"Extracorporeal Magnetic Innervation Pelvic Floor Therapy Provides Earlier and Improved Recovery of Continence After Radical Prostatectomy: Presented at EAU"
By Chris Berrie
BERLIN, GERMANY -- March 27, 2007 -- Extracorporeal magnetic innervation pelvic floor therapy (EXMI) is a novel medical treatment strategy that provides earlier and improved recovery of continence for patients following radical prostatectomy (RP), according to a prospective, randomised study presented here at the 22[nd Annual Congress of the European Association of Urology (EAU).
The strategies that are presently available for patients for post-RP incontinence include pelvic floor training (PFT), duloxetine, artificial urinary sphincter, and periurethral injections/ devices.
However, these approaches require significant time to implement, said study principal investigator Bob Djavan, MD, PhD, professor of urology and vice-president, department of urology, Medical University of Vienna, Vienna, Austria.
"We need to improve the post-operative management of our patients for radical surgery, and although today we are able to preserve continence, the question was whether we were also able to improve the velocity of continence recovery," Dr. Djavan said in a presentation on March 22nd.
The novel EXMI technique promotes recovery of continence based by stimulation of the central and peripheral nervous system via depolarisation in adjacent nerves, thereby causing muscle contractions. The device uses a magnetic field generator that provides a field in the target tissue of 80 V/m.
In their study, Dr. Kjavan and colleagues investigated the safety and efficacy of this novel EXMI technique for stress urinary incontinence in patients who underwent RP. "What this study was all about was basically to see whether patients who have a radical prostatectomy improve better, quicker, and in a higher quantity than patients on simple pelvic floor training alone," he said.
The researchers randomised 105 patients age range, 59 to 72 years to receive either EXMI or PFT, and treatment was initiated 1 week after catheter removal following RP. EXMI consisted of 20 sessions of 30 minutes each at 2 per week, with 100 daily sessions for PFT.
Patient outcomes were assessed according to quality of life and urine symptom inventory using the pad weight gain test. Incontinence was defined as 0 to 1 pad/day and/or PAD weight gain of 0 to 8 g.
On the first day following catheter removal, continence was seen in 16.8% of these patients. After 4 weeks, the pad test revealed a significant increase in continence for the patients in the EXMI group over those with PFT (51% vs 44%; P = .003). This benefit according to the pad test was maintained throughout the 4-month assessment (64% vs 50%, respectively; P = .004) to the final 12-month assessment (83% vs 69%; P = .003).
Quality of life measurement at 12 months also showed significant benefits for patients in the EXMI group versus PFT (P = .004).
Therefore, in comparison with the standard PFT, the novel EXMI strategy is significantly superior for improvement of continence following RP (P = .004) in terms of stress incontinence episodes, quality of life, urinary symptom inventory, and urge incontinence/ symptoms, Dr. Djavan and colleagues concluded.
They said their findings also promote further studies on the benefits of this novel adjuvant strategy due to indications of improvements in pelvic floor perfusion and earlier recovery of potency in these men with EXMI after RP. Hence there is also the potential for a beneficial impact on erectile dysfunction, they said.
[Presentation title: Prospective Study of Extracorporeal Magnetic Innervation Pelvic Floor Therapy (EXMI) Versus Standard Pelvic Floor Training Following Radical Prostatectomy: Impact on Timing and Magnitude of Recovery of Continence. Poster 482]
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