'Stay Dry' tested to help men with incontinence problems from prostate cancer treatments

CLEVELAND, 28 feb 2009—Following surgery and radiation treatments for prostate cancer, most men suffer some degree of incontinence. For approximately 14 percent of these men, the problem lingers five years later.

Improving the lives of these men is the goal of a new "Stay Dry" intervention being tested by Amy Zhang, assistant professor of nursing at the Frances Payne Bolton School of Nursing at Case Western Reserve University, and colleagues from University Hospitals Case Medical Center, Cleveland Clinic and the Louis Stokes Cleveland Department of Veteran Affairs Medical Center.

Researchers have received a four-year, $2.4 million grant from the National Institutes of Health to determine the effectiveness of teaching pelvic floor muscle exercises combined with biofeedback techniques and subsequent therapy.

The new study will enroll 312 men who have undergone prostate surgery at the three medical centers. Men will be selected at random to be part of one of three groups. The first group will receive exercise instructions with biofeedback and group therapy. The second group will also receive exercise instructions with biofeedback, but will receive six phone sessions instead of group therapy. The third, control group will receive standard care, which includes verbal instructions from their doctors about how to control incontinence .

Men will be assessed over seven months to find the differences between the group that received biofeedback and six group meetings, biofeedback and six phone contacts every other week for three months, and the group that receives usual care.

The study also involves two sub-studies. One research project will examine the overall cost effectiveness of this new intervention technique long term, as compared with standard care. A second project will analyze the physical changes to 51 men with moderate to severe incontinence to determine muscle changes as a result of the interventions.

The consequences of incontinence

Incontinence is suffered by some of the 200,000 men who annually undergo surgery, radiation or a combination of the two after a prostate cancer diagnosis.

Leakage of urine is a common side effect, as the surgical procedure to remove cancerous tumors involves some degree of loss of control of the sphincter muscle, which supports the bladder.

In addition to recovering from surgery and treatment, many men have to deal with the consequences of incontinence, including distress, self-identity issues and increased healthcare costs due to potential loss of work time, nursing care or medical supplies.

Finding an effective intervention is increasingly important, said Zhang. "While most men with prostate cancer are older, sophisticated diagnostic methods are able to find the cancer at a younger age, and the population with prostate cancer is growing," said Zhang.

"Strengthening the pelvic muscles shows promise in benefiting these men," said Zhang.

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Research collaborators:

CASE WESTERN RESERVE UNIVERSITY: Shirley Moore, associate dean of research at FPB and director of the Center of Excellence for Self-Management Advancement Through Research and Translation, and Nahida Gordon, professor of medicine and nursing; and formerly from the university, Laura Siminoff, professor and chair of the department of Social and Behavioral Science, Virginia Commonwealth University.

CLEVELAND CLINIC: Eric Klein, professor of surgery and director of Cleveland Clinic's Section of Urologic Oncology; Alex Fu, assistant professor and health economist at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University.

VETERAN AFFAIRS MEDICAL CENTER: Donald Bodner, professor of urology, Dr. Hui Zhu, assistant professor of urology, Gerald Strauss and Kim Schaub, health psychologists.