Issue №4-22, 2023

Personalized Rehabilitation of Patients with Prostate Cancer after Radical Prostatectomy: a Comparative Analysis of Urodynamic Parameters

^1,6 Boris S. Kasparov,4 Denis V. Kovlen,^1,2 Tatiana Y. Semiglazova,¹ Oleg V. Zaozerskii,¹ Кristina О. Kondrateva,⁵ Gennady N. Ponomarenko,¹ Valeria A. Kluge,³ Vladislav V. Semiglazov,¹ Aleksander K. Nosov,^1,2 Anton A. Krutov,^1,2 Alexey M. Belyaev

¹ N.N. Petrov National Medical Research Center for Oncology, Saint Petersburg, Russia
² I.I. Mechnikov North-Western State Medical University, Saint Petersburg, Russia
³ I.P. Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia 
⁴ S.M. Kirov Military Medical Academy, Saint Petersburg, Russia 
⁵ G.A. Albrecht Scientific and Practical Center for Medical-Social Examination, Prosthetics and Rehabilitation of Disabled Persons, Saint Petersburg, Russia 
⁶ Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia

ABSTRACT

INTRODUCTION. Applying a personalized approach in the treatment of urinary incontinence in patients after RP can significantly improve the rates of correction of postoperative incontinence.
AIM. To study the effect of personalized rehabilitation of patients with prostate cancer (PCa) after radical prostatectomy on the state of functional indicators of the lower urinary tract.
MATERIALS AND METHODS. The study included 60 patients with verified primary resectable prostate cancer who underwent laparoscopic nerve-sparing prostatectomy. Patient ages ranged between 46 and 77 years (median 62.8 years).
The patients were divided into main and control groups of 30 people each. The patients of the main group received rehabilitation using a personalized approach. The rehabilitation programs for the patients in the control group were formed on the basis of a syndromic-pathogenetic approach. Functional parameters of the lower urinary tract were assessed using a 24-hour pad test and a comprehensive urodynamic study before and after surgery, after a course of rehabilitation and 1 year after surgery.
RESULTS. Assessment of the degree of urinary incontinence in patients with prostate cancer using a 24-hour pad test showed similar clinical pictures in both groups in the postoperative period in the form of mild or moderate disorders.
After the rehabilitation course, a positive trend was observed, however, in the observation group, 66.7 % of patients completely retained urine, while in the comparison group only 40%. Similar trends were observed in a year after a surgical treatment. According to a comprehensive urodynamic study (CUDS), after rehabilitation in the observation group, 76.7 % of patients showed signs of restoration of detrusor activity to the preoperative level with retention of the effect a year after the intervention (p < 0.05). A peak decrease in maximum detrusor pressure was observed in the postoperative period with a partial recovery of the indicator after rehabilitation and after 1 year in both groups. In the comparison group, a more pronounced decrease in detrusor pressure was observed, but the difference was statistically insignificant (p > 0.05).
DISCUSSION. This study tested a personalized approach in the rehabilitation of patients with urological oncology. This concept allows the use of physical and rehabilitation medicine technologies with maximum efficiency by identifying a specific patient model. The results of functional research methods (pad test, KUDI) are one of the potential determinants of the effectiveness of the use of rehabilitation technologies.
CONCLUSION. The results of rehabilitation of patients in the group with a personalized approach can significantly improve the rates of correction of postoperative incontinence.

KEYWORDS: personalized rehabilitation, prostate cancer, prostatectomy, urinary incontinence, pad test, comprehensive urodynamic study, determinant of effectiveness

Acknowledgments: The study had no sponsorship.

Conflict of interest:: The authors declare no apparent or potential conflicts of interest related to the publication of this article.

For citation: Kasparov B.S., Kovlen D.V., Semiglazova T.Y., Zaozerskii O.V., Kondrateva K.O., Ponomarenko G.N., Kluge V.A., Semiglazov V.V., Nosov A.K., Krutov A.A., Belyaev A.M. Personalized Rehabilitation of Patients with Prostate Cancer after Radical Prostatectomy: a Comparative Analysis of Urodynamic Parameters. Bulletin of Rehabilitation Medicine. 2023; 22(4): 23-30. https://doi.org/10.38025/2078-1962-2023-22-4-23-30 (In Russ.). 

For correspondence: Oleg V. Zaozerskii, Е-mail: oncl@rion.spb.ru

References:

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Эта статья открытого доступа по лицензии CC BY 4.0. Издательство: ФГБУ «НМИЦ РК» Минздрава России.
This is an open article under the CC BY 4.0 license. Published by the National Medical Research Center for Rehabilitation and Balneology.