Behavioral therapy reduces postprostatectomy incontinence

According to a study published in JAMA, 65% of men experience urinary incontinence up to 5 years following radical prostatectomy.

American researchers conducted a randomized controlled trial involving 208 men aged 51 - 84 with incontinence persisting 1 to 17 years after radical prostatectomy, to evaluate the effectiveness of behavioral therapy for reducing post-prostatectomy incontinence and to determine whether biofeedback and electrical stimulation enhance its effectiveness. 24% of the men were black and 75 % white.

The researchers found that over the 8-week treatment period, those in the behavioral therapy group had an average reduction of incontinence episodes of 55 % (from 28 to 13 episodes per week), while the control group had an average reduction of only 24 % ( from 25 to 21 episodes per week). Those in the behavior-plus group experienced an average reduction of 51% (from 26 to 12 episodes per week), indicating that the addition of biofeedback and electrical stimulation did not improve the 8-week results compared with behavioral therapy alone.

Improvements were evident up to a year in the treatment groups, 50% reduction in the behavioral group and 59% in the behavior plus group. By the end of the treatment period, 15.7 % of men in the behavior therapy group, 17.1% in the behavior-plus group, and 5.9% in the control group achieved complete continence.

The researchers concluded that for men with incontinence following radical prostatectomy, behavioral therapy resulted in significant reduction in incontinence espisodes and that these findings have important implications for doctors and patients.

In an accompanying editorial, the author wrote that the optimal way to address postprostatectomy incontinence remains unanswered and that a better strategy would be primary prevention.

Source: Behavioral Therapy With or Without Biofeedback and Pelvic Floor Electrical Stimulation for Persistent Postprostatectomy Incontinence - A Randomized Controlled Trial. JAMA. 2011;305(2):151-159. (f/t via Athens)

General anesthesia is closer to coma than sleep

According to a review published in the NEJM, patients undergoing general anesthesia before surgery are not "going to sleep" as their doctors probably told them, they are placed in a “reversible coma".


Three US neuroscientists took 3 years to research studies in general anestheisa, sleep and coma to understand how anesthetic drugs induce and maintain the behavioral states of general anesthesia. They discussed the clinical and neurophysiological features of general anesthesia and their relationships to sleep and coma, focusing on the neural mechanisms of unconsciousness induced by selected anesthetic drugs.


They conclude that better understanding of the the different states of the process would lead to new approaches to general anesthesia and improved diagnosis and treatment for sleep problems and emergence from coma.



Source: "General Anesthesia, Sleep, and Coma". New England J of Medicine 2010; 363:2638-2650 ( f/t via Athens)

Good cholesterol may reduce Alzhemier's risk

A new study claims that high levels of high-density lipoprotein (HDL) or ‘good’ cholesterol could lower the risks of developing Alzheimer’s disease in older adults,


US researchers studied 1,130 randomly selected elderly people aged 65 and over and had no history of memory trouble or dementia. The participants were follwoed for an average of four years. Researchers found that those with the highest HDL counts, over 55 mg/dL, had about a 60% reduced risk of developing the disease compared to those whose levels were under 39 mg/dL. The study author said that the result suggested that higher level of good cholesterol decreases the risk of Alzheimer's disease, but the mechanism is unknown.


It was noted that a previous study published in Neurology in 2001 found that Japanese-American men with higher HDL cholesterol were more likely to have Alzheimer's-related plagues and tangles in their brains.


Alzheimer's Society (UK) said until now, studies have focused on the associations between 'good' cholesterol and vascular dementia....... More research is needed to fully understand the link between HDL cholesterol and the processes that lead to Alzheimer's Disease.


Source:'Association of Higher Levels of High-Density Lipoprotein Cholesterol in Elderly Individuals and Lower Risk of Late-Onset Alzheimer Disease'. Archives of Neurology. 2010;67(12):1491-1497. doi:10.1001/archneurol.2010.297