The relationship between pre‐ and postprostatectomy measures of pelvic floor muscle function and development of early incontinence after surgery

Abstract

Aims: The aim of this study is to investigate (i) whether pelvic floor muscle (PFM) shortening can be enhanced by provision of training focused on striated urethral sphincter (SUS) with feedback before prostatectomy, (ii) whether PFM shortening during voluntary efforts and coughing before and after prostatectomy differs between men who do and do not report symptoms of urinary incontinence 1 month after prostatectomy, and (iii) the relationship between severity of incontinence after prostatectomy and features of pelvic floor function (muscle shortening) and urethral length before and after prostatectomy.Methods: Sixty men referred for preoperative PFM training before radical prostatectomy participated. The International Continence Society Male Short Form questionnaire was used to quantify continence status. Transperineal ultrasound (US) imaging was used to record pelvic displacements related to activation of striated urethral sphincter, bulbocavernosus (BC) and puborectalis muscles during cough, "natural" voluntary contraction following pamphlet instruction, and trained voluntary contraction after formal physiotherapist instruction including US feedback. Results: Pelvic floor displacements following training differed between continent and incontinent men; continent participants demonstrated increased SUS shortening after training (compared with "natural"), but no difference was observed between trained and "natural" contractions for incontinent participants. Motion at ano-rectal junction during cough was reduced following surgery, but voluntary and involuntary activation of SUS or BC was not consistently affected by surgery.Conclusions: Participants' capacity to improve function of the SUS with training appears related to postprostatectomy continence outcome.

Ultrasound-Based Prognostic Anatomical Parameters for Post-Prostatectomy Incontinence: A Systematic Review

“…After the screening of titles and abstracts, 14 articles remained. A full-text review revealed 13 articles that presented relevant data [16][17][18][19][20][21][22][23][24][25][26][27][28]. Two of the remaining articles contained overlapping data (confirmed by the authors) leading to one additional exclusion [28].…”

“…The risk of bias assessment is summarised in Figure 2. The majority of the studies gave incomplete data on the characteristics of the study population [16,18,20,21,[24][25][26][27] and did not provide data on the recruitment period [16,18,20,[24][25][26][27], yielding potential bias. There was a significant risk of attrition bias in all of the studies, with inadequate reporting of response rate and no attempts to collect data on patients lost to follow-up or to consider the impact of attrition.…”

The Effect of Low-Frequency Electrical Stimulation Combined With Anus Lifting Training on Urinary Incontinence After Radical Prostatectomy in a Chinese Cohort

“…Behavioral therapy and physical therapy are still the main means ( Stafford et al, 2022 ). After RP an early supportive rehabilitation program like pelvic floor muscle training significantly reduces continence recovery time.…”

Six-Month Prostate Cancer Empowerment Program (PC-PEP) Improves Urinary Function: A Randomized Trial

“…PFMT, through targeted repetitive contractions, primarily strengthens the striated urethral sphincter, bulbocavernosus, and puborectalis—a component of the levator ani. This specific focus enhances urinary continence mechanisms in men, as extensively detailed in the body of work by Stafford and Hodges [ 11 , 12 , 13 ]. Consequently, PFMT increases the endurance and strength of the pelvic floor muscles, aiming to improve urinary, bowel, and sexual symptoms [ 11 , 12 , 13 , 14 ].…”

“…This specific focus enhances urinary continence mechanisms in men, as extensively detailed in the body of work by Stafford and Hodges [ 11 , 12 , 13 ]. Consequently, PFMT increases the endurance and strength of the pelvic floor muscles, aiming to improve urinary, bowel, and sexual symptoms [ 11 , 12 , 13 , 14 ].…”