A New Method to Quantify Male Pelvic Floor Displacement From 2D Transperineal Ultrasound Images

Abstract

Objective To develop a method to quantify displacement of pelvic structures during contraction of the pelvic floor muscles from transperineal ultrasound images in men and investigate the reliability of the method between days. Methods Ten healthy male volunteers (aged 28 – 41 years) attended two separate data collection sessions. Ultrasound images were recorded during voluntary pelvic floor muscle contractions in cine-loop (video) format with the transducer aligned in the mid-sagittal plane on the perineum. Five anatomical points were defined to represent contraction from striated urethral sphincter (SUS), levator ani (LA) and bulbocavernosus (BC) muscles. Displacement of each point was calculated between the relaxed and contracted-state images. Intra-class correlation coefficient (ICC) values were calculated from displacement data to assess reliability of the method between days. Results Displacements of the five anatomical points closely matched predictions based on anatomical considerations of the male pelvic musculature. ICC values for displacement data calculated from 1, 2 and 3 repetitions ranged between 0.82–0.95 for ICC (2,1), 0.85–0.97 for ICC (2,2) and 0.86–0.97 for ICC (2,3), respectively. Conclusions The new method reliably calculates displacements of points previously validated for females (Ano-rectal junction and bladder base) in addition to new measures of muscle actions (SUS and BC) specific to men. Future use might include assessment of clinical populations to understand how these displacements relate to symptoms of incontinence.

Postprostatectomy incontinence is related to pelvic floor displacements observed with trans‐perineal ultrasound imaging

“…Anatomical studies describe three striated muscle complexes that have the potential to develop urethral pressure. These muscle complexes are the puborectalis/pubovisceralis (PR) which draws the urethra ventrally and elevates the bladder, the striated urethral sphincter (SUS) which draws the urethra dorsally, and the bulbocavernosus (BC) which compresses the urethra at the bulb of penis. Although the nervous system controls these muscles independently, attention to the contribution of each muscle to continence has been limited.…”

Reliability of Superficial Male Pelvic Floor Structural Measurements Using Linear-Array Transperineal Sonography

“…Furthermore, this protocol may be useful in differentiating between therapy responders and non-responders to inform intervention planning and enhance targeting of interventions to those patients whom would most benefit. Combining this transperineal approach with other sonographic investigations of the pelvic floor, such as those evaluating structure orientation and dynamic movements (Davis et al 2011; Stafford et al 2012; Stafford et al 2013), may lead to a robust evaluation protocol for individuals with CPPS.…”

“…The first report using this approach meant to evaluate the orientation of anal-pelvic structures, i.e., anorectal angle and levator plate angle (Davis et al 2011). A similar transperineal approach has been reported in evaluation of the displacement and dynamic changes of pelvic structures during contraction of pelvic floor and anorectral muscles (Stafford et al 2012; Stafford et al 2013). These studies utilized a low-frequency curvilinear probe with data collection in a sagittal plane to evaluate the entire pelvic region.…”

Parameters of two-dimensional perineal ultrasonography for evaluation of urinary incontinence after Radical Prostatectomy

“…Stafford et al measured the contraction of the pelvic floor muscles, clearly defining the displacement of the urethrovesical junction, ano--rectal junction and distal urethra in healthy young men (10,12). Davis et al measured men with chronic pelvic pain syndrome and concluded that men with pain had a smaller ano-rectal angle compared to men without pain (11).…”