Atuação fisioterapêutica nos sintomas de disfunções sexuais e urinárias em pacientes pós-prostatectomia: uma revisão sistemática

Abstract

Radical prostatectomy (RP) is a surgical procedure, consisting of a technique for total removal of the prostate and seminal vesicles. Men's complaints are routine, after surgery, as secondary repercussions, being the most reported: urinary incontinence and sexual dysfunction. Physiotherapy, present in the conservative management, provides benefits in re-educating and strengthening the perineal muscles, besides improving the quality of life. The objective of the study is to know the physiotherapeutic action in the symptoms of sexual and urinary dysfunctions in patients after radical prostatectomy. This is a systematic review with meta-analysis, according to PRISMA guidelines, carried out from September to November 2021, in the Pubmed, PEDro, Medline and Lilacs databases with the following descriptors and use of booleans: (prostatic neoplasms) AND (prostatectomy), (urinary incontinence OR sexual dysfunction, physiological) AND (physiotherapy). For the meta-analysis, the random effects model adopted was the use of Cochran's Q test (P< 0.05 as statistical significance) and the I² test (ranging from 0 to 100%) to assess heterogeneity of studies. Initially, 133 articles identified. Including only randomized clinical trials, published in the last five years and applying the inclusion and exclusion criteria, nine articles. After excluding duplicates and reading titles and abstracts, six articles were selected for synthesis and data extraction. For statistical analysis, three articles presented outcomes for quality of life, using as evaluation criteria the International Consultation Questionnaire on Incontinence (ICIQ-SF) and the International Index of Erectile Function (IIFE-5). Statistically, there was heterogeneity of the selected studies, resulting in unsatisfactory evidence about the physiotherapeutic capabilities of the interventions. In conclusion, pelvic floor muscle training interventions, electromyographic biofeedback, and couples counseling therapy did not provide significant evidence in the treatment of erectile dysfunction and urinary incontinence in post-radical prostatectomy patients.