
==== Front
Support Care Cancer
Support Care Cancer
Supportive Care in Cancer
0941-4355
1433-7339
Springer Berlin Heidelberg Berlin/Heidelberg

39259369
8846
10.1007/s00520-024-08846-z
Research
Clinical efficacy of a rehabilitation management protocol for urinary incontinence after robot-assisted laparoscopic prostatectomy
Gu Jie 1
Chen Huiying 2
Gao Chengfei 1
Ren Ping 1
Lu Xiaoying luxiaoyingjoy@163.com

3
Cao Jie celion2004@126.com

3
1 https://ror.org/02bjs0p66 grid.411525.6 0000 0004 0369 1599 Department of Urology, Affiliated Changhai Hospital of Naval Medical University, Shanghai, China
2 Nursing Department, Shanghai Gongli Hospital, Shanghai, China
3 https://ror.org/02bjs0p66 grid.411525.6 0000 0004 0369 1599 Nursing Department, Affiliated Changhai Hospital of Naval Medical University, Shanghai, China
11 9 2024
11 9 2024
2024
32 10 65311 5 2024
27 8 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Objective

To evaluate the application of a rehabilitation management protocol for urinary incontinence after robot-assisted laparoscopic prostatectomy (RALP).

Methods

We conducted a retrospective cohort study of 114 patients who underwent RALP between August 2021 and November 2021 as the control group and a prospective analysis of 114 patients who underwent RALP between May 2022 and August 2022 as the experimental group. The rehabilitation management protocol focused on preoperative stage, postoperative care, day of catheter removal, 1 month postoperative, 3 months postoperative, 6 months postoperative, and 12 months or more postoperative.

Results

The 24-h pad test was significantly lower in the experimental group compared with the control group at 2 and 6 months after RALP (both P < 0.01). The scores of the international consultation on incontinence questionnaire-short form (ICIQ-SF) in the experimental group were significantly lower than those in the control group at 1 month after RALP (P < 0.01).The scores of quality of life in the experimental group were significantly higher than those of the control group at 1, 2, and 6 months after RALP (all P < 0.01).The scores of Broome Pelvic Muscle Self-efficacy Scale (BPMSES) were lower than those of the control group at 1, 2, 3, and 6 months after RALP (all P < 0.01).

Conclusion

The application of the rehabilitation management protocol had significant beneficial effects on urinary functions and quality of life in patients with prostate cancer after RALP.

Keywords

Prostate cancer
Delphi method
Urinary incontinence
Rehabilitation management
issue-copyright-statement© Springer-Verlag GmbH Germany, part of Springer Nature 2024
==== Body
pmcIntroduction

Robot-assisted laparoscopic prostatectomy (RALP) is the first-line treatment for limited prostate cancer [1], and urinary incontinence is the most common postoperative complication, which has a huge impact on the quality of patient survival and reduces the adherence to additional postoperative radiotherapy in high-risk patients [2, 3]. The incidence of postoperative urinary incontinence after RALP for prostate cancer ranges from 4 to 69%, and 15.9% of patients still suffer from moderate or severe urinary incontinence 1 year after surgery [4, 5]. Guidelines for urinary incontinence after RALP have been available [6], but the research about urinary incontinence after RALP lacks a rehabilitation program that systematically covers the assessment, prognostication, intervention, long-term rehabilitation, and self-management of urinary incontinence [7, 8]. Based on evidence-based medicine, we constructed a rehabilitation management protocol for urinary incontinence after RALP. In order to verify the effect of a rehabilitation management protocol, we compared the results of patients who used routine care and patients who used the rehabilitation management protocol.

Methods

A rehabilitation management protocol development

We performed a comprehensive literature review using the following databases: BMJ Best Practice, Ovid JBI EBP, Cochrane library, EBSCO Medline, PubMed, Web of Science, Wanfang, and CNKI, to screen published articles reporting the outcomes of applying the rehabilitation management program in RP patients. The following Medical Subject Heading (MeSH) search terms were used: [“urinary incontinence” OR “urinary control” OR “rehabilitation” OR “management” OR “training” OR” nursing”] AND [“prostate cancer” OR “prostatic cancer” OR “prostatectomy” OR “radical prostatectomy”]. To identify studies that may have been missed, we reviewed the reference lists of all related articles and published abstracts. A total of 351 English-language studies or evidence and 469 Chinese studies or evidence were identified; 789 studies with unrelated topics and 96 duplicates were excluded, leaving 19 studies for inclusion. According to the classification and recommendation of evidence-based medicine, 19 evidence-based articles were finally included in the study. The studies comprised one clinical decision [8], three guidelines [2, 9, 10], eight JBI evidence summaries [11–18], and seven meta-analysis [19–25].

A total of 41 pieces of best evidence were first summarized based on the literature review [26], and medical specialist formed a draft of the program. The final rehabilitation management protocol was developed through two rounds of correspondence with 15 specialists in January to March 2022.

Patients

The writing of this report followed the CONSORT guidelines. The inclusion criteria were as follows: patients who underwent radical prostate cancer surgery; patients reviewed in the study hospital with conditions for follow-up; patients capable of using smart phones. The exclusion criteria were as follows: postoperative chemotherapy; overactive bladder; nerve-sparing radical prostatectomy; extended lymph node dissection during radical prostatectomy; lack of written consent.

We retrospectively analyzed patients who underwent RALP between August 2021 and November 2021 and prospectively analyzed patients who underwent RALP between May 2022 and August 2022 in a prestigious urology center in Shanghai (ranked 2nd in China). The patients’ demographic data was described. The effects on 24-h urine pad test and the score of the quality of life were examined by comparing patients receiving conventional care with patients receiving the rehabilitation management program. The protocol of conventional care and the rehabilitation management program are listed in Table 1. Table 1 Protocols in the experimental and control groups

	Control group
(n = 120)	Experimental group
(n = 124)	
Preoperative stage	
   Evaluation of urinary incontinence	Assess the type of incontinence(stress, urge, mixed incontinence) and general condition (mental status, vital signs, physical condition, mobility, past medication history, pelvic floor function)	Based on the control group

Rectal palpation: check sphincter muscle strength

Blood and urine routine: to determine whether there is a urinary tract infection, if there is inflammation, a urine culture is needed

Abdominal examination: determining the presence of a pelvic mass

Perineal examination: determining the presence of the incontinence dermatitis

Urinary pad test and voiding diary for assessment recordings (if not available, teach patient how to record)

	
   Functional bladder management	Identify neurogenic bladder

Ask for history, urine flow rate or urodynamic report

	Based on the control group

Instruction in voiding diary, bladder training, intermittent catheterization

	
   Establishment of personal files	Record the patient’s preoperative data	Register the mobile application and enter the patient’s preoperative data into accounts

Introduce the use of the mobile application to the patient and family members

	
   Health education	Nurses distribute health education booklets

Content includes the treatment, classification and manifestation of urinary incontinence, pelvic floor muscle exercise methods, identification, prevention, and care of incontinence dermatitis

	Nurses use slides, videos, physical presentations for health promotion

Content as in the control group

	
Postoperative to discharge stage	
   Postoperative care	Record 24-h urine output and inform the physician

Demonstrate the catheter fixation

Perineal care 2/day and assess urinary tract irritation 1/day

Change anti-reflux collection bag 1/week, and use antibiotics as prescribed by physician

	Based on the control group

Evaluate the factors affecting patients with abnormal urine output and inform the physician

	
   Discharge care	Discharge with medication to take, urine bag change and other instructions

Record the patient’s postoperative clinical data

	Discharge with medication to take, urine bag change, and other instructions

Enter the patient’s postoperative clinical data

Regular follow-up visits to the incontinence care clinic (on the day of catheter removal, at 1, 3, 6, and 12 months postoperatively)

	
   Complete the file	Record postoperative indicators	Instruct patients to use the mobile application to record pelvic floor muscle training methods, voiding diary, and urine pad test results

Record postoperative indicators in the mobile application

	
   Inform follow-up notes	Use mobile phone to assess the severity of urinary incontinence

Follow-up time: the day of catheter removal, 1 month after operation, 2 months after operation, 3 months after operation, 6 months after operation, 12 months after operation

	Follow-up place: incontinence care clinic

Follow-up time: the day of catheter removal, 1 month after operation, 2 months after operation, 3 months after operation,6 months after operation, 12 months after operation

Follow-up content: assessment of pelvic floor function, the severity and type of urinary incontinence, guidance on lifestyle, supervision of pelvic floor muscle training, etc. (see the content of the following program for details)

	
Day of catheter removal	
   Catheter removal	Doctor	Incontinence specialist nurse

Give positive encouragement

	
   Lifestyle guidance	Drink 1500–2000 ml/day of water

Quit smoking

Avoid alcoholic beverages, tea, caffeine

If body mass index ≥ 25, weight loss is recommended

Keep bowel movement smooth

If urine test suggests urinary tract infection, instruct patients to increase water intake and antibiotic intervention

Choose disposable nursing pads for mild incontinence; choose diapers for moderate incontinence; use diaper covers for severe incontinence at night and diapers for daytime activities

	As in the control group	
   Instruction of pelvic floor muscle training	Instruct patients to identify the pelvic floor muscles	Use Glazer assessment to determine the function of the pelvic floor muscles

The mobile application timed reminder to punch in training 5 times/day

	
1 month postoperative	
   Evaluate the type and severity of incontinence	Review the voiding diary

Instruct the patient to complete the International Continence Advisory Committee Continence Questionnaire Short Form (ICIQ-SF), Continence Impact Questionnaire Short Form (IIQ-7), Continence Quality of Life Questionnaire, and Pelvic Floor Muscle Exercise Self-Efficacy Scale

	Based on the control group

Use a biofeedback instrument (Vishee SA9800) to assess patient

The Glazer assessment comprises the baseline test, quick flicks, tonic contractions, endurance contraction, and post-baseline test*

	
   Instruction in pelvic floor muscle training	Use mobile phone to instruct patient	Biofeedback to check if the patient is exercising correctly and to correct errors	
   Examination of perineal skin	Observe for incontinent dermatitis, redness, swelling, and broken skin	As in the control group	
3 months postoperative	
   Referral of patients to specialists	Indications for referral:

a. History of prior pelvic surgery, radiation therapy, or urethral injury

b. Residual urine > 50mL

c. Neurogenic bladder

d. Recurrent urinary tract infection

	As in the control group	
   Biofeedback stimulation	Doctors recommend biofeedback electrical stimulation to patients	The incontinence specialist nurse instruct patients in biofeedback electrical stimulation	
   Pharmacologic therapy	Stress incontinence: reuptake inhibitors of 5-hydroxytryptamine and norepinephrine, α1 receptor agonists

Urge incontinence: M-receptor antagonists and β3-adrenergic receptor agonists

	Based on the control group

The doctor and incontinence specialist nurse evaluate the patient and give patients prescriptions

	
6 months postoperative	
   Instruction in pelvic floor muscle training	Use mobile phone to instruct patient	Use the biofeedback of the mobile application to check if the patient exercises correctly and rectify an error	
   Biofeedback stimulation	Change the program according to the patient’s recovery by doctors	Adjust the stimulation frequency, pulse, and intensity as prescribed by the doctor and incontinence specialist nurse	
12 months or more postoperative	
   Surgical referral	Referral to doctor if the medication and conservative treatment do not work

Urine routine, residual urine volume measurement, abdominal ultrasound, cystoscopy, and urodynamics before artificial urinary sphincter implantation and sling implantation

	The doctor and incontinence specialist nurse evaluate the patient and give patients prescriptions	
   Surgical procedures	Stress incontinence: artificial urinary sphincter implantation, male sling, and periurethral balloon implantation

Urge incontinence: sacral neuromodulation, posterior tibial nerve stimulation, and botulinum toxin injections

	Based on the control group

The incontinence specialist nurse operate with doctors

	
*Baseline Test (60 s): The patient is instructed to relax completely, and the resting pelvic floor muscle tone is measured. Quick Flicks (5 times): The patient performs five rapid contractions to assess the function of fast-twitch muscle fibers. Tonic Contractions (5 times): The patient contracts and holds the pelvic floor muscles for 10 s, followed by 10 s of relaxation. Endurance Contraction (60 s): The patient sustains a contraction for one minute to test pelvic floor muscle endurance. Post-Baseline Test (60 s): After the endurance contraction, the patient relaxes again, and the post-activity resting tone is measured

This study was part of the national scientific research titled “Building and Empirical Study of a MultidisciplinaryPrecise Rehabilitation Model for Surgical Patients with Prostate Cancer Based on an Intelligent Medical Platform,” which received Institutional Review Board (IRB) approval from Changhai Hospital (approval no. CHEC2020-111). In this study, we adhered to the Declaration of Helsinki. Before each interview in the prospective section of this study, interviewees were given information about the study, and voluntary participation and the confidential handling of all data were discussed. Medical and nursing faculty also provided written informed consent for participation. We registered this trial in the Chinese Clinical Trial Registry: http://www.chictr.org.cn/(registration number: ChiCTR2200061350).

Sample size

The sample size was calculated using n = 2(u1-α/2+u1-β)2s2[(1+(n-1)p]n(μ1-μ2)2. A test level of 0.05 and a certainty of 0.9 were set. Based on a literature review [27], μ1 − μ2 = 293 − 254 = 39, s = 86, n1 = n2 = 70. Considering a 20% loss-of-visit rate, 114 cases in each of the experimental and control groups were ultimately selected for this study.

Control group

The nurse assessed the incontinence status and managed the bladder function after admission. During the perioperative period, the nurse paid attention to the volume of in and out, the prevention of urinary tract infection, and the incontinence health education, which included the catheter care precautions, the key points of changing the urinary bag, and the pelvic floor muscle training methods. Nurses distributed health education manuals and videos about incontinence for family members. From the time of discharge to 6 months after the operation, specialized nurses kept in touch with the patients by phone to guide the patients’ lifestyles and help them to identify the pelvic floor muscles. The specialist nurse completed the follow-up visits on the day of catheter removal, 1 month after the operation, and 3 months after the operation.

Experimental group

The experimental group implemented the urinary incontinence rehabilitation management program led by incontinence specialist nurses on the basis of routine care; see Table 1. The program comprised the following stages:Preoperative stage—The nurse assessed the type and severity of the patients’ urinary incontinence, carried out incontinence-related health education, set up the pelvic floor exercise application account for patients, and carried out the management of bladder function for patients with neurogenic bladder.

From postoperative to catheter removal stage—The nurse recorded the patients’ fluid intake and output, and in cases of abnormal urinary volume, factors were assessed and communicated to the physician for appropriate management. During hospitalization, the nurse focused on preventing urinary tract infections. Before discharge, patients were instructed on medication use, urinary bag replacement frequency, and follow-up schedules. After catheter removal, the specialized continence nurse addressed unhealthy lifestyle habits related to urinary incontinence, advised on incontinence care product selection and usage, and used the Glazer evaluation method to assess pelvic floor muscle function. The nurse also checked for signs of neurogenic bladder and urinary tract infections.

One month postoperative—The specialized continence nurse examined the perineal skin and corrected errors in pelvic floor muscle exercises through biofeedback.

Three months postoperative—For patients with inadequate recovery, sequential biofeedback electrostimulation therapy was administered. Patients with a history of pelvic surgery, radiation therapy, or urethral injury were referred to a specialist for further treatment.

Six months postoperative—The specialized continence nurse adjusted the frequency of biofeedback electrostimulation based on the patients’ Glazer evaluation report.

Twelve months and beyond postoperative—If symptoms persisted, patients were referred to a surgical specialist for artificial sphincter implantation.

Statistical analysis

Statistical analysis was performed using IBM SPSS Statistics for Windows, version 19.0 (IBM Corp., Armonk, NY, USA). A sample size calculation was performed using PASS 11 (NCSS, Kaysville, UT, USA). This study selected the Generalized Linear Mixed Model (GLMM) for multi-factor analysis of outcome variables. The repeated measurement factor in this study was time (1, the day the catheter was removed; 2, 1 month after surgery; 3, 2 months after surgery; 4, 3 months after surgery; 5, 6 months after surgery). Grouping variables, time variables, and all patient demographics were included as covariates in the model to examine whether there was an interaction between grouping variables and time variables. For outcome variables where the interaction was not statistically significant, we examined whether the grouping variable or the time variable had statistical significance. If the interaction was statistically significant, indicating an interaction between grouping and time, the separate effects needed to be analyzed.

For outcome variables that followed a normal distribution with homogeneity of variance and were continuous, an independent samples t-test was used for inter-group comparisons. For outcome variables that were continuous but did not follow a normal distribution, the Mann–Whitney U test was used, with the significance level adjusted using the Bonferroni correction, α = P/5 = 0.01, meaning a P-value of less than 0.01 is considered statistically significant.

Results

A total of 228 patients were included in this study. The patients’ preoperative characteristics are shown in Table 2. There were no significant differences in age, BMI, education, work status, health insurance status, the presence of hypertension, the presence of diabetes, Gleason score, clinical stage, and blood loss (P > 0.05). Table 2 Preoperative characteristics of the patients in the control and experimental groups

	Experimental group (n = 114)	Control group (n = 114)	Z/χ2	P	
Age(years)	67.8 ± 7.2	66.8 ± 7.5	 − 1.038	0.299*	
BMI(kg/m2)	24.8 ± 2.7	24.5 ± 2.5	 − 1.010	0.312*	
Education			5.005	0.080△	
   Middle school and below	41	51			
   High school or junior college	27	33			
   College and above	46	30			
Work status			2.657	0.103△	
   Yes	102	102			
   No	12	12			
Health insurance status			1.676	0.195△	
   Yes	99	105			
   No	15	9			
The presence of hypertension			0.439	0.507△	
   Yes	52	57			
   No	62	57			
The presence of diabetes			0.034	0.854△	
   Yes

   No

	97(85.1)

17(14.9)

	96(84.2)

18(15.8)

			
PSA concentration(g/L)			12.989	 < 0.001△	
    < 16	67	92			
    ≥ 16	47	22			
Gleason score, n (%)			5.083	0.024△	
    < 7	19	8			
    ≥ 7	95	106			
Clinical stage, n (%)			0.071	0.079△	
    < T3a	63	65			
    ≥ T3a	51	49			
Blood loss(ml)	100.00

(50.00,100.00)

	105.00(90.00,145.00)	 − 0.744	0.457*	
Operative time(minutes)	100.00

(50.00, 100.00)

	105.00(90.00,145.00)	 − 3.225	 < 0.001*	
Surgical technique	
   Nerve-sparing radical prostatectomy	20				
   Non-nerve-sparing radical prostatectomy	94				

24-h urine pad test

Multifactorial analysis was performed using a generalized linear mixed model, and the corrected model was statistically significant (F = 28.167, P < 0.001), with fixed effects as in Table 3. Subgroup × time was statistically significant (P = 0.003 < 0.05). Table 3 Model test of 24-h urine pad test results

	F	df 1	df 2	P	
Correction model	28.167	21	1118	 < 0.001	
Group × time	4.014	4	1118	0.003	
Group	8.057	1	1118	0.005	
Time	137.080	4	1118	 < 0.001	

ICIQ-SF score

Multifactorial analysis was performed using a generalized linear mixed model, and the modified model was statistically significant (F = 58.261, P < 0.001), with a fixed-effects model as shown in Table 4. Subgroups × time was statistically significant (P < 0.001). Table 4 Model test of ICIQ-SF score

	F	df 1	Df 2	P	
Correction model	58.261	21	1118	 < 0.001	
Group × time	5.140	4	1118	 < 0.001	
Group	1.982	1	1118	0.160	
Time	286.521	4	1118	 < 0.001	

QOL score

Multifactorial analysis was performed using a generalized linear mixed model, and the modified model was statistically significant (F = 223.731, P < 0.001), with a fixed-effects model as shown in Table 5. Subgroups × time was statistically significant (P < 0.001). Table 5 Model test of QOL score

	F	df 1	df 2	P	
Correction model	223.731	21	1118	 < 0.001	
Group × time	5.435	4	1118	 < 0.001	
Group	55.184	1	1118	 < 0.001	
Time	1133.163	4	1118	 < 0.001	

Pelvic floor muscle exercise score

Multifactorial analysis was performed using generalized linear mixed models, and the corrected model was statistically significant (F = 128.936, P < 0.001), with fixed-effects models as shown in Table 6. Subgroups × time was statistically significant (P < 0.001). Table 6 Model test of pelvic floor muscle exercise score

	F	Df 1	df 2	P	
Correction model	128.936	21	1118	 < 0.001	
Group × time	133.000	4	1118	 < 0.001	
Group	309.830	1	1118	 < 0.001	
Time	522.079	4	1118	 < 0.001	

Compared with the control group, the patients’ 24-h urine pad test in the experimental group was lower than that in the control group in the 2-month and 6-month postoperative periods (P < 0.01) (Table 7). Compared with the control group, the ICIQ-SF score in the experimental group was lower than that in the control group in the 1-month postoperative period (P < 0.01) (Table 8). Compared with the control group, the QOL score in the experimental group was lower than that in the control group in the 1-month, 2-month, and 6-month postoperative periods (P < 0.01) (Table 9). Compared with the control group, the pelvic floor muscle exercise efficacy score in the experimental group was lower than that in the control group in the 1-month, 2-month, 3-month, and 6-month postoperative period (P < 0.01) (Table 10). Table 7 Comparison of the results of the 24-h urinary pad test in the control and experimental groups

	Day of catheter removal	1 month postoperative	2 month postoperative	3 month postoperative	6 month postoperative	
Experimental group (n = 114)	369.00

(100.00,700.00)

	150.00(50.00,450.00)	50.00(10.00,150.00)	32.50(0.00,160.00)	0.00(0,30.00)	
Control group (n = 114)	450.00

(218.75,788.75)

	330.00(92.50,632.50)	100.00(43.75,200.00)	70.00(0.00,150.00)	20.00(0.00,50.00)	
Z	 − 1.628	 − 1.993	 − 3.469	 − 0.819	 − 2.800	
P	0.103	0.046	 < 0.001	0.413	0.005	

Table 8 Comparison of the results of the ICIQ-SF score in the control and experimental groups

	Day of catheter removal	1 month postoperative	2 month postoperative	3 month postoperative	6 month postoperative	
Experimental group (n = 114)	14.00(13.00,15.00)	11.00(10.00,14.00)	9.50(8.00,11.00)	8.00(0.00,11.00)	6.00(0.00,9.00)	
Control group (n = 114)	15.00(13.00,16.00)	13.50(11.00,15.00)	10.00(8.00,11.00)	9.00(0.00,10.00)	7.00(0.00,8.00)	
Z	 − 0.242	 − 3.938	 − 2.170	 − 0.420	 − 0.310	
P	0.809	 < 0.001	0.030	0.674	0.757	

Table 9 Comparison of the results of the QOL score in the control and experimental groups

	Day of catheter removal	1 month postoperative	2 month postoperative	3 month postoperative	6 month postoperative	
Experimental group (n = 114)	57.00(54.00,64.00)	74.00(70.00,77.00)	87.00(79.00,94.00)	92.00(85.00,101.25)	98.00(96.00,102.00)	
Control group (n = 114)	57.00

(53.00,61.00)

	57.50(54.00,64.00)	78.00(72.75,83.25)	87.00(74.75,110.00)	93.00(92.00,96.00)	
Z	 − 1.570	 − 9.080	 − 6.350	 − 1.567	 − 8.392	
P	0.116	 < 0.001	 < 0.001	0.117	 < 0.001	

Table 10 Comparison of the results of the pelvic floor muscle exercise efficacy score in the control and experimental groups

	Day of catheter removal	1 month postoperative	2 month postoperative	3 month postoperative	6 month postoperative	
Experimental group (n = 114)	120.00(105.00,130.00)	126.00(121.00,132.25)	140.00(129.00,154.00)	165.00(142.75,182.25)	188.50(182.00,194.25)	
Control group (n = 114)	115.00(109.75,126.25)	120.00(105.00,130.00)	128.00(113.00137.00)	142.00(132.50,150.00)	173.50(155.75,190.00)	
Z	 − 1.079	 − 3.728	 − 6.579	 − 6.999	 − 5.764	
P	0.281	 < 0.001	 < 0.001	 < 0.001	 < 0.001	

Discussion

Although pelvic floor muscle training has been shown to improve urinary function in patients after prostate cancer surgery, it is often abandoned by patients halfway due to lack of knowledge and lack of self-control. Therefore, patients after prostate cancer surgery requires incontinence-specialized nurse-led intervention, whereby specialized healthcare professionals supervise and re-educate patients on pelvic floor muscle training, which is more efficient than patients’ own pelvic floor muscle training [27]. The 24-h urine pad test in the experimental group was lower than that in the control group at all time points, indicating that the management protocol can effectively reduce the 24-h urine pad test.

After admission, patients in the control group were instructed in pelvic floor muscle training and incontinence health education by specialist nurses with WeChat or telephone to follow-up, while patients in the experimental group were instructed by incontinence specialist nurses or pelvic floor rehabilitators in the incontinence clinic via biofeedback devices, and incontinence management application were used for exercise and clocking in and out of the home, according to the results of incontinence management. At home, the incontinence management application was used for exercise clocking, and the patients were regularly reminded to exercise in a timely manner five times a day according to the training steps in the program. The results showed that the combined guidance of incontinence management application or pelvic floor rehabilitator for pelvic floor muscle training could improve the recovery rate of urinary incontinence after prostate cancer surgery.

Studies have shown that comprehensive urinary incontinence rehabilitation management can enhance the recovery rate of urinary incontinence [27–29]. In this study, the establishment of the patient’s personal file provides conditions for the implementation of multi-form continuation of intervention, and also facilitates the provision of effective care by healthcare professionals for the different conditions of patients. From the nursing care plan formulated before the patient’s discharge, to the continuous follow-up and rehabilitation guidance when the patient is referred back to the family, the multiform intervention pathway is implemented to help the patient get timely solutions when doubts arise, and to help the patient form a regular exercise habit during the pelvic floor function training process, and to strengthen the effect. The protocol constructed in this study not only covers conservative, pharmacologic, and surgical treatments, but also specifies the follow-up time to provide more comprehensive and effective rehabilitation interventions for patients.

Author contributions

Jie Gu carried out the questionnaire investigation, participated in the data analysis and drafted the manuscript. Huiying Chen carried out the questionnaire investigation and performed the statistical analysis.Chengfei Gao and Ping Ren checked the correctness of the data. Jie Cao conceived of the study, participated in its design and coordination and Obtained funding. Xiaoying Lu participated in the training of nursing in this research and proposed critical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript. Thanks to everyone above for their help.

Funding

This study received financial support from the National Natural Science Foundation of China (project number: 81903182).

Data availability

All data generated or analyzed during this research period are included in published articles. Data are available on request to the authors.

Declarations

Ethical approval and consent to participate

All authors have participated sufficiently in the work to take public responsibility for appropriate portions of the content after receiving permission from the human research ethics committee of the Hospital (approval No. CHEC2020-111). Informed consent was obtained from all individual participants included in the study.

Consent for publication

The authors affirm that human research participants provided informed consent for publication.

Competing interests

The authors declare no competing interests.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Jie Gu and Huiying Chen contributed equally to this work.
==== Refs
References

1. Bekelman JE Rumble RB Freedland SJ Clinically localized prostate cancer:ASCO clinical practice guideline endorsement of an AUA/ASTRO/SUO guideline summary J Oncol Pract 2018 14 10 618 624 10.1200/JOP.18.00434 30199312
Bekelman JE, Rumble RB, Freedland SJ (2018) Clinically localized prostate cancer:ASCO clinical practice guideline endorsement of an AUA/ASTRO/SUO guideline summary. J Oncol Pract 14(10):618–62430199312 10.1200/JOP.18.00434
2. Sandhu JS Breyer B Comiter C Incontinence after prostate treatment:AUA/SUFU Guideline J Urol 2019 202 2 369 378 10.1097/JU.0000000000000314 31059663
Sandhu JS, Breyer B, Comiter C (2019) Incontinence after prostate treatment:AUA/SUFU Guideline. J Urol 202(2):369–37831059663 10.1097/JU.0000000000000314
3. Yang ZK Liu QY Wang DL Study progress onoperation related factors of early urinary control after laparoscopic radical resection of prostate cancer Chongqing Med 2021 50 7 1227 1231
Yang ZK, Liu QY, Wang DL et al (2021) Study progress onoperation related factors of early urinary control after laparoscopic radical resection of prostate cancer. Chongqing Med 50(7):1227–1231
4. Radadia KD Farber NJ Shinder B Management of postradical prostatectomy urinary incontinence: a review Urology 2018 113 13 19 10.1016/j.urology.2017.09.025 29031841
Radadia KD, Farber NJ, Shinder B et al (2018) Management of postradical prostatectomy urinary incontinence: a review. Urology 113:13–1929031841 10.1016/j.urology.2017.09.025
5. Huang W Zhang Y Shen B-H Outcomes of health-related quality of life after open, laparoscopic, or robot-assisted radical prostatectomy in China Cancer Manag Res 2019 11 899 907 10.2147/CMAR.S189893 30697080
Huang W, Zhang Y, Shen B-H et al (2019) Outcomes of health-related quality of life after open, laparoscopic, or robot-assisted radical prostatectomy in China. Cancer Manag Res 11:899–90730697080 10.2147/CMAR.S189893
6. Comiter CV (2021) Urinary incontinence after prostate treatment. https://www-uptodate-com-443.webvpn.bjmu.tsg211.com/contents/urinary-incontinence-after-prostate-treatment. Accessed 2022-01-10
7. Wang C Song Z Li S Extended nursing for the recovery of urinary functions and quality of life after robot-assisted laparoscopic radical prostatectomy: a randomized controlled trial Support Care Cancer 2018 26 5 1553 1560 29196816
Wang C, Song Z, Li S et al (2018) Extended nursing for the recovery of urinary functions and quality of life after robot-assisted laparoscopic radical prostatectomy: a randomized controlled trial. Support Care Cancer 26(5):1553–156029196816
8. He KJ Yang XN Zhu Z Clinical effect of micturition interruption exercise on urinary incontinence after radical prostatectomy Support Care Cancer 2022 30 4 3241 3247 10.1007/s00520-021-06780-y 34984550
He KJ, Yang XN, Zhu Z et al (2022) Clinical effect of micturition interruption exercise on urinary incontinence after radical prostatectomy. Support Care Cancer 30(4):3241–324734984550 10.1007/s00520-021-06780-y
9. Huang J (2020) Guidelines for diagnosis and treatment of urology and andrology diseases in China 2019 edition. Beijing, China, pp 851–861, 877–881
10. Burkhard FC (2022) EAU guidelines on urinary incontinence in adults. https://d56bochluxqnz.cloudfront.net/media/EAU-Guidelines-on-Urinary-Incontinence-2020.pdf. Accessed 2022-01-10
11. Burkhard FC (2020) EAU guidelines on urinary incontinence in adults. https://d56bochluxqnz.cloudfront.net/media/EAU-Guidelines-on-Urinary-Incontinence-2020.pdf. Accessed 2022-01-10
12. Fong E (2021) Urinary incontinence(older person):assessment[EB/OL]. https://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=jbi&NEWS=N&AN=JBI1666. Accessed 2022-01-10
13. Magtoto LS (2021) Urinary incontinence:conservative management. https://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=jbi&NEWS=N&AN=JBI15229. Accessed 2022-01-10
14. Aginga C (2021) Urinary incontinence(post-prostatectomy):man-agement. https://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=jbi&NEWS=N&AN=JBI270. Accessed 2022-01-10
15. Sivapuram, MS (2021) Urinary and fecal incontinence(men):physical therapy treatment. https://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=jbi&NEWS=N&AN=JBI941. Accessed 2022-01-10
16. Jayasekara R (2021) Urinary incontinence: prompted voiding. https://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=jbi&NEWS=N&AN=JBI347. Accessed 2022-01-10
17. Le LK (2021) Incontinence absorbent products (daytime):ambulatory adults-moderate to heavy. https://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=jbi&NEWS=N&AN=JBI1705. Accessed 2022-01-10
18. Sivapuram MS (2022) Incontinence associated skin damage: topical skin products incontinence associated skin damage. https://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=jbi&NEWS=N&AN=JBI941. Accessed 2022-01-10
19. Sciarra A Viscuso P Arditi A A biofeedback guided programme or pelvic floor muscle electric stimulation can improve early recovery of urinary continence after radical prostatectomy:a meta-analysis and systematic review Int ClinPract 2021 75 10 e14208
Sciarra A, Viscuso P, Arditi A et al (2021) A biofeedback guided programme or pelvic floor muscle electric stimulation can improve early recovery of urinary continence after radical prostatectomy:a meta-analysis and systematic review. Int ClinPract 75(10):e14208
20. Baumann FT Reimer N Gockeln T Supervised pelvic floor muscle exercise is more effective than unsupervised pelvic floor muscle exercise at improving urinary incontinence in prostate cancer patients following radical prostatectomy: a systematic review and Meta-analysis Disabil Rehabil 2022 44 19 5374 5385 10.1080/09638288.2021.1937717 34550846
Baumann FT, Reimer N, Gockeln T et al (2022) Supervised pelvic floor muscle exercise is more effective than unsupervised pelvic floor muscle exercise at improving urinary incontinence in prostate cancer patients following radical prostatectomy: a systematic review and Meta-analysis. Disabil Rehabil 44(19):5374–538534550846 10.1080/09638288.2021.1937717
21. Widdison R Rashidi A Whitehead L Effectiveness of mobile APPs to improve urinary incontinence: a systematic review of randomised controlled trials BMC Nurs 2022 21 1 32 10.1186/s12912-022-00812-6 35090464
Widdison R, Rashidi A, Whitehead L (2022) Effectiveness of mobile APPs to improve urinary incontinence: a systematic review of randomised controlled trials. BMC Nurs 21(1):3235090464 10.1186/s12912-022-00812-6
22. Chen H, Liu Y, Wu J et al (2022) Acupuncture for postprostatectomy incontinence:a systematic review. https://pubmed.ncbi.nlm.nih.gov/33239324/. Accessed 2022-01-10
23. Lin L Sun W Guo X Artificial urinary sphincter is better than slings for moderate male stress urinary incontinence with acceptable complication rate: a systematic review and Meta-analysis Front Surg 2022 9 841555 10.3389/fsurg.2022.841555 35223981
Lin L, Sun W, Guo X et al (2022) Artificial urinary sphincter is better than slings for moderate male stress urinary incontinence with acceptable complication rate: a systematic review and Meta-analysis. Front Surg 9:84155535223981 10.3389/fsurg.2022.841555
24. Angulo JC Ruiz S Lozano M Systematic review and Meta-analysis comparing adjustable transobturator male system (ATOMS) and male readjustment mechanical externa(REMEEX) system for post-prostatectomy incontinence World J Urol 2021 39 4 1083 1092 10.1007/s00345-020-03300-1 32529450
Angulo JC, Ruiz S, Lozano M et al (2021) Systematic review and Meta-analysis comparing adjustable transobturator male system (ATOMS) and male readjustment mechanical externa(REMEEX) system for post-prostatectomy incontinence. World J Urol 39(4):1083–109232529450 10.1007/s00345-020-03300-1
25. Chen YC Lin PH Jou YY Surgical treatment for urinary incontinence after prostatectomy: a meta-analysis and systematic review PLoS One 2017 12 5 e0130867 10.1371/journal.pone.0130867 28467435
Chen YC, Lin PH, Jou YY et al (2017) Surgical treatment for urinary incontinence after prostatectomy: a meta-analysis and systematic review. PLoS One 12(5):e013086728467435 10.1371/journal.pone.0130867
26. Gu J Ma Q Gao X Construction and application of a rehabiitation management programme for urinary incontence after prostate cancer surgery Chin J Nurs 2023 58 9 1029
Gu J, Ma Q, Gao X et al (2023) Construction and application of a rehabiitation management programme for urinary incontence after prostate cancer surgery. Chin J Nurs 58(9):1029
27. Junwen S Rongjiang W The efficacy of the WeChat App combined with pelvic floor muscle exercise for the urinary incontinence after radical prostatectomy Biomed Res Int 2020 220 6947839
Junwen S, Rongjiang W (2020) The efficacy of the WeChat App combined with pelvic floor muscle exercise for the urinary incontinence after radical prostatectomy. Biomed Res Int 220:6947839
28. An D Wang J Zhang F Wu J Effects of biofeedback combined with pilates training on post-prostatectomy incontinence Urology 2021 155 152 159 10.1016/j.urology.2021.04.057 34186138
An D, Wang J, Zhang F, Wu J et al (2021) Effects of biofeedback combined with pilates training on post-prostatectomy incontinence. Urology 155:152–15934186138 10.1016/j.urology.2021.04.057
29. Pané-Alemany R Ramírez-García I Kauffmann S Efficacy of transcutaneous perineal electrostimulation versus intracavitary anal electrostimulation in the treatment of urinary incontinence after a radical prostatectomy: randomized controlled trial Neurourol Urodyn 2021 40 7 1761 1769 10.1002/nau.24740 34224598
Pané-Alemany R, Ramírez-García I, Kauffmann S et al (2021) Efficacy of transcutaneous perineal electrostimulation versus intracavitary anal electrostimulation in the treatment of urinary incontinence after a radical prostatectomy: randomized controlled trial. Neurourol Urodyn 40(7):1761–176934224598 10.1002/nau.24740
