Programa cognitivo-conductual para el control de los síntomas del tracto urinario inferior después de la prostatectomía radical: un ensayo clínico aleatorizado

Izidoro, Lívia Cristina de Resende; Mata, Luciana Regina Ferreira da; Azevedo, Cissa; Paula, Adriano Augusto Peclat de; Pereira, M. Graça; Santos, Jackelline Evellin Moreira dos; Brasil, Virginia Visconde; Oliveira, Lizete Malagoni de Almeida Cavalcante

doi:10.1590/0034-7167-2021-0818

Brasil

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (5) • 2022 • https://doi.org/10.1590/0034-7167-2021-0818 linkcopiar

Programa cognitivo-conductual para el control de los síntomas del tracto urinario inferior después de la prostatectomía radical: un ensayo clínico aleatorizado

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo: evaluar la efectividad de un programa cognitivo-conductual para controlar los síntomas del tracto urinario inferior después de la prostatectomía radical.

Métodos: estudio de ensayo clínico aleatorizado, con 41 participantes aleatorizados en intervención (n=20) y control (n=21), durante tres meses. El grupo de intervención recibió el programa cognitivo-conductual, mientras que el grupo control recibió orientación rutinaria del servicio. Las variables de resultado fueron la intensidad de la incontinencia urinaria y los síntomas del tracto urinario inferior, evaluados mediante Pad-Test y Urinary Incontinence Scale of Radical Prostatectomy y King’s Health Questionnaire.

Resultados: al final del estudio, el grupo intervención presentó menor intensidad de incontinencia urinaria (p≤0,001), y hubo menos posibilidades de presentar cambios en la frecuencia urinaria (p≤0,001), urgencia urinaria (p≤0,001), nicturia (p=0,005), incontinencia urinaria de esfuerzo (p≤0,001) e incontinencia de urgencia (p≤0,045).

Conclusión: el programa cognitivo-conductual fue eficaz para reducir los síntomas del tracto urinario inferior después de la prostatectomía radical. Registro Brasileño de Ensayos Clínicos: RBR-3sstqg.

Descriptores: Enfermería; Incontinencia Urinaria; Síntomas del Sistema Urinario Inferior; Prostatectomía; Ensayo Clínico

	Mean (SD)		Effect: group^a a statistical difference between the two groups in T0 (reference: CG);		Effect: time^b b statistical difference between the assessment times (reference: T0);		Group^*time^c c statistical difference in IG in relation to CG in the different post-test moments (reference: T0).
	IG	CG	β (95% CI)	p value	β (95% CI)	p value	β (95% CI)	p value
Pad-Test
T₀	50.9(7.8)	53.6(12.8)	-0.051 (-0.611;0.508)	0.858	-	-	-	-
T₁	12.5(3.0)	32.2(9.0)			-0.508 (-0.934;-0.081)	0.020	-0.895 (-1.427;-0.363)	≤0.001
T₂	7.2(4.7)	20.9(4.9)			-0.941 (-1.286;-0.586)	≤0.001	-1.006 (-2.277; 0.265)	0.121
T₃	3.4(2.8)	15.1(3.9)			-1.266 (-1.709;-0.824)	≤0.001	-1.413 (-3.023;0.197)	0.085
UISRP
T₀	18.5(1.2)	18.4(1.1)	0.006 (-0.179;0.192)	0.946	-	-	-	-
T₁	11.8(1.0)	15.8(1.4)			-0.151 (-0.242;-0.060)	≤0.001	-0.293 (-0.487;-0.098)	0.003
T₂	5.3(0.9)	13.6(1.5)			-0.299 (-0.457;-0.141)	≤0.001	-0.952 (-1.292;-0.611)	≤0.001
T₃	3.0(1.1)	13.0(1.2)			-0.343 (-0.563;-0.123)	0.002	-1.447 (-2.166;-0.729)	≤0.001

	Mean (SD)				T₀-T₁ (95% CI)^† † confidence interval for the difference of means in 95%; p value	T₀-T₂ (95% CI)^† † confidence interval for the difference of means in 95%; p value	T₀-T₃ (95% CI)^† † confidence interval for the difference of means in 95%; p value
	T₀	T₁	T₂	T₃
Pad-Test
IG	50.9(7.8)	12.5(3.0)	7.2 (4.7)	3.4 (2.8)	(23.0;53.8) ≤ 0.001	(22.5;64.7) ≤0.001	(26.9;67.9) ≤0.001
CG	53.6(12.8)	32.2(9.0)	20.9(4.9)	15.1(3.9)	(-4.1; 46.8) 0.165	(6.5; 58.8) 0.006	(9.4; 67.5) 0.003
(IC 95%)^† † confidence interval for the difference of means in 95%; p value	(-32.2;26.9) 0.859	(-38.5;-0.9) 0.039	(-27.0;-0.2) 0.045	(-21.0;-2.1) 0.016	-	-	-
UISRP
IG	18.5 (1.2)	11.8 (1.0)	5.3 (0.9)	3.0 (1.1)	(3.2; 10.0) ≤0.001	(10.0;16.4) ≤0.001	(11.4;19.4) ≤0.001
CG	18.4 (1.1)	15.8 (1.4)	13.6 (1.5)	13.0 (1.2)	(0.7;4.4) ≤0.001	(1.9;7.6) ≤0.001	(0.9;9.7) 0.008
(IC 95%)^† † confidence interval for the difference of means in 95%; p value	(-3.3; 3.5) 0.946	(-7.4; -0.4) 0.027	(-11.8; -4.8) ≤0.001	(-13.2; -6.6) ≤0.001

Urinary symptoms	n (%)				Effect: group^a a statistical difference between IG and CG at T0 (reference: CG); bstatistical difference between pre-test and post-test (reference: T0);		Effect: time^b		Group^*time^c c statistical difference in IG compared to CC at post-test (reference: CG at T0).
Urinary symptoms	T₀	T₁	T₂	T₃	β (95% CI)	p value	β (95% CI)	p value	β (95% CI)	p value
Frequency
CG	17 (25.0)	14 (20.6)	12 (17.6)	15 (22.1)	1.000 (1.000;1.000)	<0.001	0.941 (0.868;1.021)	0.144	0.625 (0.525;0.744)	≤0.001
IG	17 (25.0)	10 (14.7)	2 (2.9)	3 (4.4)	1.000 (1.000;1.000)	<0.001	0.941 (0.868;1.021)	0.144	0.625 (0.525;0.744)	≤0.001
Nocturia
CG	16 (23.5)	14 (20.6)	11 (16.2)	10 (14.7)	1.030 (0.973;1.091)	0.310	0.818 (0.691;0.969)	0.020	0.719 (0.572;0.904)	0.005
IG	17 (25.0)	10 (14.7)	2 (2.9)	3 (4.4)	1.030 (0.973;1.091)	0.310	0.818 (0.691;0.969)	0.020	0.719 (0.572;0.904)	0.005
Urgency
CG	16 (23.5)	15 (22.1)	13 (19.1)	14 (20.6)	0.879 (0.764;1.010)	0.069	0.939 (0.833;1.060)	0.309	0.661 (0.544;0.802)	≤0.001
IG	12 (17.6)	6 (8.8)	1 (1.5)	1 (1.5)	0.879 (0.764;1.010)	0.069	0.939 (0.833;1.060)	0.309	0.661 (0.544;0.802)	≤0.001
Urge incontinence
CG	16 (23.5)	14 (20.6)	10 (14.7)	9 (13.2)	0.879 (0.764;1.010)	0.069	0.788 (0.660;0.941)	0.009	0.788 (0.624;0.995)	0.045
IG	12 (17.6)	5 (7.4)	1 (1.5)	1 (1.5)	0.879 (0.764;1.010)	0.069	0.788 (0.660;0.941)	0.009	0.788 (0.624;0.995)	0.045
Effort UI
CG	16 (23.5)	15 (22.1)	15 (22.1)	15 (22.1)	1.030 (0.973;1.091)	0.310	0.970 (0.874;1.076)	0.562	0.728 (0.599;0.885)	≤0.001
IG	17 (25.0)	16 (23.5)	13 (19.1)	7 (10.3)	1.030 (0.973;1.091)	0.310	0.970 (0.874;1.076)	0.562	0.728 (0.599;0.885)	≤0.001
Nocturnal enuresis
CG	13 (19.1)	6 (8.8)	7 (10.3)	4 (5.9)	0.933 (0.780;1.116)	0.450	0.700 (0.573;0.856)	≤0.001	0.867 (0.680;1.107)	0.253
IG	11 (16.2)	1 (1.5)	2 (2.9)	0 (0.0)	0.933 (0.780;1.116)	0.450	0.700 (0.573;0.856)	≤0.001	0.867 (0.680;1.107)	0.253
Sexual UI
CG	2 (2.9)	1 (1.5)	2 (2.9)	1 (1.5)	0.947 (0.797;1.126)	0.540	0.947 (0.971;1.135)	0.557	0.997 (0.809;1.229)	0.977
IG	1 (1.5)	0 (0.0)	1 (1.5)	0 (0.0)	0.947 (0.797;1.126)	0.540	0.947 (0.971;1.135)	0.557	0.997 (0.809;1.229)	0.977
Urinary tract infections
CG	2 (2.9)	0 (0.0)	0 (0.0)	0 (0.0)	0.947 (0.797;1.126)	0.540	0.895 (0.780;1.026)	0.112	1.118 (0.909;1.373)	0.290
IG	1 (1.5)	0 (0.0)	1 (1.5)	1 (1.5)	0.947 (0.797;1.126)	0.540	0.895 (0.780;1.026)	0.112	1.118 (0.909;1.373)	0.290
Bladder pain
CG	4 (5.9)	2 (2.9)	0 (0.0)	1 (1.5)	0.857 (0.706;1.041)	0.120	0.857 (0.738;0.995)	0.043	1.102 (0.918;1.323)	0.298
IG	1 (1.5)	0 (0.0)	1 (1.5)	0 (0.0)	0.857 (0.706;1.041)	0.120	0.857 (0.738;0.995)	0.043	1.102 (0.918;1.323)	0.298
Difficulty urinating
CG	3 (4.4)	2 (2.9)	1 (1.5)	1 (1.5)	0.900 (0.747;1.085)	0.269	0.900 (0.789;1.027)	0.117	1.049 (0.886;1.242)	0.576
IG	1 (1.5)	0 (0.0)	1 (1.5)	0 (0.0)	0.900 (0.747;1.085)	0.269	0.900 (0.789;1.027)	0.117	1.049 (0.886;1.242)	0.576

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[TFN1] ^a
statistical difference between the two groups in T₀ (reference: CG);

[TFN2] ^b
statistical difference between the assessment times (reference: T₀);

[TFN3] ^c
₀