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The inclusion of biofeedback assisted pelvic floor muscle education (PFME) (administered via electromyography sensors or a rectal pressure probe) for men to assist with resolution of urinary incontinence due to resection of the prostate has shown promising outcomes from the current literature. Re-gaining partial urinary continence after surgery is possible with most men, however, the chances of fully re-gaining ability to control the bladder is dependent upon many variables. The compliance with a home exercise program (HEP), the degree of continence the patient had prior to surgery, the surgical expertise and technique, the number of biofeedback treatments, the time-frame between surgery and treatment, and other measures such as conflicting medications, dementia and neurological impairments or injuries (which are typically excluded in studies) all have a large effect on the patient's recovery. The specifics of all these variables have yet to be defined and need to be included with future research in this area. Furthermore, the need for research with higher overall scores of statistical validity and study strength are also needed to set any gold standards for the treatment of urinary incontinence in men following surgical prostate removal.
Pelvic Floor Re-education encompasses a variety of techniques for increasing the strength of, and control over, the pelvic floor muscles. These techniques are now emerging as an effective and viable alternative to surgery in the treatment of urinary incontinence and related conditions. This volume presents a reasoned, scientific approach to the use of pelvic floor re-education. Starting with the latest theories on anatomy, pathophysiology and possible causes of pelvic floor damage, the text then describes the importance of pelvic floor evaluation in determining the type of treatment required. A number of re-education techniques are assessed including isolated muscle exercise, vaginal cones, biofeedback control and electrical stimulation. Recent research work is also reviewed which allows the reader to evaluate the different modalities advocated in the management of pelvic floor dysfunction.
Considering prostate adenocarcinoma, the cancer of higher incidence in men, having as treatment of choice the prostatectomy, and the high prevalence of urinary incontinence (UI) and erectile dysfunction (ED) after the surgery, the physiotherapy becomes an eligible treatment for such alterations. The rehabilitation of post-prostatectomy effort urinary incontinence is considered a recommendation grade B. Erectile dysfunction has as its first line of treatment penile vacuum therapy. Pelvic health physical therapy has as its main tool the rehabilitation of the pelvic floor muscles (PFM), which can be assisted by biofeedback and electrotherapy. The training of these muscles accelerates the recovery process of post-prostatectomy stress urinary incontinence and has greater therapeutic relevance when the physiotherapeutic treatment is initiated in the pre-surgical period. Post-micturition dribble is also treated by training the pelvic floor muscles. Urinary urgency, associated or not with incontinence, can be treated with electrotherapy, which is considered second or third line of treatment. Erectile rehabilitation has two physical resources of treatment, physical therapy, one through the vacuum and the other of the shock wave. Both penile vacuum therapy and shock wave therapy are considered the first line of treatment in the approach to erectile dysfunction.
Internationally known experts offer multidisciplinary guidance on the diagnosis and management of the full spectrum of pelvic floor disorders. It covers the diagnosis and clinical assessment of continence mechanisms and sexual dysfunction, as well as conservative management of the lower urinary tract, disorders of anorectal functions and sexual functions, exploring techniques such as electrical stimulation, anti-incontinence devices, and biofeedback. This valuable text also provides information on the management and treatment of a full range of disorders, from childbirth damage and post-prostatectomy incontinence, to neuropathic voiding dysfunction. Reviews normal anatomy and physiology as well as pathophysiology, providing an in-depth understanding of how and why various pelvic floor disorders occur. Covers the complete spectrum of pelvic floor disorders, including childbirth damage · lower urinary tract dysfunction in the female and male · urinary incontinence in the elderly · pelvic organ prolapse · post-prostatectomy incontinence · neurogenic voiding dysfunction · fecal incontinence · defecatory disorders · pediatric urology · male and female sexual dysfunction. Discusses all types of diagnostic approaches, including urodynamics · imaging · MRI · endoscopy · and electrodiagnosis. Conservative treatment is based on different techniques: pelvic floor muscles training · behavioral therapy · biofeedback · electrical stimulation and anti-continence devices. Represents a practical approach to surgery and conservative treatment for the physician and health care professionals and provides practical suggestions on these techniques. Features contributions from urologists, gynecologists, coloproctologists, continence specialists, specialist physical therapists, and nurses, for exceptionally multidisciplinary, well-rounded coverage of every aspect of the field.
Bridging the gap between evidence-based research and clinical practice, Physical Therapy for the Pelvic Floor has become an invaluable resource to practitioners treating patients with disorders of the pelvic floor. The second edition is now presented in a full colour, hardback format, encompassing the wealth of new research in this area which has emerged in recent years. Kari Bø and her team focus on the evidence, from basic studies (theories or rationales for treatment) and RCTs (appraisal of effectiveness) to the implications of these for clinical practice, while also covering pelvic floor dysfunction in specific groups, including men, children, elite athletes, the elderly, pregnant women and those with neurological diseases. Crucially, recommendations on how to start, continue and progress treatment are also given with detailed treatment strategies around pelvic floor muscle training, biofeedback and electrical stimulation. aligns scientific research with clinical practice detailed treatment strategies innovative practice guidelines supported by a sound evidence base colour illustrations of pelvic floor anatomy and related neuroanatomy/ neurophysiology MRIs and ultrasounds showing normal and dysfunctional pelvic floor incorporates vital new research and material uses key summary boxes throughout new edition to highlight quick reference points now in full colour throughout and a hardback format
This text provides a comprehensive, state – of – the art review of this new and emerging field, as the number of men who suffer from post-prostatectomy incontinence increases by greater than 10,000 per year. How to evaluate and manage this devastating disorder has become a necessary part of nearly every urologic practice. This book serves a valuable resource for physicians with an interest in managing patients with post-prostatectomy incontinence. In addition, treatment includes algorithms and suggested office evaluation that will help guide conservative management that is appropriate for most patients. The text provides insight into the history of male incontinence surgery, as well as the current surgical techniques for the operative management of post-prostatectomy incontinence in those who fail conservative management. This text reviews current data regarding surgical outcomes for the most common and newly developed incontinence procedures, as well as step-by-step descriptions of the key surgical steps necessary for success. All chapters are written by world renowned experts in this field and include the most up to date clinical information.
The remarkably complex pelvic floor and its disorders comprise one of the most interesting -- and challenging -- areas of physical therapy. And recently, common problems once considered taboo, such as incontinence, have become mainstream issues. More than ever before, a solid understanding of the structure and function of the manifold problems of the pelvic floor is vital to successful treatment. This groundbreaking work brings together an international team of world-renowned experts in the treatment of urinary and fecal incontinence, as well as sexual dysfunction, to provide a comprehensive guide to the structure and function of the muscles of the pelvic floor. Using concise text and clear illustrations and helpful photographs, the authors present all phenomena associated with pelvic floor dysfunction. The authors begin with a detailed overview of the anatomy and physiology of the pelvic floor, and then discuss all state-of-the-art diagnostic and treatment strategies, from biofeedback and manual therapy to the causes of different types of pain and psychosocial problems. Detailed discussions of the specific issues associated with children, women, and men, as well as with rectal and anal dysfunction, follow. With its thorough coverage, this highly practical text is essential reading for all health care professionals who wish to provide their patients suffering from disorders of the pelvic floor with the best care available.