Perineal Ultrasound in Postprostatectomy Incontinence: An Overview of Technique and Practice - Abstract
Introduction: Continence after prostatectomy depends on a combination of preoperative patients’ characteristics, surgical techniques and intraoperative details. The integrity of pelvic floor muscles and striated urethral sphincter significantly influence the recovery of continence after surgery. An accurate assessment of possible risk factors aids in identifying patients with a higher likelihood of postoperative incontinence and those who would benefit from a personalized postoperative rehabilitation. This overview aims to describe the use of perineal ultrasound in the evaluation of anatomy and function of the male pelvic floor, in particular after prostatectomy.
Methods: Literature search through the MEDLINE, Ovid, and Embase databases Main outcome measures: Literature review and clinical research studies on the use of perineal ultrasound in the diagnostic and pelvic floor training programs for postprostatectomy incontinence.
Results: The bladder neck and urethra, the bulb of penis and the anorectal junction can be easily identified during perineal ultrasound. They represent important reference landmarks, and their displacement correspond to activation of the pelvic floor muscle, in particular the striated urethral sphincter, bulbospongiosus and puborectalis muscles. Real time dynamic imaging provides an individualized assessment of the coordinated function of pelvic floor muscles.
Clinical implications: Activation of the striated urethral sphincter, bulbospongiosus muscle and puborectalis muscle can be reliably observed by perineal ultrasound. Perineal ultrasound gives feedback during pelvic floor muscle training leading to early detection of failure in specific muscle activation and helps to develop individually tailored rehabilitation programs in postprostatectomy incontinence.
Strengths and limitations: Research about motor control of the male pelvic floor based on ultrasound techniques provide a new understanding in pathophysiology and rehabilitation of postprostatectomy incontinence. To date there are only few studies using perineal ultrasound as a diagnostic and functional feedback tool in the management of postprostatectomy incontinence.
Conclusion: Perineal ultrasound is an easy and reproducible diagnostic tool for the assessment of the anatomy of the male pelvis and pelvic floor muscles. Real time dynamic imaging provides a precise assessment of the coordinated function of the striated urethral sphincter, bulbospongiosus and puborectalis muscles. It gives feedback of pelvic floor muscle training leading to early detection of failure in specific muscle activation and helps to develop individually tailored rehabilitation programs in postprostatectomy incontinence.