Table 4.
Current management strategies for LUTS post pelvic cancer treatment from literature analysis
| First author | LUTS | Primary outcome | Time to symptom improvement | Adverse events | Summary |
|---|---|---|---|---|---|
| Conservative treatment | |||||
| Pelvic floor muscle training (PFMT) | |||||
| Campbell et al. 72 | UI |
UI symptoms
Treated vs. control: No significant benefit of therapists teaching PFMT for either prevention or treatment |
N/a | None | No significant benefit from pelvic floor exercises for UI |
| Centemero et al. 73 | UI |
1 mo: Significantly more patients in pre‐op PFMT were continent 3 mo: Significantly more patients in pre‐op PFMT were continent Pre‐op PFMT also decreased risk of becoming incontinent at 1 month post op |
1 mo | None | Preoperative PFMT may improve early continence and QoL outcomes after RP |
| Centemero et al. 74 | UI | 1 and 3 mo: UI symptoms significantly improved in pre‐op PFMT group | 1 mo | None | Pre‐op PFMT hastens the return to continence more than post‐op alone and decreases the severity of UI following RRP |
| Dieperink et al. 75 | Urinary, bowel, sexual, and hormonal symptoms |
TG guided intervention vs. standard care improved urinary symptoms significantly Patients with more severe impairment gained most |
4 wk | None | Multidisciplinary rehabilitation in irradiated PCa patients improved urinary and hormonal symptoms, and QoL |
| Dubbelman et al. 76 | UI | No significant difference in recovery of continence between physiotherapist assisted PFMT and self‐training with information folder | 6 mo | None | Physiotherapist assisted PFMT seems to have no beneficial effect on the recovery of continence over an information only approach |
| Faithfull et al. 77 | LUTS |
IPSS: Significant improvement in LUTS symptoms and voiding volume*
Improvement in QoL |
4 mo | None | Self‐management provided benefits for men |
| Filocamo et al. 78 | UI | At 1 mo significantly more patients in structured PFMT group achieved continence | 1 mo | None | After RRP an early supportive rehabilitation PFMT programme significantly reduces continence recovery time |
| Geraerts et al. 79 | UI |
No significant improvement re duration of UI between pre‐op and post‐op PFMT QoL better with pre‐op patients |
30 d | None | Three preop sessions of PFMT did not improve duration of incontinence but may impact QoL positively |
| Glazener et al. 80 | UI | Trials 1 and 2: Rates of UI not significantly different between PFMT vs. advise only | 12 mo | None | One‐to‐one PFMT is unlikely to be effective or cost effective |
| Goode et al. 81 | UI | Mean UI episodes decreased significantly in both behaviour and behaviour + stimulation groups vs. controls (p = 0.001) | 8 wk | None |
Behavioural therapy, compared with a delayed‐treatment control, resulted in fewer incontinence episodes Addition of BF and PFES † didn't result in greater effectiveness |
| Khoder et al. 17 | UI |
Grade of incontinence after RP
Significantly improved after PFMT, AES, or combinations* |
3 wk | None | |
| Lin et al. 82 | UI |
Urinary control in the exercise group was better than in the non‐exercise group Urine leakage decreased over time regardless of the group |
1 mo | None | Patient education regarding PFMT by a nurse prior to and after surgery has a significant impact on the early recovery of UI |
| Marchori 18 | UI |
Median time of continence recovery
Significantly quicker time to recovery with pelvic floor re‐educational dedicated program vs. no education* |
44 (treatment) vs. 76 (control) days (p < 0.01) | None | PFMT supported significantly improves time to recovery of continence |
| Mariotti et al. 19 | UI |
The mean leakage weight became significantly lower (p < 0.05) in group 1 than Median time of continence recovery:
Reductions in UI in treatment vs. control* |
4 wk | None | Early, pelvic floor electrical stimulation plus biofeedback have a significant positive impact on the early recovery of UI |
| Nilssen et al. (based on Overgard subjects) 83 | Urinary, sexual and bowel function | No statistically significant difference in HRQoL was found between treatment groups | 12 mo | None | No significant difference between physiotherapist‐guided training vs. standard self‐training |
| Overgard et al. 16 | UI |
3 mo: no statistically significant difference in continence status 6 mo: guided PFMT significantly better continence than self‐training 12 mo: clinically and statistically significant improvements with guided training |
6 mo | None | Physiotherapist‐guided PFMT training for up to 6 mo significantly improves continence status vs. self or standard training |
| Park et al. 31 | UI | 12 wk: Except for grip strength, all physical functions were better in the exercise group than in the control group. Better continence recovery and improved QoL in exercise group | 12 wk | None | 12‐wk combined exercise intervention after RP results in improvement of physical function, continence rate, and QoL |
| Patel et al. 84 | UI |
6 wk: UI symptoms significantly lower in physiotherapist‐guided preop group 3 mo: No significant difference Physiotherapist‐guided PFMT reduced time to continence significantly |
6 wk | None | Physiotherapist‐guided PFMT 4 wk preoperatively, significantly reduces the time to continence and it significantly reduces the duration and severity of early UI after RP |
| Ribeiro et al. 85 | UI |
Number of pads used daily 96.15% (PFMT) vs. 75.0% (control) continent at 12 mo* + improvements in other LUTS symptoms* |
12 mo | None | Early biofeedback‐PFMT is beneficial for reducing duration and severity of UI |
| Serdà 86 | UI |
UI symptom, intensity, frequency, difficulty and limitation of activity were significantly improved QoL correlated with UI improvement |
24 wk | None | Improvement in QoL is mediated by improvement in UI symptoms |
| Tienforti et al. 87 | UI | 3 and 6 mo: UI symptoms significantly improved in pre‐op PFMT group and better NS QoL scores | 1 mo | None | Pre‐op PFMT, even if started a day before surgery, can confer significant benefits in terms of UI symproms |
| Van Kampen et al. 88 | UI | Continence achieved in both groups but duration and degree of incontinence significantly better with PFMT vs. placebo | 3 mo | None | PFMT improved UI if started at catheter removal |
| Wille et al. 89 | UI | UI symptoms: No significant difference among the three groups | N/A | None | PFMT, electrical stimulation (ES) and biofeedback did not affect continence |
| Zahariou et al. 90 | UI |
1 mo: No difference between groups 3 and 6 mo: Significantly higher number of continent patients in treatment vs. control group |
3 mo | None | Nurse‐trained patients achieve higher continence rates vs. patients who were just informed re PFMT |
| Oral medication | |||||
| Serotonin‐norepinephrine reuptake inhibitor | |||||
| Cornu et al. 91 | SUI | Significant reduction in urinary symptoms as well as QoL improvements with duloxetine vs. placebo | 3 mo | Both treatments well tolerated (fatigue was the only AE associated with duloxetine) | Duloxetine is effective in the treatment of SUI & improves QoL |
| Filocamo et al. 92 | SUI |
Duloxetine + rehab: Significant decrease in pad use and significantly more dry patients at 16 wk At 24 wk no significant difference between groups in dry rates |
16 wk | 15.2% had adverse effects | Duloxetine improves continence temporarily after RP |
| Neff et al. 93 | Stress UI | Significant decrease in daily pad use and Incontinence Impact Questionnaire (IIQ‐7) | 1 mo |
Intolerable side effects in 14/94 (15%) Fatigue, light‐headedness, insomnia, nausea and dry mouth |
Duloxetine improved post‐prostatectomy SUI though drop out rate was high |
| Alpha blockers | |||||
| Jang et al. 94 | Voiding function | Postop voiding parameters were not better with tamsulosin vs. control | 7 d | Well tolerated | Tamsulosin 0.2 mg/day does not prevent acute voiding difficulty |
| Oyama et al. 95 | LUTS | Better IPSS scores and recovery with silodosin compared with tamsulosin or naftopidil | 3 mo | Not specified | Silodosin may provide a favourable improvement of LUTS after BT |
| Shimizu et al. 96 | LUTS |
6 mo; Significant improvements in the IPSS with silodosin vs patients not on it 3 and 12 mo:Silodosin significantly enlarged the bladder capacity No improvement of bladder outlet obstruction index (BOOI) |
3 mo | Well tolerated | Silodosin temporarily improves LUTS |
| Tsumura et al. 97 | Urinary symptoms |
1 mo: Significantly greater decreases in urinary symptoms with silodosin than naftopidil 6 mo: Silodosin showed a significant improvement in the PVR vs. tamsulosin |
1 mo | Well tolerated | Silodosin has a greater impact on improving PI‐induced LUTS vs. naftopidil and tamsulosin |
| Antimuscarinics | |||||
| Zhang et al. 98 | Urinary symptoms |
Significant reductions in overactive bladder symptom scores with solifenacin Episodes of daytime, frequency, nocturia, urgency, and urge urinary incontinence were significantly lower than with solifenacin (p < 0.05) |
2 wk | Well tolerated | Solifenacin can be beneficial for the management of urinary symptoms after surgery for bladder tumours |
| Phosphodiesterase type 5 inhibitor (PDE5‐I) | |||||
| Gacci et al. 99 | UI |
Urinary function (UF) improved significantly in all arms Nightly resulted in greater UF at 3, 6, and 9 mo vs. placebo |
1 mo | Well tolerated | Daily use of vardenafil provides better continence rate |
| Gandaglia et al. 20 | Recovery of sphincter and pelvic floor function |
Significantly lower rates of continence recovery with no PDE5‐I Daily PDE5‐I associated with higher continence recovery at vs. on demand |
1 yr | Well tolerated |
PDE5‐I use significantly improved continence recovery Effect is significantly better with daily vs. on demand use |
| Other treatments | |||||
| Bonetta and Di Pierro 100 | UTIs | Significantly more LUTS without cranberry extract observed | Preventative study – lasted 7 wk | Gastric pain | Cranberry extracts reduced the incidence of LUTIs when given during RT |
| Campbell et al. 101 | Urinary symptoms | No significant difference in urinary symptoms | 2 wk | None | No significant difference in urinary symptoms during EBRT with cranberry juice vs. apple juice |
| Cowan et al. 102 | Urinary symptoms | Non‐significant increase in urinary symptoms with placebo vs. cranberry | 6 wk | None | Cranberry juice did not affect urinary symptoms though the study was of limited size and duration |
| Matsushita et al. 103 | Urinary symptoms | No difference between the groups in terms of urinary function | 3 mo | None | Vitamin B12 doesn't improve urinary function significantly after RP |
| Sommariva et al. 104 | Cystitis |
4 wk – bladder capacity and urinary symptoms improved in all patients 8 wk – significant improvements in urinary symptoms and pain |
4 wk | None | Intravescical sodium hyaluronate seems a valid and quick therapeutic solution for cystitis from chemo or RT |
| Tanaka et al. 105 | LUTS | Eviprostat‐treated patients showed significantly better recovery compared to Eviprostat‐untreated control at 6 mo | 3 mo | None | Eviprostat demonstrated benefits in post‐op LUTS after BT |
| Containment devices | |||||
| Fader et al. 106 | UI |
Pads most highly rated vs. Sheaths, clamps and BWUs BWU rated worse than the sheath Sheath rated highest for extended period use ~50% used combination of these over 3 mo |
N/A | Clamp rated as significantly more painful than other devices |
Male devices can help men with UI Most men prefer to use a combination of devices and pads in order to meet their lifestyle needs |
PFMT, Pelvic floor muscle training; AES, anal electrical stimulation; IPSS, International Prostate Symptom Scores; d, day; wk, week; mo, month; yr, year. *p ≤ 0.05. †Pelvic muscle electrical stimulation.