Two‐ and three‐/four dimensional perineal ultrasonography in men with urinary incontinence after radical prostatectomy

Abstract

and videos were also analysed by two independent investigators not present at the actual investigation. RESULTS• Using perineal ultrasonography we were able to visualize hypermobility of the proximal urethra, funnelling of the bladder neck, voluntary pelvic floor contraction, urethral and paraurethral fibrosis, and suture or sling material.• Men with and without PPI differed mainly in the degree of hypermobility of the proximal urethra and opening of the bladder neck.• Inter-investigator agreement was 100% in assessing paraurethral tissue and voluntary muscle contraction and 94% in quantifying mobility of the proximal urethra.• We were able to evaluate the bladder neck opening in 85% of the men. There was 82% agreement between the initial investigators in evaluation of the bladder neck and 76% in quantifying mobility of the proximal urethra using retrospective analysis of stored images. CONCLUSIONS• Two-dimensional and 3D/4D perineal ultrasonography provides more insight into the diagnosis of men with PPI • Perineal ultrasonography can be used further as a visual aid for biofeedback to teach correct muscle contraction of men with stress incontinence after radical prostatectomy. We know that perineal ultrasound is a well accepted method for women with stress incontinence. We evaluated feasibility of this method for men with stress incontinence after radical prostatectomy. We find differences between continent and incontinent men in amount of fibrosis, mobility of the proximal urethra, bladder neck opening and ability to contract pelvic floor muscles in a sufficient and correct way. KEYWORDS OBJECTIVE• To investigate the feasibility and interinvestigator reproducibility of perineal ultrasonography in men with and without post-prostatectomy urinary incontinence (PPI). PATIENTS AND METHODS• This clinical pilot study involved 33 male patients, with a mean (range) age of 67.8 (51-76) years, who underwent radical prostatectomy (RP) ≥ 1 year ago.• We investigated 21 men with clinically and urodynamically proven grade ≥ 2 PPI and compared them with 12 men without PPI in objective testing as well as in validated questionnaires.• We used an abdominal 3.5-5 MHz ultrasound probe, which was placed at the perineum between scrotum and anus. With the help of three-/four-dimensional (3D/4D) multislice imaging we obtained good visualization of the bladder neck, the urethra and pelvic floor muscle contraction.• The data from all 33 men was evaluated by two investigators and archived images

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

“…However, only LA activation has been analysed in this manner from ARJ, urethra and urethra-vesical junction (UVJ) movements using transperineal US in women 23, 24 . In men, quantification of UVJ motion with transabdominal 27 and transperineal 28, 29 US, and SUS motion with transurethral 26 and transrectal US 25 has been investigated. However, these studies only evaluated single structures, generally involved limited quantification of movements, and did not consider the relative contributions of the multiple striated muscles with potential to influence continence.…”

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

“…Kirschner-Hermanns et al performed a study on men after radical prostatectomy. They observed that 81% of the incontinent men had good or excellent voluntary muscle contraction compared to only 50% of continent men (13). There are only limited data comparing anatomical and physiological changes in men before and after radical prostatectomy.…”

“…The transducer was placed on the perineal area in a sagittal orientation, to obtain images of the pubic symphysis, bladder, bladder neck and urethra (13,16). Ultrasound assessment of the male bladder is best achieved when the urine volume is at least 300 mL.…”

“…During the examination, we were able to evaluate the mobility of the proximal urethra, urethral angle, funneling of the bladder neck, and voluntary contraction of the pelvic floor, following standardized criteria under three conditions: at rest, during contraction and during a Valsalva maneuver (8,9,13,17).…”

“…The funneling index is calculated as the product of the width in millimeters of the bladder neck and the depth to the apex of urethral dilation (13,18) (Figure-1). …”