Behavioral therapy found efficacious in post-radical prostatectomy men

Birmingham, AL-Behavioral therapy can net significant improvements for men with incontinence post-radical prostatectomy, even in patients 5 years removed from surgery, according to a study from the Center for Aging at the University of Alabama, Birmingham and the Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center.

Roughly 1% to 3% presented with urge incontinence, 43% to 47% presented with stress incontinence, and 50% to 54% presented with mixed incontinence depending on the cohort. Again, depending on the cohort, 25% to 39% had done pelvic floor exercise prior to entering the trial and 19% had received antimuscarinic medication. Only 3% to 4% had been given alpha-blockers.

"No matter how far removed from their prostatectomies men might be, they should be told that they may improve their incontinence with behavioral therapy," lead author Patricia Goode, MD, MSN, told Urology Times. "The men [in the study] showed a 50% decrease in episodes. About one in ten became completely dry.

"These men could see improvement at 2 weeks according to their diaries. The greatest improvement was seen in the first 3 to 4 weeks. After that, it levels out, but there is still continued improvement," said Dr. Goode, medical director of the University of Alabama. She noted that the nearly immediate improvement the men saw had an effect on compliance with the regimen.

"These men were motivated. At 8 weeks-the main outcome measure for short-term improvement-the adherence to the regimen was 100% and 93% [for the behavioral therapy and combination therapy groups, respectively]. At 12 months, it was 91% and 81%," she said.

The treatment regimen consisted of four office visits approximately 2 weeks apart. During the first visit, the men were given exercise instructions and told to follow them three times daily. They were also told to keep daily bladder diaries.

On the second visit, the men were given additional bladder control instruction. The third and fourth visits consisted of diary review and instructions for a continuing maintenance program.

When asked why these men had not received treatment earlier, Dr. Goode said she was uncertain.

"The prevailing opinion in some urology circles is that after a year [following prostatectomy], men become fairly stable," Dr. Goode said. "They might be able to achieve a small improvement, but nothing much. They had healed from their initial surgery, and their only option was surgery for incontinence."

Dr. Goode said that she and her colleagues are currently analyzing predictors of behavioral treatment success or failure.