Pelvic Floor Muscle Function and Its Relationship with Post-Prostatectomy Incontinence
Abstract
Objectives Post-prostatectomy incontinence (PPI) is a common condition, but the underlying mechanisms are
not completely understood. Transperineal ultrasound (TPUS) assessment of voluntary pelvic floor muscle (PFM)
function may be associated with PPI. This study investigates the relationship between PPI and pre- and postoperative
displacement of anatomical landmarks related to PFM function.
Methods This was a prospective longitudinal cohort study of 40 patients undergoing robotic-assisted radical
prostatectomy (RARP) by a high-volume single surgeon. All patients underwent PFM training pre- and
postoperatively. TPUS was used to obtain sagittal images of pelvic structures during maximal voluntary PFM
contractions: (1) preoperatively, (2) 3 weeks postoperatively, and (3) 6 weeks postoperatively. TPUS images were
analyzed to calculate displacement of anatomical landmarks associated with activation of striated urethral sphincter
(SUS), bulbocavernosus muscle (BC), and puborectalis muscle (PR). Continence was assessed at 3 and 6 weeks
postoperatively, defined as use of ≤ 1 pad/day. The relationship of continence to the displacement of SUS, BC, and PR
was analyzed.
Results SUS, BC, and PR displacement decreased significantly 3 weeks postoperatively (P = 0.042, P = 0.002,
P < 0.001, respectively). Continent men exhibited significantly greater SUS displacement (median, 5.13 mm) than
incontinent men (median, 3.90 mm) 3 weeks postoperatively (P = 0.029). Between 3 and 6 weeks following RARP,
there was significant increase in SUS, BC, and PR displacement (P = 0.003, P = 0.030, P < 0.001, respectively).
Conclusions A significant decrease in PFM function occurs following RARP, with a subsequent recovery of
postoperative PFM function between 3 and 6 weeks post-procedure in men who undergo PFM training. SUS
activation was significantly greater in continent patients compared to incontinent patients at 3 weeks following RARP.
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