Pelvic floor muscle assessment in men post prostatectomy: comparing digital rectal examination and real-time ultrasound approaches

Abstract

This paper reports three studies. Study 1 assessed the degree of association between traditionally used digital rectal measures, and real-time ultrasound assessments of pelvic floor muscle function in men who report incontinence following prostatectomy. Study 2 compared transabdominal and transperineal approaches to view the pelvic floor using real-time ultrasound. Study 3 explored inter- and intra-observer reliability of two functional tests using real-time ultrasound: a rapid response test requiring participants to perform 10 rapid pelvic floor muscle contractions with elapsed time recorded, and a sustained endurance test wherein participants performed a single sustained pelvic floor muscle contraction with task failure visually confirmed and elapsed time recorded. A modest correlation was observed between the rectal assessment of squeeze pressure and objective perineometer measures (r=0.51, p<0.05). Rapid response test (r=0.18, p=0.36) and sustained endurance test (r=0.18, p=0.36) assessments were unrelated to pelvic floor muscle squeeze pressure measured by perineometry. Strong agreement was found using Bland-Altman analysis for both the rapid response and sustained endurance tests when they were performed using transabdominal and transperineal approaches, or when determining inter- and intra-observer reliability. The two simple functional tests using real-time ultrasound provide objective, non-invasive and reproducible assessment of pelvic floor muscle function that is more acceptable to men than rectal approaches.