- 學位論文
骨盆底肌肉訓練及生理回饋介入對中高齡男性接受攝護腺剜除術後尿失禁之成效
Effects of pelvic floor muscle training and a physiological feedback intervention on urinary incontinence aftertransurethral enucleation of prostatectomy in middle-aged and older men
摘要
背景:對於全球老年人口比例越來越多，慢性疾病也備受關注，良性攝護腺肥大是中老年男性常見的慢性疾病，藥物治療不理想時，現多以攝護腺剜除手術(Transurethral enucleation of prostatectomy，TUEP)治療。剜除手術(Enucleation methods)在術後六個月尿的最大流速及國際攝護腺症狀評分，優於一般刮除(Resection methods)及其他汽化手術(Vapourisation methods)。但攝護腺剜除手術後早期約有17-40%病人產生尿失禁，導致生活品質下降。 目的:本研究探討骨盆底肌肉訓練及生理回饋輔助對降低中老年男性於內視鏡攝護腺剜除術後尿失禁之成效。 方法:類實驗研究設計於2020年12月至2021年10月期間，在雲林某區域教學醫院，所有接受內視鏡攝護腺剜除之50歲以上中老年男性共收69位，實驗組31位施以骨盆底肌肉訓練及生理回饋輔助，控制組38位常規指導骨盆底肌肉訓練。分別於術前、1週、4週衛教指導，於術後2、4、8週做尿失禁量表簡版(ICIQ-SF)包含尿失禁頻率、量以及對生活影響，及棉墊測試包含量、墊大小、棉墊濕的程度及生活品質。資料以個數、百分比、平均值、標準差、卡方、t檢定、成對t檢定、重複測量及廣義方程式等描述性統計及推論性統計分析結果。 結果:實驗組與對照組中之人口學與慢性病資料除教育程度外，其餘均未達統計顯著差異。經由骨盆底肌肉訓練與生理回饋輔助介入後，實驗組於ICIQ-SF之總分隨著時間點(2.4.8週)變化有顯著降低(p<.05)，且每個測量點均比上個階段有顯著降低(p<.05)，棉墊試驗中尿失禁對於生活品質影響在術後4週有明顯改善，且可持續至術後8週。然而實驗組若與控制組做比較，其尿失禁評估量表，總分及棉墊試驗之尿失禁對生活品質影響在術後2.4.8週時間點，均未比控制組有顯著差異(p>.05)。以GEE檢定結果發現，影響評估尿失禁量表總分及生活品質影響程度之變項為「教育程度」(p<.05)，國小以上教育程度者比不識字者更能理解骨盆底肌肉運動及改善尿失禁。骨盆底肌肉運動對於攝護腺剜除個案尿失禁者可有效改善漏尿，但本研究並未凸顯生理回饋之功能可能跟選樣誤差有關，教育程度高者可改善尿失禁及生活品質。 結論:本研究結果顯示持續8週骨盆底肌肉訓練，隨著時間增加，可降低發生攝護腺剜除術後尿失禁率，若輔以生理回饋不一定能加速改善，能正確執行骨盆底肌肉訓練，可以有效降低尿失禁與提升生活品質。本研究實證數據可提供臨床攝護腺剜除術後漏尿防治與改善之參考。
並列摘要
Background: Chronic diseases have attracted more attention as the elderly population is increasing globally. Benign prostatic hypertrophy is common chronic disease in middle-aged and elderly men. Transurethral enucleation of prostatectomy (TUEP) is often performed when drug therapy is not satisfactory , and leads to a better maximum urine flow rate and International Prostate Symptom Score in the six months after surgery than general curettage resection and other vaporisation methods. However, there is a 17-40% risk of early urinary incontinence, which lead to a lower quality of life after prostatectomy. Objective: This study investigated the effect of pelvic floor muscle training and physiological feedback assistance on urinary incontinence in middle-aged and elderly men after endoscopic prostatectomy. Methods: Quasi-experimental research study at a regional teaching hospital in Yunlin. Between December 2020 and October 2021, all 69 men over the age of 50-years-old who underwent endoscopic prostatectomy for urinary incontinence after surgery were recruited. The 31 patients in the experimental group received pelvic floor muscle training and physiological feedback assistance; the 38 patients in the control group only received pelvic floor muscle training. The Urinary Incontinence Assessment Scale (ICIQ-SF; frequency, volume and impact of incontinence on life) and cotton pad test (quantity, pad size, wetness of the pads, and quality of life) were performed 2, 4, and 8 weeks after surgery.Data were analyzed using descriptive and inferential statistics such as number, percentage, mean, standard deviation, chi-square test, t-tests , paired t-tests, repeated measures and generalized estimating equations. Results: Demographic and clinicopathological features were not significantly different between the experimental and control groups, except for the level of education. After the pelvic floor muscle training and physiological feedback-assisted intervention, the total ICIQ-SF score in the experimental group decreased significantly (p <.05) at 2, 4, and 8 weeks; the reductions between each time-point were significant (p<.05). The cotton pad test showed the effect of urinary incontinence on quality of life was significantly reduced at 4 and 8 weeks after surgery. However,the total score on the urinary incontinence assessment scale and the effect of urinary incontinence on quality of life in the cotton pad test were not significantly different between the control group and experimental group at 2,4, and 8 weeks after surgery (p >.05). GEE revealed the variable education level significantly affected the score on the urinary incontinence scale and the influence of incontinence on quality of life (p<.05), indicating people with elementary school education or higher understood the pelvic floor muscles better than patients who are illiterate. Pelvic floor muscle exercises can effectively improve the rate of urinary leakage in patients with urinary incontinence in cases of prostate enucleation, but this study did not highlight that the function of physiological feedback may be related to sample selection errors. Conclusions: This study shows that correctly performing pelvic floor muscle training continuously for 8-weeks can reduce the incidence of urinary incontinence and improve quality of life after prostatectomy; the beneficial effects increase over time, but supplementation with physiological feedback may not accelerate this improvement. Moreover, higher levels of education are significantly associated with reduced urinary incontinence and improved quality of life. This empirical data provides a reference for the prevention and improvement of urinary leakage after prostatectomy.