Introduction
enign prostate hyperplasia (BPH) is common in the elderly, and its treatment options include medical and surgical methods, such as radical prostatectomy (RP) and transurethral resection of the prostate (TURP). The most important complication after prostate surgeries is urinary incontinence (UI), which causes a decrease in self-esteem and an increase in frailty syndrome [14]. One of the treatment methods for UI is Kegel’s exercises, which include voluntary and continuous contractions of the urethral sphincter muscle. According to studies, the Kegel exercises reduce UI after RP [27]. This study aims to investigate the effect of Kegel’s exercises on UI, frailty syndrome, and self-esteem in elderly people with BPH who underwent TURP.

Methods
This randomized clinical trial was conducted on 76 elderly people with BPH who underwent TURP surgery. They were randomly assigned to the control and intervention groups using the permuted block randomization method. Entry criteria were age ≥65 years, at least a primary school education, having a smart cell phone, not being diagnosed with prostate cancer after surgery, a score of 24 or higher in the mini-mental state examination (MMSE), a score of 4 or higher in items 1, 2 and 3 of the questionnaire for urinary incontinence diagnosis (QUID) and a score of 8 or higher in the Edmonton frailty scale (EFS). Exclusion criteria were not doing exercises for more than two days, re-hospitalization during the study, taking medication to control UI, and death. The tools used in this study included EFS, international consultation on incontinence questionnaire – UI short form (ICIQ-UI SF), rosenberg self-esteem scale (RSES), MMSE, QUID, and a demographic form, which were completed before the intervention, eight weeks after the start of the intervention, and four weeks after the end of the intervention. Descriptive statistics (Mean±SD) and inferential statistics (chi-square test, repeated measures ANOVA, Fisher’s test, and LSD post hoc test) were used for data analysis. Data were analyzed using SPSS software, version 26. The significance level was set at 0.05.

Results
The mean age of the participants was 71.78±4.85 years. Most of the participants were young elderly, married, retired, with primary school education, at least one child, a history of smoking, hypertension, diabetes, no history of stroke or heart attack, and less than one hour of mobility during the day. Using chi-square test, there was no significant difference in any demographic variables between the control and intervention groups. The scores of UI, fragility syndrome, and self-esteem in the control and intervention groups were not significantly different before the intervention, while eight weeks after the start of the intervention and four weeks after the end of the intervention, the differences were significant (P<0.05). The mean UI and fragility syndrome scores in the control group increased, indicating the worsening of these conditions, while they decreased in the intervention group, indicating an improvement in these conditions. Moreover, the mean score of self-esteem decreased in the control group, but increased in the intervention group (Table 1).



The comparison of the mean scores in each group in three time periods also showed that in the control group, the mean difference in scores of UI and fragility syndrome increased over time, but in the intervention group, the mean difference decreased. The mean difference in the score of self-esteem decreased in the control group over time, but increased in the intervention group. The LSD post hoc test showed that Kegel’s exercises in the intervention group had a significant effect on three variables over time, indicating the persistence of the treatment effect over time (P<0.001). However, there was no statistically significant difference over time in the control group (P>0.05) (Table 1).

Conclusion
The findings of the current study showed that Kegel’s exercises for 3 months improved UI, frailty syndrome, and self-esteem in elderly people with BPH following TURP. However, it was not proved whether the increase or decrease of UI, as a mediating variable, is effective in the relationship between self-esteem and frailty syndrome. Investigating this relationship requires more studies with more samples.

Ethical Considerations

Compliance with ethical guidelines
All ethical principles, such as obtaining informed consent from the participants, protecting their confidentiality, and giving them the right to leave the study, were considered in this research. The present study was approved by the Ethics Committee of Ilam University of Medical Sciences (Code: IR.MEDILAM.REC.1400.167) and was registered by the Iranian Registry of Clinical Trials (IRCT) (ID: IRCT20211110053030N1).

Funding
This article was extracted from a master’s thesis of Alireza Vasiee, approved by Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences.

Authors' contributions
Conceptualization and data curation: Alireza Vasiee and Mosayeb Mozafari; Methodology, formal analysis and visualization: Alireza Vasiee and Reza Pakzad; Validation and resources: Nasrin Ghiasi; Investigation: Alireza Vasiee, Mosayeb Mozafari and Mansour Masoumi; The original draft preparation: Alireza Vasiee and Mansour Masoumi; Review and editing: Mosayeb Mozafari; Supervision: Mosayeb Mozafari, Nasrin Ghiasi and Mansour Masoumi; Project administration: Alireza Vasiee, Mansour Masoumi; Funding acquisition: Ilam University of Medical Sciences.

Conflicts of interest
The authors declared no conflict of interest

Acknowledgements
The authors would like to thank and the seniors and their families, as well as the Clinical Research Unit of Imam Khomeini Hospital in Ilam for their cooperation.



 

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