Effects of Biofeedback in Preventing Urinary Incontinence and Erectile Dysfunction after Radical Prostatectomy

Abstract

In this study, we present a biofeedback method for the strengthening of perineal muscles during the preoperative procedures for radical prostatectomy, and we evaluate this technique as a prevention measure against complications such as urinary incontinence (UI) and erectile dysfunction (ED), which affect prostatectomy patients after surgery. In the experimental protocol, the patients performed specific exercises with the help of a device that provided the patient with visual biofeedback, based on a plot of the anal pressure. For the experimental protocol, we selected 20 male patients, with an average age of 64.0 years, and submitted them to ten therapeutic sessions each. A control group consisting of 32 men with an average age of 66.3 years, who were treated with the same surgical procedure but not with the preoperative procedures, also took part in the experiment. To evaluate UI and ED after the surgery in both control and experimental groups, we used two validated questionnaires-to assess UI, we used the King's Health Questionnaire (KHQ) and, for ED, we used the International Index of Erectile Function (IIEF-5) Questionnaire. We compared the variables associated with UI and ED after the surgery for the control and experimental groups. The occurrence of UI after radical prostatectomy in the control group (100% of the patients) was higher than that for the experimental group (5% of the patients), with p < 0.0001. Likewise, the occurrence of erectile dysfunction after prostatectomy in the control group (48.6% of the patients) was higher than that for the experimental group (5% of the patients), with p < 0.0001. The number of nocturia events also decreased as a consequence of the intervention (p < 0.0001), as did the number of disposable underwear units for urinary incontinence (p < 0.0001). Furthermore, we compared, only for the experimental group, the anal pressure before the biofeedback intervention and after the surgery, and we verified that the anal pressure after surgery was significantly higher (p < 0.0001). The results strongly suggest that the preoperative biofeedback procedure was effective in decreasing urinary incontinence and erectile dysfunction after radical prostatectomy. As future work, we intend to extend this analysis for larger samples and considering a broader age range.

Keywords: biofeedback intervention; erectile dysfunction; preoperative care; radical prostatectomy; urinary incontinence.

Figure 1

Inflatable anal latex probe used with the Neurodyn Evolution biofeedback device (Ibramed, Amparo, Sao Paulo, Brazil).

Figure 2

(A) Patient positioning (right lateral decubitus position) for both the taring and biofeedback stages. (B) Probe insertion using the decubitus positioning (here inverted for probe visualization).

Figure 3

Example of pressure signal measured during the pressure taring, which precedes the biofeedback protocols. The Neurodyn Evolution screen shows the maximum voluntary contraction that each volunteer manages to apply to the anal probe (in this example, around 10% of the maximum sensor capacity). The procedure is repeated for a total of three times, and we take the maximum MVC, and use it as a reference for defining the target pressure during the biofeedback sessions.

Figure 4

The fast, triangular-shaped pressure waveforms used as the reference for each volunteer during the first stage of the biofeedback sessions, and the corresponding pressures exerted by a patient. We oriented each participant to try and reproduce the reference waveforms by exerting pressure over the anal probe, while watching the generated signals in real time. Note that, as requested, the patient tried to maintain the actual pressure values above the minimum reference, while following the basic triangular shapes.

Figure 5

The slow, sustained pressure waveform used as the reference for each volunteer during the second stage of the biofeedback sessions, and the corresponding pressures exerted by a patient. We oriented each participant to try and keep a sustained pressure level above the reference waveform, by exerting pressure over the anal probe, while watching the generated signals in real time.