Fizioterapevtski pristopi za urinsko inkontinenco po prostatektomiji : pregled literature

Štavar, Janja (author), Šćepanović, Darija (mentor)

Uvod:Urinska inkontinenca je nezanemarljiva posledica radikalne prostatektomije. Ker ima velik vpliv na kakovost pacientovega življenja, se skuša s konzervativnimi intervencijami čimbolj izboljšati simptome ali skrajšati čas do povrnitve kontinence. Časovno izvajanje intervencije je različno – od predoperativne, pooperativne ali pa kombinacije obojega. Pomembno vlogo pri izvajanju teh intervencij imajo fizioterapevti in medicinske sestre. Namen: Namen diplomskega dela je na podlagi sistematičnega pregleda strokovne in znanstvene literature preveriti načine fizioterapevtskih intervencij za urinsko inkontinenco po prostatektomiji, kakšna je učinkovitost intervencij na simptome urinske inkontinence in kakovost življenja ter ali dodatek električne stimulacije, biofeedbacka ali nadzorovanega treninga poveča učinkovitost samostojne vadbe mišic medeničnega dna, pa tudi, ali intervencije pripomorejo k hitrejši ponovni vzpostavitvi kontinence. Metode dela: Iskanje literature je potekalo po splošnih podatkovnih zdravstvenih in medicinskih zbirkah: PubMed, MEDLINE, CINAHL, PEDro in Cochrane Library. Izbrani članki so morali zadostiti naslednjim kriterijem: randomizirana kontrolirana študija, objava po letu 2008, fizioterapija urinske inkontinence po radikalni prostatektomiji, predoperativne in/ali postoperativne intefvencije, slovenski in angleški jezik, urinska inkontinenca pri moških, ocena po PEDro lestvici višja ali enaka 4. Rezultati: Med iskanjem literature je bilo najdenih 71 strokovnih člankov. V pregled je bilo vključenih 13 člankov, ki so najbolj ustrezali vključitvenim in izključitvenim kriterijem med letoma 2008 in 2018. Najpogosteje uporabljena intervencija je vadba mišic medeničnega dna kot samostojna intervencija ali v kombinaciji z električno stimulacijo, biofeedbackom, vedenjsko terapijo. Poleg tega pa se preverja tudi učinkovitost pilates vadbe. Vse omenjene intervencije so pokazale pozitivne učinke na simptome urinske inkontinence. Individualno učenje in spremljanje izvajanja vadbe mišic medeničnega dna pa se je izkazalo kot najbolj vsestransko uporabno. Razprava in zaključek: Katera oblika intervencije je najbolj učinkovita, je skoraj nemogoče oceniti. Vrednost različnih pristopov za konzervativno zdravljenje urinske inkontinence po prostatektomiji, vključno z vadbo mišic medeničnega dna, biofeedbackom in električno stimulacijo, ostaja nejasno zaradi nizke do srednje kvalitete vseh raziskav, pa tudi zaradi precejšnjih razlik v intervencijskih protokolih, populaciji in različnih meritev izidov intervencij. Kot najbolj uporabna se sicer izkaže najbolj osnovna vadba mišic medeničnega dna. Za boljšo primerjavo, katera intervencija je učinkovita, ostaja potreba po kvalitetnih raziskavah, ki se bodo osredotočale tudi na vpliv intervencije na kakovost življenja pacientov.

• Language: Slovenian
• Keywords: urinska inkontinenca pri moških, urinska inkontinenca po prostatektomiji, fizioterapija, radikalna prostatektomija, vadba mišic medeničnega dna
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2018
• PID: 20.500.12556/RUL-104877
• COBISS.SI-ID: 5514347
• Publication date in RUL: 14.10.2018

Secondary language

• Language: English
• Title: Physiotherapy intervention for urinary incontinence after prostatectomy : literature review

Abstract

Introduction: Urinary incontinence is common after radical prostatectomy and it has major impact on patience′s quality of life. Physiotherapists try to shorten time to regain continence or improve symptoms of urinary incontinence by using different methods of conservative management. Timing of application vary from preoperative, postoperative or combination of preoperative and postoperative interventions. Purpose: The main purpose of the thesis is to verify conservative methods of physiotherapy for urinary incontinence after radical prostatectomy, their impact and efficiency on symptoms of urinary incontinence and on quality of life. Beside that we want to verify if addition of electrical stimulation, biofeedback or supervised pelvic floor muscles training increase efficacy of independent home exercises of pelvic floor muscles and if interventions help shortening time to regain continence. Everything is based on the review of scientific literature. Methods: The research was obtained using the following online databases: PubMed, MEDLINE, CINAHL, PEDro and Cochrane library. The inclusion criteria were: randomized controlled trial, published after year 2008, physiotherapy of urinary incontinence after radical prostatectomy, preoperative and/or postoperative interventions, in Slovenian or English language, score 4 or more on the PEDro scale. Results: From 71 examined articles, 13 were included in the literature review. They were published between the years 2008 and 2018. Results show that most often used intervention is pelvic floor muscle exercise (alone or in combination with electrical stimulation or biofeedback or behavioral therapy). All these combinations were found effective on symptomes of urinary incontinence compared to no treatment. Positive impact has also pilates exercise. The most convenient intervention was individual teaching and monitoring of pelvic floor exercise. Discussion and conclusion: It is impossible to determine witch intervention or combination of interventions is the most effective due to poor quality of studies, big differences in protocols, populations and measurement of the income. Pelvic floor muscle exercise is found to be most convenient. In witch cases or how is electrical stimulation the most useful, is still unknown. Additional high-quality research oriented on improving patience′s quality of life is needed.

• Keywords: urinary incontinence in men, post prostatectomy urinary incontinence, radical prostatectomy, physical therapy, pelvic floor muscle exercise