Conservative treatment for urinary incontinence in Men After Prostate Surgery (MAPS)

two parallel randomised controlled trials

C Glazener, C Boachie, B Buckley, C Cochran, G Dorey, A Grant, S Hagen, M Kilonzo, A McDonald, G McPherson, K Moore, J N'Dow, C Ramsay, L Vale

Research output: Contribution to journalArticle

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Abstract

Objective
To determine the clinical effectiveness and cost-effectiveness of active conservative treatment, compared with standard management, in regaining urinary continence at 12 months in men with urinary incontinence at 6 weeks after a radical prostatectomy or a transurethral resection of the prostate (TURP).
Background
Urinary incontinence after radical prostate surgery is common immediately after surgery, although the chance of incontinence is less after TURP than following radical prostatectomy.
Design
Two multicentre, UK, parallel randomised controlled trials (RCTs) comparing active conservative treatment [pelvic floor muscle training (PFMT) delivered by a specialist continence physiotherapist or a specialist continence nurse] with standard management in men after radial prostatectomy and TURP.
Setting
Men having prostate surgery were identified in 34 centres across the UK. If they had urinary incontinence, they were invited to enroll in the RCT.
Participants
Men with urinary incontinence at 6 weeks after prostate surgery were eligible to be randomised if they consented and were able to comply with the intervention.
Interventions
Eligible men were randomised to attend four sessions with a therapist over a 3-month period. The therapists provided standardised PFMT and bladder training for male urinary incontinence and erectile dysfunction. The control group continued with standard management.
Main outcome measures
The primary outcome of clinical effectiveness was urinary incontinence at 12 months after randomisation, and the primary measure of cost-effectiveness was incremental cost per quality-adjusted life-year (QALY). Outcome data were collected by postal questionnaires at 3, 6, 9 and 12 months.
Results
Within the radical group (n = 411), 92% of the men in the intervention group attended at least one therapy visit and were more likely than those in the control group to be carrying out any PFMT at 12 months {adjusted risk ratio (RR) 1.30 [95% confidence interval (CI) 1.09 to 1.53]}. The absolute risk difference in urinary incontinence rates at 12 months between the intervention (75.5%) and control (77.4%) groups was -1.9% (95% CI -10% to 6%). NHS costs were higher in the intervention group [£ 181.02 (95% CI £ 107 to £ 255)] but there was no evidence of a difference in societal costs, and QALYs were virtually identical for both groups. Within the TURP group (n = 442), over 85% of men in the intervention group attended at least one therapy visit and were more likely to be carrying out any PFMT at 12 months after randomisation [adjusted RR 3.20 (95% CI 2.37 to 4.32)]. The absolute risk difference in urinary incontinence rates at 12 months between the intervention (64.9%) and control (61.5%) groups for the unadjusted intention-to-treat analysis was 3.4% (95% CI -6% to 13%). NHS costs [£ 209 (95% CI £ 147 to £ 271)] and societal costs [£ 420 (95% CI £ 54 to £ 785)] were statistically significantly higher in the intervention group but QALYs were virtually identical.
Conclusions
The provision of one-to-one conservative physical therapy for men with urinary incontinence after prostate surgery is unlikely to be effective or cost-effective compared with standard care that includes the provision of information about conducting PFMT. Future work should include research into the value of different surgical options in controlling urinary incontinence.
Original languageEnglish
Pages (from-to)1-296
Number of pages296
JournalHealth Technology Assessment
Volume15
Issue number24
DOIs
Publication statusPublished - Jun 2011

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Urinary Incontinence
Prostate
Randomized Controlled Trials
Pelvic Floor
Confidence Intervals
Transurethral Resection of Prostate
Costs and Cost Analysis
Quality-Adjusted Life Years
Muscles
Prostatectomy
Control Groups
Random Allocation
Cost-Benefit Analysis
Odds Ratio
Conservative Treatment
Intention to Treat Analysis
Physical Therapists
Erectile Dysfunction
Urinary Bladder
Therapeutics

Cite this

Conservative treatment for urinary incontinence in Men After Prostate Surgery (MAPS) : two parallel randomised controlled trials. / Glazener, C; Boachie, C; Buckley, B; Cochran, C; Dorey, G; Grant, A; Hagen, S; Kilonzo, M; McDonald, A; McPherson, G; Moore, K; N'Dow, J; Ramsay, C; Vale, L.

In: Health Technology Assessment, Vol. 15, No. 24, 06.2011, p. 1-296.

Research output: Contribution to journalArticle

Glazener, C ; Boachie, C ; Buckley, B ; Cochran, C ; Dorey, G ; Grant, A ; Hagen, S ; Kilonzo, M ; McDonald, A ; McPherson, G ; Moore, K ; N'Dow, J ; Ramsay, C ; Vale, L. / Conservative treatment for urinary incontinence in Men After Prostate Surgery (MAPS) : two parallel randomised controlled trials. In: Health Technology Assessment. 2011 ; Vol. 15, No. 24. pp. 1-296.
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abstract = "ObjectiveTo determine the clinical effectiveness and cost-effectiveness of active conservative treatment, compared with standard management, in regaining urinary continence at 12 months in men with urinary incontinence at 6 weeks after a radical prostatectomy or a transurethral resection of the prostate (TURP).BackgroundUrinary incontinence after radical prostate surgery is common immediately after surgery, although the chance of incontinence is less after TURP than following radical prostatectomy.DesignTwo multicentre, UK, parallel randomised controlled trials (RCTs) comparing active conservative treatment [pelvic floor muscle training (PFMT) delivered by a specialist continence physiotherapist or a specialist continence nurse] with standard management in men after radial prostatectomy and TURP.SettingMen having prostate surgery were identified in 34 centres across the UK. If they had urinary incontinence, they were invited to enroll in the RCT.ParticipantsMen with urinary incontinence at 6 weeks after prostate surgery were eligible to be randomised if they consented and were able to comply with the intervention.InterventionsEligible men were randomised to attend four sessions with a therapist over a 3-month period. The therapists provided standardised PFMT and bladder training for male urinary incontinence and erectile dysfunction. The control group continued with standard management.Main outcome measuresThe primary outcome of clinical effectiveness was urinary incontinence at 12 months after randomisation, and the primary measure of cost-effectiveness was incremental cost per quality-adjusted life-year (QALY). Outcome data were collected by postal questionnaires at 3, 6, 9 and 12 months.ResultsWithin the radical group (n = 411), 92{\%} of the men in the intervention group attended at least one therapy visit and were more likely than those in the control group to be carrying out any PFMT at 12 months {adjusted risk ratio (RR) 1.30 [95{\%} confidence interval (CI) 1.09 to 1.53]}. The absolute risk difference in urinary incontinence rates at 12 months between the intervention (75.5{\%}) and control (77.4{\%}) groups was -1.9{\%} (95{\%} CI -10{\%} to 6{\%}). NHS costs were higher in the intervention group [£ 181.02 (95{\%} CI £ 107 to £ 255)] but there was no evidence of a difference in societal costs, and QALYs were virtually identical for both groups. Within the TURP group (n = 442), over 85{\%} of men in the intervention group attended at least one therapy visit and were more likely to be carrying out any PFMT at 12 months after randomisation [adjusted RR 3.20 (95{\%} CI 2.37 to 4.32)]. The absolute risk difference in urinary incontinence rates at 12 months between the intervention (64.9{\%}) and control (61.5{\%}) groups for the unadjusted intention-to-treat analysis was 3.4{\%} (95{\%} CI -6{\%} to 13{\%}). NHS costs [£ 209 (95{\%} CI £ 147 to £ 271)] and societal costs [£ 420 (95{\%} CI £ 54 to £ 785)] were statistically significantly higher in the intervention group but QALYs were virtually identical.ConclusionsThe provision of one-to-one conservative physical therapy for men with urinary incontinence after prostate surgery is unlikely to be effective or cost-effective compared with standard care that includes the provision of information about conducting PFMT. Future work should include research into the value of different surgical options in controlling urinary incontinence.",
author = "C Glazener and C Boachie and B Buckley and C Cochran and G Dorey and A Grant and S Hagen and M Kilonzo and A McDonald and G McPherson and K Moore and J N'Dow and C Ramsay and L Vale",
note = "Final Report Submitted to NIHR HTA Programme",
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language = "English",
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TY - JOUR

T1 - Conservative treatment for urinary incontinence in Men After Prostate Surgery (MAPS)

T2 - two parallel randomised controlled trials

AU - Glazener, C

AU - Boachie, C

AU - Buckley, B

AU - Cochran, C

AU - Dorey, G

AU - Grant, A

AU - Hagen, S

AU - Kilonzo, M

AU - McDonald, A

AU - McPherson, G

AU - Moore, K

AU - N'Dow, J

AU - Ramsay, C

AU - Vale, L

N1 - Final Report Submitted to NIHR HTA Programme

PY - 2011/6

Y1 - 2011/6

N2 - ObjectiveTo determine the clinical effectiveness and cost-effectiveness of active conservative treatment, compared with standard management, in regaining urinary continence at 12 months in men with urinary incontinence at 6 weeks after a radical prostatectomy or a transurethral resection of the prostate (TURP).BackgroundUrinary incontinence after radical prostate surgery is common immediately after surgery, although the chance of incontinence is less after TURP than following radical prostatectomy.DesignTwo multicentre, UK, parallel randomised controlled trials (RCTs) comparing active conservative treatment [pelvic floor muscle training (PFMT) delivered by a specialist continence physiotherapist or a specialist continence nurse] with standard management in men after radial prostatectomy and TURP.SettingMen having prostate surgery were identified in 34 centres across the UK. If they had urinary incontinence, they were invited to enroll in the RCT.ParticipantsMen with urinary incontinence at 6 weeks after prostate surgery were eligible to be randomised if they consented and were able to comply with the intervention.InterventionsEligible men were randomised to attend four sessions with a therapist over a 3-month period. The therapists provided standardised PFMT and bladder training for male urinary incontinence and erectile dysfunction. The control group continued with standard management.Main outcome measuresThe primary outcome of clinical effectiveness was urinary incontinence at 12 months after randomisation, and the primary measure of cost-effectiveness was incremental cost per quality-adjusted life-year (QALY). Outcome data were collected by postal questionnaires at 3, 6, 9 and 12 months.ResultsWithin the radical group (n = 411), 92% of the men in the intervention group attended at least one therapy visit and were more likely than those in the control group to be carrying out any PFMT at 12 months {adjusted risk ratio (RR) 1.30 [95% confidence interval (CI) 1.09 to 1.53]}. The absolute risk difference in urinary incontinence rates at 12 months between the intervention (75.5%) and control (77.4%) groups was -1.9% (95% CI -10% to 6%). NHS costs were higher in the intervention group [£ 181.02 (95% CI £ 107 to £ 255)] but there was no evidence of a difference in societal costs, and QALYs were virtually identical for both groups. Within the TURP group (n = 442), over 85% of men in the intervention group attended at least one therapy visit and were more likely to be carrying out any PFMT at 12 months after randomisation [adjusted RR 3.20 (95% CI 2.37 to 4.32)]. The absolute risk difference in urinary incontinence rates at 12 months between the intervention (64.9%) and control (61.5%) groups for the unadjusted intention-to-treat analysis was 3.4% (95% CI -6% to 13%). NHS costs [£ 209 (95% CI £ 147 to £ 271)] and societal costs [£ 420 (95% CI £ 54 to £ 785)] were statistically significantly higher in the intervention group but QALYs were virtually identical.ConclusionsThe provision of one-to-one conservative physical therapy for men with urinary incontinence after prostate surgery is unlikely to be effective or cost-effective compared with standard care that includes the provision of information about conducting PFMT. Future work should include research into the value of different surgical options in controlling urinary incontinence.

AB - ObjectiveTo determine the clinical effectiveness and cost-effectiveness of active conservative treatment, compared with standard management, in regaining urinary continence at 12 months in men with urinary incontinence at 6 weeks after a radical prostatectomy or a transurethral resection of the prostate (TURP).BackgroundUrinary incontinence after radical prostate surgery is common immediately after surgery, although the chance of incontinence is less after TURP than following radical prostatectomy.DesignTwo multicentre, UK, parallel randomised controlled trials (RCTs) comparing active conservative treatment [pelvic floor muscle training (PFMT) delivered by a specialist continence physiotherapist or a specialist continence nurse] with standard management in men after radial prostatectomy and TURP.SettingMen having prostate surgery were identified in 34 centres across the UK. If they had urinary incontinence, they were invited to enroll in the RCT.ParticipantsMen with urinary incontinence at 6 weeks after prostate surgery were eligible to be randomised if they consented and were able to comply with the intervention.InterventionsEligible men were randomised to attend four sessions with a therapist over a 3-month period. The therapists provided standardised PFMT and bladder training for male urinary incontinence and erectile dysfunction. The control group continued with standard management.Main outcome measuresThe primary outcome of clinical effectiveness was urinary incontinence at 12 months after randomisation, and the primary measure of cost-effectiveness was incremental cost per quality-adjusted life-year (QALY). Outcome data were collected by postal questionnaires at 3, 6, 9 and 12 months.ResultsWithin the radical group (n = 411), 92% of the men in the intervention group attended at least one therapy visit and were more likely than those in the control group to be carrying out any PFMT at 12 months {adjusted risk ratio (RR) 1.30 [95% confidence interval (CI) 1.09 to 1.53]}. The absolute risk difference in urinary incontinence rates at 12 months between the intervention (75.5%) and control (77.4%) groups was -1.9% (95% CI -10% to 6%). NHS costs were higher in the intervention group [£ 181.02 (95% CI £ 107 to £ 255)] but there was no evidence of a difference in societal costs, and QALYs were virtually identical for both groups. Within the TURP group (n = 442), over 85% of men in the intervention group attended at least one therapy visit and were more likely to be carrying out any PFMT at 12 months after randomisation [adjusted RR 3.20 (95% CI 2.37 to 4.32)]. The absolute risk difference in urinary incontinence rates at 12 months between the intervention (64.9%) and control (61.5%) groups for the unadjusted intention-to-treat analysis was 3.4% (95% CI -6% to 13%). NHS costs [£ 209 (95% CI £ 147 to £ 271)] and societal costs [£ 420 (95% CI £ 54 to £ 785)] were statistically significantly higher in the intervention group but QALYs were virtually identical.ConclusionsThe provision of one-to-one conservative physical therapy for men with urinary incontinence after prostate surgery is unlikely to be effective or cost-effective compared with standard care that includes the provision of information about conducting PFMT. Future work should include research into the value of different surgical options in controlling urinary incontinence.

U2 - 10.3310/hta15240

DO - 10.3310/hta15240

M3 - Article

VL - 15

SP - 1

EP - 296

JO - Health Technology Assessment

JF - Health Technology Assessment

SN - 1366-5278

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