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Milios J.E.1, Atkinson C.L.1, Taylor L.1, Ackland T.1, Green D.1,2
1University of Western Australia, School of Sports Science, Exercise & Health, Perth, Australia, 2Research Institute for Sport and Exercise Science, Liverpool, United Kingdom
Background: Prostate Cancer is the leading diagnosed male cancer globally. Assessment of pelvic floor muscle (PFM) function is clinically relevant in men, particularly following radical prostatectomy, as it is related to the expected side effects of urinary incontinence and erectile dysfunction. There are no current, universally accepted PFM tests to assess these aspects of physiological function in men.
Purpose: To assess the reproducibility of novel tests of PFM function, utilising both transperineal and transabdominal real-time-ultrasound, in post-prostatectomy patients and to subsequently determine their relevance to clinical presentation of urinary incontinence. This has previously been compared in women but not men.
Methods: We have previously developed and assessed two non-invasive, 2D real-time-ultrasound (RTUS) based tests of PFM function, utilising Transabdominal (TrA) RTUS. The rapid response test (RRT) required 10 PFM contractions as rapidly as possible under RTUS, with elapsed time recorded. The sustained endurance test (SET) required a single sustained PFM contraction, with task failure visually confirmed under RTUS and elapsed time recorded. Our new experiments compared the recently validated Transperineal (TrP) RTUS and the TrA RTUS approaches to assess reliability and clinical application in different postures. A second experiment compares urinary incontinence via total 24 hour continence pad weight with new tests to determine their clinical relevance.
Results: Of the 95 men in experiment 1,(63 ± 11 y, 172.0 ± 15.2 cm, 72.9 ± 16.9 kg), significant , direct relationships for RRT using TrP and TrA protocols were recorded for measurements in supine (r=0.97) and in standing (r=0.97). Similarly, significant direct relationships for SET using TrP and TrA protocols were recorded for measurements in supine (r=0.97) and in standing (r= 0.95). Experiment 2 is currently under way with 24 hour pad weight and the SET and RRT tests comparing urinary incontinence in standing and supine, as seen clinically due to PFM muscle fatigue in gravity dependent postures.
Conclusion(s): We present two simple tests that provide objective, non-invasive and reproducible assessments of PFM function in men utilising both TrA and TrP RTUS.The RRT assesses fast twitch muscle fibre function for actions such as coughing, sneezing and sit to stand, whilst the SET measures endurance capacity of slow twitch fibres for functions relating to bladder holding, frequency and urgency. These tests are significantly correlated with functional postures and are based on PFM physiology. In the relationship between urinary incontinence and the novel tests, data collection is currently underway. Upon completion,it is hoped that these tests may be used clinically for the diagnosis of PFM dysfunction and as a basis for treatment plans and patient goal setting.
Implications: TrP RTUS is the new gold standard approach for assessing the male pelvic floor but given its more invasive technique, is not always suitable, particularly for men wearing continence pads, embarrassed patients or victims of sexual abuse. It is also more technically difficult to learn and decipher for clinicians. TrA RTUS provides a non-invasive alternative comfortable for clinicians and patients. Both approaches,used in combination with the new physiological tests, offer valid, reliable and a clinically relevant baseline for PFM assessment.
Funding acknowledgements: Professor Green´s research is supported by the Australian Research Council (ARC): Grant DP130103793
Topic: Women's & mens pelvic health
Ethics approval: All studies were approved by the University of Western Australia´s Human Research Ethics Committee and the participants provided written consent.
All authors, affiliations and abstracts have been published as submitted.
