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DOI: 10.1055/s-2006-926980
© Georg Thieme Verlag KG Stuttgart · New York
Evidenz physiotherapeutischer Behandlung bei Postprostatektomie-Inkontinenz
Evidence of Physiotherapy for Postprostatectomy IncontinencePublication History
eingereicht: 29.03.2006
angenommen: 18.06.2006
Publication Date:
23 August 2006 (online)
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Zusammenfassung
Hintergrund: Die Harninkontinenz gilt als häufigste Nebenwirkung und wichtigstes klinisches Problem nach radikaler Prostatektomie. Beckenbodenübungen, Biofeedback und Elektrostimulation kommen als konservative Therapieoptionen einzeln oder in Kombination zur Anwendung.
Ziel: Die Literaturarbeit prüft die Evidenz der Therapieoptionen zur Behandlung der Harninkontinenz und bewertet somit ihren Nutzen. Außerdem wird eine entsprechende Therapieempfehlung gegeben.
Methode: Die Datenbankrecherche erfolgte nach randomisierten kontrollierten Studien und nach Reviews im Zeitraum 1995 - 2005, die den Effekt der konservativen Therapie bei Postprostatektomie-Inkontinenz untersuchen. Die Literaturlisten relevanter Artikel lieferten zusätzliche Referenzen. Die methodologische Qualität und der klinische Nutzen der RCT wurden beurteilt und den Ergebnissen der vorliegenden Reviews gegenübergestellt.
Ergebnisse: Von den 13 die Einschlusskriterien erfüllenden RCT waren 3 aufgrund methodologischer Mängel ausgeschlossen. Anhand der 10 ausgewählten RCT war es aufgrund der großen Unterschiede bezüglich Patientenanzahl, Therapiemaßnahmen und Messmethoden nicht möglich, eine Therapie zuverlässig als nützlich oder unbrauchbar zu identifizieren.
Schlussfolgerung: Der Nutzen der verschiedenen Therapieoptionen bei Postprostatektomie-Inkontinenz bleibt unsicher. Die Anwendung von Beckenbodenübungen zum frühen Wiedererlangen der Kontinenz ist zu befürworten. Für die Bewertung der konservativen Therapie sind Studien von besserer Qualität notwendig.
Abstract
Background: Urinary incontinence is considered to be the most common side-effect and most important clinical problem after radical prostatectomy. Conservative management includes pelvic floor muscle exercises, biofeedback, electrical stimulation or a combination of methods.
Objective: The literature review examines the evidence and assesses the beneficial effects of conservative management for urinary incontinence. In addition, an appropriate treatment recommendation is given.
Method: The database search for randomised controlled trials and reviews on the effect of conservative interventions for urinary incontinence after prostatectomy was carried out for the years 1995 - 2005. The bibliographies of relevant articles supplied additional references. The methodological quality and the clinical benefits of the included trials were assessed and the results compared with the available reviews.
Results: Of the 13 RCT meeting the inclusion criteria 3 trials were excluded due to insufficient methodological quality. Based on the included 10 trials it was not possible to reliably identify a treatment method as effective or ineffective because of the considerable variation in the interventions, populations and outcome measures.
Conclusions: The value of the various approaches to conservative management of postprostatectomy incontinence remains uncertain. In order to promote an earlier continence regain pelvic floor muscle exercises early in the postoperative period can be recommended. More research of better quality is needed to assess conservative management.
Schlüsselwörter
Prostatektomie - postoperative Harninkontinenz - Beckenbodenübungen - Biofeedback - Elektrostimulation
Key words
Prostatectomy - postoperative urinary incontinence - pelvic floor muscle exercises - biofeedback - electrical stimulation
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Sandra Machold, PT, BSc
Am Grün 17
D-35037 Marburg
Email: sandramachold@web.de