ARE PRE- AND POST-PROSTATECTOMY MEASURES OF PELVIC FLOOR MUSCLE FUNCTION MADE WITH TRANSPERINEAL ULTRAOUND RELATED TO EARLY INCONTINENCE AFTER SURGERY?

R. Stafford¹, S. Doorbar-Baptist², P. Hodges¹

¹The University of Queensland, School of Health and Rehabilitation Science, Brisbane, Australia, ²Sydney Physiotherapy Solutions, Sydney, Australia

Background: Pelvic floor muscle (PFM) training is increasingly advocated for the prevention and treatment of urinary incontinence after prostatectomy. Although promising, not all trials provide positive outcomes. There are many unanswered questions regarding how best to explain recovery of continence after prostatectomy and methods to train the PFM in men. The development and validation of methods to assess PFMs with dynamic transperineal ultrasound imaging has provided a new opportunity to address these critical questions.

Purpose: This study aimed to use transperineal ultrasound imaging to investigate:
(i) whether PFM contraction can be enhanced by provision of training focused on striated urethral sphincter (SUS) with ultrasound feedback (before prostatectomy),
(ii) whether PFM contraction during voluntary efforts and coughing before and after prostatectomy differs between men who do and do not report symptoms of urinary incontinence 1 month after prostatectomy, and
(iii) the relationship between severity of incontinence after prostatectomy and features of PFM function and urethral length before and after prostatectomy.

Methods: Sixty men referred for preoperative PFM training before radical prostatectomy participated. The International Continence Society Male Short Form questionnaire was used to quantify continence status. Transperineal ultrasound imaging was used to record pelvic displacements related to activation of SUS, bulbocavernosus (BC) and puborectalis (PR) muscles during cough, "natural" voluntary contraction following pamphlet instruction, and trained voluntary contraction after formal physiotherapist instruction including ultrasound feedback. Measures were made before and approximately 1 month after prostatectomy.

Results: PFM displacements following training differed between continent and incontinent men; continent participants demonstrated increased SUS shortening after training (compared with "natural"), but no difference was observed between trained and "natural" contractions for incontinent participants. Motion at ano-rectal junction related to contraction of PR during cough was reduced following surgery, but voluntary and involuntary activation of SUS or BC was not consistently affected by surgery.

Conclusions: Men undergoing prostatectomy for prostate cancer can be trained to improve activation of the SUS. Men with a greater improvement capacity to contract the SUS have greater continence function at 1 month. Both SUS function and urethral length are correlated with postprostatectomy continence outcome.

Implications: This study supports the notion that continence function after prostatectomy relates to function of the striated urethral sphincter muscle. The relationship greater capacity to enhance sphincter function with training and continence outcomes lends weight to the argument that SUS function should be a major target for post-prostatectomy continence management. This is being tested in a current randomised controlled clinical trial.

Funding acknowledgements: National Health and Medical Research Council (Australia)

Keywords:
Men's Health
Prostatectomy
Incontinence

Topics:
Pelvic, sexual and reproductive health
Oncology, HIV & palliative care
Service delivery/emerging roles

Did this work require ethics approval? Yes

Institution: The University of Queensland

Committee: Medical Research Ethics Committee

Ethics number: #2017001736