. However, a study25 performed with 120 patients, of which 60 had incontinence 14 days after catheter removal and 60 had incontinence after 12 months, where both received the same BFB + ES protocol, more than 90% of the atients achieved continence . at 6 months of treatment. This suggests that BFB + ES can be a non-invasive alternative for PPUI treatment both after catheter removal and after 12 months of surgery25. Several conservative therapeutic approaches such as behavioral therapy and pelvic floor muscle training have been used with different protocols in an attempt to reestablish the continence of these patients as early as possible20, however, so far the evidence is fragile, making it almost impossible to recommend a specific training program for PPUI.

Regarding the evaluation of the quality of the studies, all claimed to be controlled and randomized clinical trials. However, some of them failed to describe the randomization and blinding method used15,18 19-20, which resulted in a low score in the Jadad scale. Thus, some were considered as poor quality studies (total score less than or equal to 2). However, it is important to take into account that blinding of the involved parties (patient and therapist) is very difficult in an intervention study where the patient needs to participate actively, performing PFMT or receiving biofeedback or electrical stimulation. To attribute a score in this issue, any type of blinding that occurred in the study was taken into consideration (e.g., blindness in the statistical analysis). More detailed assessments of the methodological quality of these studies are needed for further conclusions.

The evidence found in this review indicates that PFMT associated or not with BFB and ES can have a positive effect on PPUI treatment. Patients with early identification of pelvic floor muscles may benefit from ES and BF sessions followed by structured training of the pelvic floor muscles. However, further studies are needed to generate better recommendations on therapies.

A systematic Cochrane review published in 2015 examined 99 clinical trials evaluating the effectiveness of PFMT with or without electrical stimulation and/or biofeedback in the prevention or treatment of PPUI and concluded that only 10.2% of the patients receiving the intervention remained incontinent after 12 months of surgery and 32.1% of patients who had no influence of the therapies remained incontinent26. However, the authors state that because of the fragility and contradictory results in some studies, it is not possible to make an official recommendation regarding the use of PFMT as soon as the catheter is removed, as well as of the positive results on the indication of BFB and ES26. The European Society of Urology27 corroborates the results of the Cochrane Review and both conclude that more robust clinical trials and more structured study designs should be performed in order to obtain more precise conclusions regarding the therapies evaluated26-27 .

Contributions to Nursing

Although PPUI treatment is part of nursing care, little has been described in the literature about the possible therapies to be applied by nurses. The analysis of the studies included in this review was no different; most of the studies had physicians or physical therapists as the researchers responsible, directly or indirectly conducting the rehabilitation of the patients.

An integrative review reports some nursing care for PPUI: guidance on the correct execution of pelvic floor strengthening exercises; development of a urinary control chart (voiding diary) to be used concomitantly with behavioral therapy; training of the perineum musculature through electrical stimulation or biofeedback28. The authors emphasize that nurses can continuously provide care through telemonitoring, reinforcing the series of the exercises and stimulating the motivation to persist in the treatment28.

CONCLUSION

PFMT associated or not with biofeedback and electrical stimulation for PPUI treatment may contribute to the early recovery of continence. Patients with early identification of pelvic floor muscles may benefit from ES and BFB sessions followed by structured training of the pelvic floor muscles.

However, larger studies with better methodological quality are necessary in order to generate more consistent recommendations.

A greater participation of nurses in the care related to the early return of the continence in post-prostatectomized patients through the implementation of pelvic floor strengthening exercises and behavioral therapy.

REFERENCIAS

1. Obrador AB, Ramos M, De La Iglesia MT, Zaforteza M. Treatment of prostate cancer according to life expectancy, comorbidity and clinical practice guidelines. An Sist Sanit Navar. 2014; 37(3):339-348. [ Links ]

2. Mata RF, Silva AC, Pereira MG, Carvalho EC. Acompanhamento telefônico de pacientes pós-prostatectomia radical: revisão sistemática. Rev Latino-Am Enfermagem. 2014; 22(2):337-45. Disponível em: http://dx.doi.org/10.1590/0104-1169.3314.2421Links ]

3. Dubbelman Y, Groen J, Wildhagen M, Rikken B, Bosch R. The recovery of urinary continence after radical retropubic prostatectomy: a randomized trial comparing the effect of physiotherapist-guided pelvic floor muscle exercises with guidance by an instruction folder only. BJU Int. 2010 Aug;106(4):515-22. Disponível em: http://dx.doi.org/10.1111/j.1464-410X.2010.09159.x [ Links ]

4. Barbalho EV, Chagas MIS, Pinto VPT, Dias MAS, Parente RF. Domiciliary survey on urinary incontinence in women. Journal of Nursing UFPE on line. 2011; 1716-1722. Disponível em: http://www.revista.ufpe.br/revistaenfermagem/index.php/revista/article/view/1709/pdf_625. [ Links ]

5. Abrams P, Cardozo, Khoury S, Wein A (editors). Incontinence. 4th edition. Paris: Health Publication Ltd. July; 2009. Disponível em: http://www.ics.org/Publications/ICI_4/book.pdfLinks ]

6. Averbeck MA, Rios LAS .Incontinência Urinária Pós-Prostatectomia Radical: Técnica de Implante do Esfíncter Urinário Artificial. Urologia essencial. 2014;4(1):24-34. Disponivel em: http://urologiaessencial.org.br/pdf/ed_1_2014/tecnica_cirurgica.pdfLinks ]

7. Zaidan P, Silva EB. Electrostimulation, response of the pelvic floor muscles, and urinary incontinence in elderly patients post prostatectomy. Fisioter mov. online. 2014; 27(1):93-100.Disponível em: http://www.scielo.br/pdf/fm/v27n1/0103-5150-fm-27-01-0093.pdfLinks ]

8. Kubagawa LM, Pellegrini JRF, Lima VP, Moreno AL. A eficácia do tratamento fisioterapêutico da incontinência urinária masculina após prostatectomia. Revista Brasileira de Cancerologia. 2006; 52(2):179-83. Disponível em: http://www.inca.gov.br/rbc/n_52/v02/pdf/revisao4.pdfLinks ]

9. Goode PS, Burgio KL, Johnson TM 2nd, Clay OJ, Roth DL, Markland AD, Burkhardt JH, Issa MM, Lloyd LK. Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy incontinence: a randomized controlled trial. JAMA. 2011 Jan 12; 305(2): 151-9. Disponível em: http://dx.doi.org/10.1001/jama.2010.1972 [ Links ]

10. MacDonald R, Fink HA, Huckabay C, Monga M, Wilt TJ. Pelvic floor muscle training to improve urinary incontinence after radical prostatectomy: a systematic review of effectiveness. BJU Int. 2007 Jul;100(1):76-81. [ Links ]

11. Tobía I, González MS, Martínez P, Tejerizo JC., Gueglio G, Damia O et al . Estudio randomizado sobre continencia urinaria postprostatectomía radical con rehabilitación perineal kiesica previa. Arch Esp Urol. 2008 Sep; 61(7):793-8. Disponível em: http://dx.doi.org/10.4321/S0004-06142008000700005. [ Links ]

12. Galvão TF; Pereira MG. Revisões sistemáticas da literatura: passos para sua elaboração. Epidemiol Serv Saude. 2014; 23(1):183-4. Disponível em: http://dx.doi.org/10.5123/S1679-49742014000100018 [ Links ]

13. University of Oxford. Centre for Evidence-Based Medicine (CEBM). Oxford Centre for Evidence-based Medicine - Levels of Evidence (March 2009) Internet. 2009 Disponível em: http://www.cebm.net/index.aspx?o=1025Links ]

14. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996 Feb;17(1):1-12. [ Links ]

15. Filocamo MT, Li Marzi V, Del Popolo G, Cecconi F, Marzocco M, Tosto A, Nicita G. Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. Eur Urol. 2005 Nov;48(5):734-8 [ Links ]

16. Manassero F, Traversi C, Ales V, Pistolesi D, Panicucci E, Valent F, Selli C. Contribution of early intensive prolonged pelvic floor exercises on urinary continence recovery after bladder neck-sparing radical prostatectomy: results of a prospective controlled randomized trial. Neurourol Urodyn. 2007;26(7):985-9. [ Links ]

17. Moore KN, Valiquette L, Chetner MP, Byrniak S, Herbison GP. Return to continence after radical retropubic prostatectomy: a randomized trial of verbal and written instructions versus therapist-directed pelvic floor muscle therapy. Urology. 2008 Dec;72(6):1280-6. Disponível em: http://dx.doi.org/10.1016/j.urology.2007.12.034. [ Links ]

18. Overgård M, Angelsen A, Lydersen S, Mørkved S. Does physiotherapist-guided pelvic floor muscle training reduce urinary incontinence after radical prostatectomy?: a randomised controlled trial. Eur Urol. 2008 Aug; 54(2):438-48. Disponível em: http://dx.doi.org/10.1016/j.eururo.2008.04.021. [ Links ]

19. Mariotti G, Sciarra A, Gentilucci A, Salciccia S, Alfarone A, Di Pierro G, Gentile V.Early recovery of urinary continence after radical prostatectomy using early pelvic floor electrical stimulation and biofeedback associated treatment. J Urol. 2009 Apr;181(4):1788-93. Disponível em: http://dx.doi.org/10.1016/j.juro.2008.11.104 [ Links ]

20. Ribeiro LH, Prota C, Gomes CM, de Bessa J Jr, Boldarine MP, Dall'Oglio MF, Bruschini H, Srougi M. Long-term effect of early postoperative pelvic floor biofeedback on continence in men undergoing radical prostatectomy: a prospective, randomized, controlled trial. J Urol. 2010 Sep;184(3):1034-9. Disponível em: http://dx.doi.org/10.1016/j.juro.2010.05.040. [ Links ]

21. Glazener C, Boachie C, Buckley B, Cochran C, Dorey G, Grant A, Hagen S, Kilonzo M, McDonald A, McPherson G, Moore K, N'Dow J, Norrie J, Ramsay C, Vale L. Conservative treatment for urinary incontinence in Men After Prostate Surgery (MAPS): two parallel randomised controlled trials. Health Technol Assess. 2011 Jun;15(24):1-290, iii-iv. Disponível em: http://dx.doi.org/10.3310/hta15240. [ Links ]

22. Ahmed MT, Mohammed AH, Amansour A. Effect of pelvic floor electrical stimulation and biofeedback on the recovery of urinary continence after radical prostatectomy. Turkish Journal of Physical Medicine & Rehabilitation. 2012; 58(3):171-7. [ Links ]

23. Lombraña M, Izquierdo L, Gómez A, Alcaraz A. Impact of a nurse-run clinic on prevalence of urinary incontinence and everyday life in men undergoing radical prostatectomy. J Wound Ostomy Continence Nurs. 2013;40(3):309-312. Disponível em: http://dx.doi.org/10.1097/WON.0b013e31828f5e22 [ Links ]

24. Fernández RA, García-Hermoso A, Solera-Martínez M, Correa MT, Morales AF, Martínez-Vizcaíno V. Improvement of continence rate with pelvic floor muscle training post-prostatectomy: a meta-analysis of randomized controlled trials. Urol Int. 2015;94(2):125-32. Disponível em: http://dx.doi.org/10.1159/000368618 [ Links ]

25. Mariotti G, Salciccia S, Innocenzi M, Gentilucci A, Fasulo A, Gentile V, Sciarra A. Recovery of Urinary Continence After Radical Prostatectomy Using Early vs Late Pelvic Floor Electrical Stimulation and Biofeedback-associated Treatment. Urology. 2015 Jul;86(1):115-20. Disponível em: http://dx.doi.org/10.1016/j.urology.2015.02.064. [ Links ]

26. Anderson CA, Omar M, Campbell SE, Hunter KF, Cody JD, Glazener CMA. Conservative management for postprostatectomy urinary incontinence. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD001843. DOI: 10.1002/14651858.CD001843.pub5 http://uroweb.org/wp-content/uploads/20-Urinary-Incontinence_LR1.pdf [ Links ]

27. Lucas MG; Bedretdinova D.; Berghmans LC; Bosch JLHR; Burkhard FC; Cruz F; Nambiar AK; Nilsson CG; Tubaro A; . Pickard RS. Guidelines on Urinary Incontinence. European Association of Urology 2015. Disponível em: http://uroweb.org/wp-content/uploads/20-Urinary-Incontinence_LR1.pdfLinks ]

28. Santos D, Silva F, Saldanha E, Lira A, Vitor A. Cuidados de enfermagem ao paciente em pós-operatório de prostatectomia: revisão integrativa. Revista Eletrônica de Enfermagem Internet. 2012 Set 30; 14(3): 690-701. Disponível em: http://revistas.ufg.emnuvens.com.br/fen/article/view/14980Links ]

Received: March 03, 2017; Accepted: July 08, 2017

Creative Commons License Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons