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Ouchi M1,2, Kitta T1, Takahashi Y1, Kanno Y1, Higuchi M1, Togo M1, Moriya K1, Shinohara N1
1Hokkaido University, Graduate School of Medicine, Sapporo, Japan, 2Health Science University of Hokkaido, Tobetsu, Japan
Background: With regard to pelvic floor muscle (PFM) function measurement, vaginal pressure (cmH2O) has been used to assess objectively the strength and endurance of PFM contractions in women. Recent studies have confirmed the reliability of manometry. Regarding PFM training for men, previous studies showed that PFMT may be effective with patients after radical prostatectomy. The numerous and objective measurement is needed to assess PFM function for men after radical prostatectomy. However, the intra- and inter-rater reliability of manometry to measure anorectal pressure have not known.
Purpose: The purpose of this study was to clarify the reliability of anorectal pressure for PFM function in healthy men.
Methods: Healthy male subjects over age 20 were recruited in sequential fashion. Regarding measurement, we asked them not to exercise during the present reliability study period in order to eliminate the chances of training and de-training effect. The manometry with anal sensor (cmH2O), PeritronTM (Laborie, Canada) was used for measuring the PFM functions, including maximum anorectal pressure, resting pressure, duration, average pressure, gradient, and area under curve (AUC). Examinations performed for inter- and intra- rater reliability by two examiners. A standardised protocol including the exact instruction “squeeze and lift or tighten and pull up the PFM”, and voice volume were implemented to assure correct and reproducible data. Subjects were assessed as follows:
(1) the completion of the testing protocol in the first visit,
(2) subjects returned for a second visit between 2 - 6 weeks after the first visit, and the same procedure of examination was repeated.
Subjects were assessed in lateral position and knees drawn up at 45 degrees. The PFM functions were measured repeatedly 3 times, and then the average value was recorded in all parameters. Statistical analysis was performed using the Statistical Package for the Social Sciences 23.0J for mac (IBM, Armonk, NY). Intraclass correlation coefficients (ICC) was used for Intra-rater reliability. Inter-rater reliability was examined by calculating Pearson correlation coefficients for normally distributed variables and Spearman correlation coefficients for non-normally distributed variables. The significance level was set at p-value 0.05.
Results: Eleven healthy male subjects were participated in this study. The median age of participants was 41 years old (range: from 29 to 46). Intra-reter reliability tested by ICC values was as follows: maximum anorectal pressure (ICC, examiner1: 0.64, examiner2: 0.83), average value (ICC, examiner1: 0.74, examiner2: 0.79). Spearman's or Peason's correlation coefficients was calculated for all parameters to evaluate the relationship between two examiners. There were significant correlation in maximum anorectal pressure (r=0.90, P= 0.0001), duration (r=0.72, p= 0.0011) and average pressure (r=0.83, p= 0.0017), AUC (r=0.66, p= 0.0277).
Conclusion(s): This is the first prospective study to reveal the reliability of anorectal pressure in healthy men. Our findings suggest that a manometry can provide both reliable and reproducible data regarding PFM function.
Implications: The manometry with anorectal pressure for PFM contractions demonstrated good for intra-rater reliability. There was good to almost perfect for inter-rater reliability between two examiners for maximum anorectal pressure, duration, average pressure and AUC.
Keywords: anorectal pressure, healthy men, reliability
Funding acknowledgements: This research was supported by grants from Grants-in-Aid for Scientific Research.
Purpose: The purpose of this study was to clarify the reliability of anorectal pressure for PFM function in healthy men.
Methods: Healthy male subjects over age 20 were recruited in sequential fashion. Regarding measurement, we asked them not to exercise during the present reliability study period in order to eliminate the chances of training and de-training effect. The manometry with anal sensor (cmH2O), PeritronTM (Laborie, Canada) was used for measuring the PFM functions, including maximum anorectal pressure, resting pressure, duration, average pressure, gradient, and area under curve (AUC). Examinations performed for inter- and intra- rater reliability by two examiners. A standardised protocol including the exact instruction “squeeze and lift or tighten and pull up the PFM”, and voice volume were implemented to assure correct and reproducible data. Subjects were assessed as follows:
(1) the completion of the testing protocol in the first visit,
(2) subjects returned for a second visit between 2 - 6 weeks after the first visit, and the same procedure of examination was repeated.
Subjects were assessed in lateral position and knees drawn up at 45 degrees. The PFM functions were measured repeatedly 3 times, and then the average value was recorded in all parameters. Statistical analysis was performed using the Statistical Package for the Social Sciences 23.0J for mac (IBM, Armonk, NY). Intraclass correlation coefficients (ICC) was used for Intra-rater reliability. Inter-rater reliability was examined by calculating Pearson correlation coefficients for normally distributed variables and Spearman correlation coefficients for non-normally distributed variables. The significance level was set at p-value 0.05.
Results: Eleven healthy male subjects were participated in this study. The median age of participants was 41 years old (range: from 29 to 46). Intra-reter reliability tested by ICC values was as follows: maximum anorectal pressure (ICC, examiner1: 0.64, examiner2: 0.83), average value (ICC, examiner1: 0.74, examiner2: 0.79). Spearman's or Peason's correlation coefficients was calculated for all parameters to evaluate the relationship between two examiners. There were significant correlation in maximum anorectal pressure (r=0.90, P= 0.0001), duration (r=0.72, p= 0.0011) and average pressure (r=0.83, p= 0.0017), AUC (r=0.66, p= 0.0277).
Conclusion(s): This is the first prospective study to reveal the reliability of anorectal pressure in healthy men. Our findings suggest that a manometry can provide both reliable and reproducible data regarding PFM function.
Implications: The manometry with anorectal pressure for PFM contractions demonstrated good for intra-rater reliability. There was good to almost perfect for inter-rater reliability between two examiners for maximum anorectal pressure, duration, average pressure and AUC.
Keywords: anorectal pressure, healthy men, reliability
Funding acknowledgements: This research was supported by grants from Grants-in-Aid for Scientific Research.
Topic: Women's & men's pelvic health
Ethics approval required: Yes
Institution: Hokkaido University
Ethics committee: Hokkaido University Hospital Clinical Research and Medical Innovation Center
Ethics number: 017-0050
All authors, affiliations and abstracts have been published as submitted.
