The Pelvic Health Physical Therapy and the Prostatectomy

*Mauro Luis Barbosa Junior, Ericka Kirsthine Valentin and Karoline Camargo Bragante*

### **Abstract**

Considering prostate adenocarcinoma, the cancer of higher incidence in men, having as treatment of choice the prostatectomy, and the high prevalence of urinary incontinence (UI) and erectile dysfunction (ED) after the surgery, the physiotherapy becomes an eligible treatment for such alterations. The rehabilitation of postprostatectomy effort urinary incontinence is considered a recommendation grade B. Erectile dysfunction has as its first line of treatment penile vacuum therapy. Pelvic health physical therapy has as its main tool the rehabilitation of the pelvic floor muscles (PFM), which can be assisted by biofeedback and electrotherapy. The training of these muscles accelerates the recovery process of post-prostatectomy stress urinary incontinence and has greater therapeutic relevance when the physiotherapeutic treatment is initiated in the pre-surgical period. Post-micturition dribble is also treated by training the pelvic floor muscles. Urinary urgency, associated or not with incontinence, can be treated with electrotherapy, which is considered second or third line of treatment. Erectile rehabilitation has two physical resources of treatment, physical therapy, one through the vacuum and the other of the shock wave. Both penile vacuum therapy and shock wave therapy are considered the first line of treatment in the approach to erectile dysfunction.

**Keywords:** physical therapy, erectile dysfunction, urinary incontinence, prostate cancer, prostatectomy

### **1. Pelvic health physiotherapy**

Pelvic health physiotherapy has as its main therapeutic pillar the rehabilitation of the pelvic floor muscles (PFM). Since the work done by the gynecologist Arnold Kegel in the 1940s, the treatment of the pelvic floor has been evolving and being recognized by the scientific community. Kegel began his work in this area by creating exercises for PFM for the treatment of female urinary incontinence. When assumed by physical therapy, the exercises became perineal kinesiotherapy, currently having a gold standard of recommendation grade A, in the rehabilitation of female urinary stress incontinence (SUI).

With evolution, the "Kegel exercises" also reached male pelvic health. However, because the anatomy and pathophysiology of urinary incontinence (UI) in men are distinct from women, which also influences the lower prevalence of SUI in the male population, around 10%, the effectiveness of the treatment may be variable, when compared to the woman's. The detrusor hyperactivity associated with

urinary urgency with or without loss of urine is commonly associated with prostatic disease, needing to be investigated, with the pelvic floor having little influence on male urinary incontinence.
