INTERPRETING THE AMERICAN UROLOGICAL ASSOCIATION INCONTINENCE AFTER PROSTATE TREATMENT GUIDELINES THROUGH THE LENS OF PHYSICAL THERAPY

Background: Urinary incontinence after prostate treatment (IPT) is a clinically significant condition that causes a high degree of patient distress. It is one of the few urologic diseases that is iatrogenic, and, therefore, predictable and perhaps preventable. It is also a patient population we should be seeing in our clinics as physical therapists due to the efficacy of the interventions within our skill set.  However, there has been debate regarding this efficacy, but this clinical practice guideline for IPT illuminates the necessary role of physical therapy after an exhaustive literature analysis. 

Purpose: Come join us as we review the American Urological Association (AUA) Guideline for Incontinence After Prostate Treatment. See where physical therapy fits in and how we can use this evidence-driven resource in our clinical practices for guidance on recommendations, prognosis and patient education.

Methods: The systematic review utilized to inform this guideline was conducted by a methodology team at the Mayo Clinic Evidence-Based Practice Research Program. The scope of the topic and the discussion of the final systematic review used to develop guideline statements was conducted in conjunction with the Incontinence after Prostate Treatment expert panel. A research librarian conducted searches in Ovid MEDLINE (from 2000 to December 21st, 2017), Cochrane Central Register of Controlled Trials (from 2000 to December 21st, 2017) and Cochrane Databases of Systematic Reviews (from 2000 to December 21st, 2017). Searches of electronic databases were supplemented by reviewing reference lists of relevant articles. Panel members identified additional references through 12/31/2018.

Results: The specific role of physical therapy in the patient population experiencing incontinence after prostate treatment is identified in four of the guideline statements.  These statements address with Level B evidence how pelvic floor muscle training and exercise should be recommended immediately post-prostatectomy, as well as, later in the recover period for those seeking intervention.  Pre-operative pelvic floor muscle training and exercise may be offered with potential benefits clearly outweighing any potential risks despite Level C evidence.  There are several other included guideline statements which are highly useful to physical therapists for assisting patients with prognosis information and long term continence recovery planning.        

Conclusion(s): This clinical practice guideline demonstrates a sufficient level of evidence for the efficacy of physical therapy care in patients with incontinence after prostate treatment.  

Implications: Based on our findings, physical therapists who work with patients experiencing incontinence after prostate treatment should have confidence that pelvic floor muscle training and exercise, along with patient education, plays an important role in the patient's recovery of continence.  However, not all outcomes are optimal, and this guideline also addresses evidence based recommendations physical therapists can use to guide an alternate intervention plan and offer education for the long term recovery of our patients.   

Funding, acknowledgements: None

Keywords: pelvic floor muscle training, urinary incontinence, prostatectomy

Topic: Pelvic, sexual and reproductive health

Did this work require ethics approval? No

Institution: American Urological Association

Committee: American Urological Association

Reason: This presentation includes information from a systematic review