Keywords
1. Pelvic Floor Muscle Training
2. Urinary Incontinence
3. Radical Prostatectomy
4. Prostate Cancer Rehabilitation
5. Transperineal Ultrasound Biofeedback
Prostate cancer stands as the most prevalent cancer among men, leading to the widespread use of radical prostatectomy as a treatment method. However, a significant majority of those who undergo this surgical intervention experience a sharp decline in their quality of life owing to postoperative complications such as urinary incontinence. With an estimated 80% of men post-prostatectomy facing this demoralizing challenge, the need for effective rehabilitative strategies has become more pressing than ever.
In a pioneering effort to combat this issue, a randomised controlled trial titled the MaTchUP, and published in BMJ Open, has put forward a protocol aiming to redress urinary incontinence through a personalized pelvic floor muscle training program. Professors Paul P. Hodges and Ryan R. Stafford from the School of Health and Rehabilitation Sciences, The University of Queensland, in collaboration with other experts in the field, outlined the efficacy of a training program that begins preoperatively and focuses on the functional training of specific pelvic floor muscles crucial for urinary continence. The study was published under the digital object identifier (DOI) 10.1136/bmjopen-2018-028288.
The significance of a customized training regime over the usual ‘one-size-fits-all’ approach is meticulously analyzed in this program. Unlike conventional training, which gauges maximal pelvic floor muscle contraction via digital rectal examination, the proposed protocol uniquely incorporates assessment and biofeedback through transperineal ultrasound imaging to aid in training. This advanced methodology is expected to yield more substantial outcomes in maintaining urinary continence post-surgery.
The study plans to enroll 363 men scheduled to undergo radical prostatectomy for prostate cancer. These participants will be randomly categorized into three groups: focused urethral training, conventional training, and no training. Clinical data will be accumulated at multiple junctions: baseline (1-2 weeks before surgery), after catheter removal, weekly up until the 3-month mark (the primary endpoint), and monthly up until 12 months. The primary outcome measured will be using the 24-hour pad weight test, among other pertinent data such as incidence of incontinence, quality of life impacts, and cost-effectiveness of the intervention. Additionally, neuromuscular control measures of the pelvic floor muscles will be assessed at baseline, postsurgery, 6 weeks, and at the 3 and 12 months timeframes.
This study holds particular promise due to its rigorous methodological design, incorporating blinding of assessors and statisticians to participant group allocation to mitigate bias. Furthermore, its registration with the Australian New Zealand Clinical Trials Registry and the granting of ethical approval by university and host hospital ethics committees establish its credibility and adherence to ethical standards.
As prostatectomy remains the prevailing treatment, the morbidity associated with this surgical option includes not just the encumbrance of urinary incontinence but also the broader ramifications it has on the patient’s overall welfare. Prior systematic reviews have found insufficient evidence to support the efficacy of post-surgical pelvic floor muscle training, thus throwing into question the commonly prescribed treatments that currently prevail in clinical settings. The dire need for a revamp in the rehabilitative paradigm finds its cornerstone in this randomized clinical trial and the results it anticipates.
The expected scope of this study is vast, with outcomes to be disseminated through national and international conference presentations and publications in peer-reviewed journals. It aims to set a new precedent for post-prostatectomy care that could revolutionize the approach to mitigating urinary incontinence in this patient demographic.
References
1. BMJ Open. Efficacy of a personalised pelvic floor muscle training programme on urinary incontinence after radical prostatectomy (MaTchUP): protocol for a randomised controlled trial. 2019;9(5):e028288. doi: 10.1136/bmjopen-2018-028288.
2. AIHW. Cancer in Australia 2017. Cancer series no101. Canberra: AIHW, 2017.
3. Litwin MS, Melmed GY, Nakazon T. Life after radical prostatectomy: a longitudinal study. J Urol 2001;166:587–92. doi: 10.1016/S0022-5347(05)65989-7.
4. Yaxley JW, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet 2016;388:1057–66. doi: 10.1016/S0140-6736(16)30592-X.
5. Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2010;1:CD005654. doi: 10.1002/14651858.CD005654.pub2.
The MaTchUP trial not only seeks to establish the effectiveness of preoperative and postoperative pelvic floor muscle training but also strives to underline the importance of personalized, biomechanically informed approaches. Advances in ultrasound imaging and biofeedback have rendered such targeted interventions possible, which could be pivotal in restoring continence and quality of life to countless men following radical prostatectomy.
Upon completion, if proven successful, personalized training regimes informed by ultrasound imaging could set a new standard in urinary incontinence management. It is a move that may herald a long-awaited shift toward precision medicine in the domain of postoperative prostate cancer care, delivering hope and improved outcomes for the many facing a diagnosis of prostate cancer and its challenging aftermath.