Combined rehabilitation therapy for postoperative urinary incontinence in men

Objective. To develop and substantiate the rehabilitation complex including perineal magnetic stimulation and pelvic floor muscle training using biofeedback technologies in the treatment of urinary incontinence in men after surgical interventions for prostate diseases. Material and methods. The study included 46 men with postoperative urinary incontinence aged 58—75 years (mean 64.5±5.7) and 20 healthy volunteers of the same age with normal examination results. All patients underwent surgery for prostate diseases (robotic prostatectomy for prostate cancer (n=21), transurethral laser enucleation of prostate adenoma (n=25)) within the period from 3 to 12 months. The main complaint after surgery was prolonged (more than 3 months) urinary incontinence in vertical position requiring constant use of pads or diapers. This significantly disrupted the quality of life. All patients completed a questionnaire and kept urination diaries. In addition to urodynamic examinations, they underwent needle electroneuromyography (ENMG) of perineal muscles with assessment of action potentials of muscle units and corticospinal tract conductivity. The developed rehabilitation complex included high-intensity pulsed magnetic perineal stimulation and training of pelvic floor muscles using biofeedback technologies. Treatment effectiveness was monitored using objective neurofunctional technique (perineal ENMG). Results. At baseline, ENMG revealed obvious signs of denervation and pathological reinnervation of perineal muscles as an indicator of loss of central nervous control over muscle units. After treatment, urinary incontinence disappeared in 43.4% of cases (20 patients) and significantly decreased in 34.78% of cases (16 patients). In 26% of cases (12 patients), imperative urges decreased, but intensity of urinary incontinence did not decrease. Patients were still forced to constantly use diapers, external urine bags or other locking devices. Surgical treatment with installation of artificial sphincter was recommended. Conclusion. The rehabilitation complex including perineal magnetic stimulation and pelvic floor muscle training using biofeedback technologies in the treatment of men with postoperative urinary incontinence eliminated severe neurogenic disorders of pelvic floor muscles, improved urinary continence and increased detrusor compliance, as well as improved mental state by reducing anxiety.