Behavioral therapy improved continence after prostatectomy

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Behavioral therapy helped reduce urinary incontinence in men who had the condition for at least 1 year following radical prostatectomy.

In a prospective randomized trial, 208 men aged 51 to 84 years whose incontinence persisted for 1 to 17 years after radical prostatectomy were assigned to 1 of 3 groups: One set of men underwent 8 weeks of behavioral therapy (four visits approximately 2 weeks apart), which entailed pelvic-floor-muscle training and bladder-control strategies. The men in the “behavior plus” group received the behavioral therapy as well as in-office, dual-channel electromyography biofeedback and daily home pelvic-floor electrical stimulation at 20 Hz, current up to 100 mA. Finally, the control group members kept daily bladder diaries that were reviewed during their clinic visits—every 2 weeks for 8 weeks.

At the end of 8 weeks, mean incontinence episodes had fallen by 55% in the behavioral therapy group, from 28 to 13 per week. The behavior-plus intervention yielded a 51% decrease, from 26 to 12 episodes per week. Both reductions were significantly greater than the 24% drop noted in the control group (from 24 to 21 incontinence episodes per week). At the end of treatment, complete continence was reported by 15.7% of the men undergoing behavior therapy and 17.1% of the behavior-plus group, but just 5.0% of the control group.

The active-treatment improvements endured through the1-year follow-up period: The behavior group participants ended follow-up with a 50% reduction in episodes, to 13.5 episodes per week, and the behavior-plus men averaged a 59% reduction, to 9.1 episodes per week (JAMA. 2011;305:151-159).

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