Efetividade da acupuntura auricular associada ao treinamento muscular pélvico para controle da incontinência urinária pós-prostatectomia radical: ensaio clínico randomizado

• Ano de defesa: 2021
• Autor(a) principal: Cissa Azevedo
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; Brasil; ENFERMAGEM - ESCOLA DE ENFERMAGEM; Programa de Pós-Graduação em Enfermagem; UFMG
• Palavras-chave em Português: Neoplasias da Próstata; Incontinência Urinária; Sintomas do Trato Urinário Inferior; Terapia Comportamental; Acupuntura Auricular; Enfermagem; Dissertação Acadêmica
• Link de acesso: http://hdl.handle.net/1843/35193; https://orcid.org/0000-0001-5881-5710

Radical prostatectomy can cause undesirable urinary effects such as urinary incontinence, nocturia, urinary urgency, frequency and incomplete emptying of the bladder. Voiding dysfunctions cause feelings and experience of social exclusion and, consequently, decrease in quality of life. For cases of urinary incontinence after radical prostatectomy, muscle training of the pelvic floor is indicated as the first choice to assist in the urethral closure mechanism. Among the integrative and complementary practices that have contributions in the health area, we can mention auricular acupuncture. This is based on the stimulation of acupoints in the ear to relieve signs and symptoms of several conditions, including lower urinary tract symptoms. The aim of this study was to evaluate the effectiveness of auricular acupuncture associated with pelvic floor muscle training in urinary incontinence after radical prostatectomy. This is a randomized clinical trial based on the recommendations of the Consolidated Standards of Reporting Trials and Standards for Reporting Interventions in Clinical Trials of Acupuncture. Data were collected between April 2019 and April 2020. The sample consisted of 60 men with urinary incontinence after removal of the indwelling bladder catheter, allocated into two groups: control (n = 30) who received guidance on floor muscle training pelvic; and intervention (n = 30) that received auricular acupuncture associated with guidelines on muscle training of the pelvic floor. The guidelines on muscle training took place during eight weekly face-to-face sessions associated with the delivery of a booklet that helped to continue the exercises at home. For the intervention group, auricular acupuncture was also offered in eight weekly sessions. The evaluation took place in two moments: before any treatment (pre-test) and after eight weeks of follow-up (9th session - post-test). The socio-demographic and clinical questionnaire, daily pad used, one-hour pad test, urinary incontinence scale after radical prostatectomy, International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and King’s Health Questionnaire (KHQ) were used. The longitudinal model, using generalized estimation equations and proportional difference test, was used in the statistical analysis. The level of significance adopted was 0.05. Results: the severity of urinary incontinence decreased between the pre-test and post-test in the intervention group and also in the control group without statistical differences in the evolution between the two groups. Regarding the impact of incontinence on quality of life, a statistically significant difference was identified between the groups in the post-test at the level of the “severity measures” domain (p = 0.013), which indicated a lower impact of UI for this domain only in the intervention group. In the analysis of the frequency of the items in this domain, a statistically significant difference was detected between the groups in the post-test for the item “change your underwear when they are wet” (p = 0.018). It was also evident that the intervention group had, respectively, 20.8% (p = 0.007) and 25.3% (p = 0.002) less chance of presenting nocturia and urinary urgency. There was also a statistically significant reduction in the impact of incontinence on quality of life in the domains "emotions" (p <0.001) and "sleep and mood" (p = 0.008) in the intervention group. Conclusion: AA was not effective in potentiating the action of muscle training in reducing the severity of urinary incontinence. On the other hand, regarding the impact of urinary incontinence on quality of life, the association of ear acupuncture with training proved to be more effective, mainly due to the statistically significant difference between the groups in the post-test for the “severity measures” domain, as well as by reducing the chance of nocturia symptoms and urinary urgency. In view of these findings, the association of therapies as an effective care for men with urinary incontinence after radical prostatectomy is recommended. Brazilian Registry of Clinical Trials: RBR-3jm5y2.