Assessing muscle function of the male pelvic floor using real time ultrasound

Following surgical removal of the prostate, there may be compromise to the function of the pelvic floor muscles causing continence problems. Assessing the pelvic floor muscles of male patients can be an invasive process that causes discomfort, making it worthwhile to evaluate alternatives to the conventional method of Digital Rectal Examination (DRE). Real time ultrasound (RTUS) has been used with female patients as an alternative to internal assessments. This paper examines the reliability and validity of assessing the male pelvic floor using abdominal RTUS.

Twenty-eight men (mean age 66.2) with a history of treatment for prostate cancer were recruited to the study. They were assessed via DRE and RTUS. Findings from the procedures were correlated for evaluation of validity, and the RTUS readings were repeated by different therapists to assess reliability.

Measurements on screen correlated moderately with DRE findings (r = 0.57, P = 0.002), and RTUS was found to have good reliability (Intra-class Correlation Coefficient = 0.90). Continent men had more movement of the bladder wall on RTUS than those who were incontinent (P = 0.043). Scar tissue and an inability to maintain a moderately full bladder were found to cause the most difficulty in getting a complete picture of pelvic floor movement.

RTUS can be used clinically to examine male pelvic floor function, and its use would be enhanced once it has been established by DRE that a true pelvic floor contraction is occurring. RTUS can give an indication of pelvic floor function as an alternative measurement method when DRE is contraindicated.