Novel Insight into the Dynamics of Male Pelvic Floor Contractions Through Transperineal Ultrasound Imaging

Abstract

Purpose Transperineal ultrasound imaging (US) enables minimally invasive assessment of pelvic floor muscle function. Although commonly used in females, the approach has not been reported in males. This approach has advantages because the mid-sagittal view visualises a bony landmark and the entire urethral length. This allows investigation of displacement of multiple points along the urethra and the unique mechanical actions of multiple muscles that could influence continence. We used a new transperineal US technique to compare relative displacement of urethra-vesical junction, ano-rectal junction, and distal urethra during voluntary pelvic floor muscle contractions in continent men. Materials and Methods Measurement and comparison of urethral displacement at specific urethral regions in ten continent males (28-41 years). Measures made on 2D mid-sagittal plane ultrasound images included the displacements of specific points along the urethra. Anatomic considerations suggest that these are caused by contraction of the levator ani, striated urethral sphincter and bulbocavernosus muscles. Pearson's correlation coefficient was used in investigate the relationship between displacements of pairs of points. Results Data show individual variation in displacement of the distal urethra (striated urethral sphincter contraction) and urethra-vesical junction (levator ani contraction). A strong inverse linear relationship (0.723) between displacements of these points indicates two alternative strategies of urethral movement. Conclusions Transperineal US imaging allows simultaneous investigation of multiple pelvic floor muscles by measurement of urethral displacement. Data provide evidence of different but coordinated strategies of urethral displacement in males.

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).…”

This Month in Adult Urology

“…Stafford et al (page 1224) from Australia and the U.S. investigated the role of 2-dimensional midsagittal perineal ultrasound in 10 continent men noting contractions along specific points of the urethra. 7 They were able to discern contractions by levator ani, striated urethral sphincter and bulbocavernosus muscle groups. Furthermore, displacement was measured for the urethral sphincter and urethrovesical junction.…”