[Transrectal sonography biofeedback training (TSB). Incontinence training after radical prostatectomy]

Abstract

Background: Biofeedback methods are used in severe incontinence after radical prostatectomy (RP). Although contraction of the urethral sphincter can be demonstrated very well to the patient by video urethrocystoscopy, this method is invasive. Transrectal sonography biofeedback training (TSB) is a less invasive method for visualization of contractions of the musculus sphincter urethrae externus.

Patients and methods: A total of 100 patients with urinary incontinence after RP either lost 50 g urine or more during a 1-h pad test or they could not feel their sphincter contraction during physiotherapy continence training. Patients lying on their left side followed the examination with a 7.5-MHz ultrasound probe on a second monitor. Patients were then asked to reduce the urinary stream for 5 s with 10%, 30%, 70% and 100% of maximum possible strength. A reduction in the diameter of the fluid column just above the sphincter urethrae externus proportional to the strength of contraction could be demonstrated to the patients.

Results: Pain prevented TSB in 8%; 8% reported on severe, 5% on moderate and 24% on mild pain. In 4% the sphincter could not be precisely detected. A total of 88% showed differentiated tension, while 96% claimed that TSB was helpful for restoring continence after radical prostatectomy.

Conclusion: TSB, particularly in the transversal plane, is a viable method to treat urinary incontinence after radical prostatectomy. In 8% of patients pain prevented TSB, in 4% TSB did not lead to evaluable results, while in 88% TSB demonstrated the effects of different tension strength of the sphincter muscle to the patients. The method is very well accepted by the patients themselves.