Sprakel, A. (2012) Pelvic floor physiotherapy versus alpha-blockers in treating men with LUTS in Secondary Care. thesis, Medicine.
Full text available on request.Abstract
Background and objectives: The etiology of Lower Urinary Tract Symptoms (LUTS) becomes less and less organ centric. There seems to be no evidential association between symptoms of troubled micturition and the size of the prostate. Current treatment options still do focus on the prostate and the bladder. In women with LUTS pelvic floor physiotherapy (PFPT) is often being used with success. It’s a cost-effective form of treatment and doesn’t have any side effects. Therefore this new treatment option should also be tested in men. In this study PFPT was compared to treatment with (the regular) α1-blockers in men with LUTS. The primary outcome measure was the change of the maximal urinary flow (Qmax). The secondary outcome measures were the changes in the average urinary flow (Qavg), the residual volume (RV), the International Prostate Symptom Score (IPSS), the quality of life score, the micturition frequency, the Male Pelvic Floor Symptom score (MPFS), the palpation of the pelvic floor (DRE) and the electromyography (EMG) values of the pelvic floor. All of these parameters were also tested in the subgroup of men with a pelvic floor dysfunction at the start of the trial (subgroup). Methods: The study is a randomized controlled trial with non-inferiority. The study population consisted of men, aged between 20-70 years of age with symptoms of LUTS. Patients randomized for pelvic floor physiotherapy (N=20) were referred to a registered pelvic floor physiotherapist for treatment according to a protocol. Patients randomized to the standard treatment with an α1-blocker (N=17) were prescribed Tamsulosin 0,4 mg once daily or Doxasozin 4 mg once daily. Duration of both interventions was four months. Results: 14 men in the PFPT-group and 13 men in the medication group were analyzed in a per protocol analysis. Both groups didn’t show a significant improvement of the primary outcome, the Qmax. Both groups did show a significant improvement in the IPSS without a significant difference between both groups. The improvement of the Qavg, RV, quality of life score, micturition frequency (day and night), EMG parameters (activity of slow twitch and activity of relaxation) and DRE parameters (voluntary contraction/relaxation and involuntary contraction/relaxation) didn’t significantly differ between both groups. The improvement in the MPFS and the condition of the pelvic floor are significantly different, both in favor of the PFPT-group. These two significant differences are also present in the subgroup of men who had a pelvic floor dysfunction at the start of the trial. Conclusion: Based on this trial with 27 analyzed men in a secondary care setting, the effect of PFPT is at least comparable to the standard treatment with α1-blockers in men with LUTS with respect to Qmax, Qavg, RV, quality of life, IPSS, micturition frequency, EMG parameters and DRE parameters. PFPT even seems to be better than α1-blockers when looking at the improvement of the MPFS and the condition of the pelvic floor. This also applies when there is a pre-existent pelvic floor dysfunction. Pelvic floor physical therapy seems to be a good alternative compared to the current medical therapy with alpha-1-blockers. Mainly because of the small sample size, more research with larger groups will be needed to confirm these results.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultary supervisor: and Heide, dr. W.K. van der GP and Co-supervisor: and Dekker, dr. J.H. GP and Locations: and Department of general practice, University Medical Center Gr and Department of urology, University Medical Center Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:49 |
| Last Modified: | 25 Jun 2020 10:49 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/986 |
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