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

Stafford, Ryan E.; Hoorn, Wolbert van den; Coughlin, Geoff; Hodges, Paul W.

doi:10.1002/nau.23371

Cited by 34 publications

(64 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Coordinated contraction of these muscles contributes to urinary continence, in conjunction with the smooth muscle of the urethra and bladder neck 5,20 . Furthermore, shortening (contraction) of these striated muscles is reduced in men with incontinence after prostatectomy 13 . In contrast, overactivity of specific striated muscles (eg, PR) has been suggested in chronic pelvic pain 16 …”

Section: Introductionmentioning

confidence: 99%

“…5,20 Furthermore, shortening (contraction) of these striated muscles is reduced in men with incontinence after prostatectomy. 13 In contrast, overactivity of specific striated muscles (eg, PR) has been suggested in chronic pelvic pain. 16 The activity of the striated PFMs increases with intraabdominal pressure (IAP) to constrict the urethra and resist caudal descent of the abdominal and pelvic organs.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Influence of body position on dynamics of the pelvic floor measured with transperineal ultrasound imaging in men

Cowley

Stafford

Hodges

2020

Neurourology and Urodynamics

Self Cite

View full text Add to dashboard Cite

Aims This paper aims to evaluate the feasibility of transperineal ultrasound imaging (TPUS) for visualizing the motion of pelvic landmarks associated with striated pelvic floor muscle contraction in men in standing; to compare the locations of pelvic landmarks between sitting and standing; and to compare the effects of different body positions on measures of pelvic floor muscle contraction. Methods Thirty‐five men awaiting prostatectomy volunteered to participate. Participants performed three repetitions of submaximal pelvic floor contraction in sitting and again in standing. Movement of pelvic landmarks with contraction was recorded using an ultrasound imaging transducer placed on the perineum. Results The feasibility of TPUS in men in standing was demonstrated through the visualization of three out of four pelvic landmarks in more than 95% of images in the standing position. Analysis of pelvic landmarks and their respective relationships with muscle shortening demonstrated that the anorectal junction and urethrovesical junction were lower and the estimated length of puborectalis was shorter in standing than sitting. The mid‐urethra (striated urethral sphincter) and anorectal junction (puborectalis) landmark displaced further cranially in standing than sitting. Conclusions TPUS can be used to visualize three pelvic landmarks in men with cancerous prostates. Puborectalis is shorter at rest in standing than sitting, and elevation of the mid‐urethra and the anorectal junction is more in standing than sitting. Together these findings indicate that feedback for pelvic floor muscle training is possible in both positions, but the position needs to be standardized for a comparative assessment.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of body position on dynamics of the pelvic floor measured with transperineal ultrasound imaging in men

Cowley

Stafford

Hodges

2020

Neurourology and Urodynamics

Self Cite

View full text Add to dashboard Cite

show abstract

“…This concurs with recent data that show activation of urethral muscles is linked to continence/incontinence in men after RP. 12 Although it might be expected that muscles that constrict the urethra will activate in conjunction with those around the anus during pelvic floor muscle contraction, recent work has highlighted that coordination between different muscles depends on instructions. 20 Fourth, PFMT was more efficacious than the control if the comparison was "no instruction" but not if the control involved "some instruction" (ie, verbal or written information about pelvic floor muscle contractions).…”

Section: Consideration Of Trial Featuresmentioning

confidence: 99%

“…Recent physiological findings also suggest that differences in the muscles that are targeted by PFMT might contribute to outcome variation. Although the SUS function is a determinant of continence after RP, 12 and greater SUS activation is achieved with specific instructions, 20 many clinical trials focus on contraction around the anus, which focuses on muscles that are not involved in urinary continence 21,22 …”

Section: Introductionmentioning

confidence: 99%

“…Although multiple factors contribute to PPI, including short urethral length and detrusor overactivity, [6][7][8][9][10][11] inadequate urethral sphincter muscle function is considered the predominant cause. 12 Postoperative continence depends on the integrity, strength, and activation of the striated urethral sphincter (SUS) muscle of the pelvic floor to create urethral resistance. Pelvic floor muscle training (PFMT) is commonly recommended to treat/prevent PPI.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Do features of randomized controlled trials of pelvic floor muscle training for postprostatectomy urinary incontinence differentiate successful from unsuccessful patient outcomes? A systematic review with a series of meta‐analyses

Hall

Neumann

Hodges

2020

Neurourology and Urodynamics

Self Cite

View full text Add to dashboard Cite

Aims: Efficacy of pelvic floor muscle training (PFMT) for postprostatectomy incontinence (PPI) differs between randomized clinical trials (RCT). This might be explained by variation in content/delivery of PFMT (eg, biofeedback, muscles targeted, and time of commencement of training). This review investigated whether outcome of meta-analysis differs based on presence or not of specific RCT features. Methods: PubMed, CINAHL, EMBASE, Physiotherapy Evidence Database (PEDro), and Cochrane were searched for RCTs that investigated efficacy of PFMT on PPI. PFMT details and outcomes were extracted. Methodological quality and comprehensiveness of PFMT reporting was assessed using the PEDro scale and Consensus on Reporting Template, respectively. Effect size and 95% confidence intervals were calculated for incontinence rate at 3 months. To identify features that influenced efficacy, separate meta-analyses were performed for studies with and without specific features. Results: Twenty-two trials were included, and 15 were used for meta-analysis of 3-month outcomes. Overall, meta-analysis showed reduced incontinence with PFMT (risk ratio [RR] = 0.85; I 2 = 55%; P = .005). Meta-analyses showed better outcomes for PFMT than control groups when the study included preoperative PFMT (RR = 0.76; I 2 = 30%; P = .006), biofeedback (RR = 0.73; I 2 = 58%; P = .006), instruction to contract around the urethra (RR = 0.9; I 2 = 43%; P = .009), a control group without PFMT instruction (RR = 0.85; I 2 = 69%; P = .05), inclusion of all men irrespective of continence status (RR = 0.84; I 2 = 30%; P = .003) and continence defined as no leakage (RR = 0.85; I 2 = 48%; P = .05). Conclusions: Preoperative PFMT, biofeedback, urethral instructions, no PFMT instruction for controls, inclusion of all men, and continence defined as no leakage are features associated with successful patient outcomes. Future studies should consider these features in design of interventions and pooling data for meta-analysis. K E Y W O R D Smeta-analysis, pelvic floor muscle training, prostatectomy, systematic review, urinary incontinence | 543 | CONCLUSIONSThis systematic review is the first to deconstruct the details of PFMT program design and implementation in an attempt to explain variation in efficacy of PFMT in men with PPI in RCTs, systematic reviews, and metaanalyses. The multiple meta-analyses provide preliminary evidence for important candidate features.This study was developed in accordance with the PRISMA statement and registered with PROSPERO (CRD42017059589).

show abstract

Transperineal Ultrasound Before and After Prostatectomy: Technical Approach and Description

Colarieti

Shaida

Thiruchelvam

et al. 2022

J of Ultrasound Medicine

View full text Add to dashboard Cite

This study assessed the feasibility of dynamic transperineal ultrasound (TPUS) pre/post-radical prostatectomy (RP). Ninety-eight patients were scanned preoperatively and at four time-points post-operatively. TPUS was performed in 98 patients using an abdominal transducer at rest, during pelvic floor contraction (PFC) and Valsalva (VS) maneuver in supine and standing positions. Urodynamic evaluations included bladder neck angle at rest/PFC/VS, and degree of bladder neck movement. Pre-operative and post-operative measurements were technically feasible in >85% (supine) and >90% (standing) of patients. TPUS offers a reliable non-invasive dynamic assessment of the pelvic floor post-prostatectomy and may prove a useful adjunct for guiding exercises to preserve continence.

show abstract

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

Abstract: Dynamic features of pelvic floor muscle activation, particularly shortening of the striated urethral sphincter during cough and voluntary contraction, are related to continence status after prostatectomy.

Cited by 34 publications

References 26 publications

Influence of body position on dynamics of the pelvic floor measured with transperineal ultrasound imaging in men

Influence of body position on dynamics of the pelvic floor measured with transperineal ultrasound imaging in men

Do features of randomized controlled trials of pelvic floor muscle training for postprostatectomy urinary incontinence differentiate successful from unsuccessful patient outcomes? A systematic review with a series of meta‐analyses

Transperineal Ultrasound Before and After Prostatectomy: Technical Approach and Description

Contact Info

Product

Resources

About