School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Neurourol Urodyn. 2018 Feb;37(2):658-665. doi: 10.1002/nau.23371. Epub 2017 Jul 26.
To investigate the relationship between post-prostatectomy incontinence and dynamic features of activation of specific pelvic floor muscles in addition to anatomical parameters of the urethra.
Forty-two men aged 66 (7) years (incontinent [N = 19] and continent [N = 23]) who had undergone prostatectomy participated. Transperineal ultrasound imaging was used to record sagittal images of pelvic structures during involuntary coughing and sustained maximal voluntary contractions. Imaging data were analyzed to calculate displacements of pelvic floor landmarks associated with activation of the puborectalis, striated urethral sphincter, and bulbocavernosus muscles. Anatomical features of functional urethral length and the resting position of the ano-rectal and urethra-vesical junctions were calculated. A principal component analysis and multiple logistic regression were used to consider which combinations of variables best distinguish between men with and without incontinence.
Five principal components were identified that together explained 72.0% of the data. Two principal components that represented (i) striated urethral sphincter activation and (ii) bulbocavernosus and puborectalis muscle activation were significantly different between participants with and without incontinence. Together these components correctly identified 88.1% of incontinent men, with a specificity and sensitivity of 91.3% and 84.2%, respectively. Poor function of the bulbocavernosus and puborectalis muscles could be compensated by good striated urethral sphincter function, but the bulbocavernosus and puborectalis muscles had less potential to compensate for poor striated urethral sphincter function.
Dynamic features of pelvic floor muscle activation, particularly shortening of the striated urethral sphincter during cough and voluntary contraction, are related to continence status after prostatectomy.
研究前列腺切除术后尿失禁与特定盆底肌激活的动态特征之间的关系，以及尿道的解剖学参数。
42 名年龄为 66（7）岁的男性（尿失禁 [N=19] 和非尿失禁 [N=23]）参与了本研究。经会阴超声成像用于记录在不自主咳嗽和持续最大自主收缩期间骨盆结构的矢状图像。对成像数据进行分析，以计算与耻骨直肠肌、横纹尿道括约肌和球海绵体肌激活相关的盆底标志的位移。计算功能尿道长度的解剖特征以及肛门直肠和尿道膀胱交界处的休息位置。使用主成分分析和多变量逻辑回归来考虑哪些变量组合可以最好地区分有无尿失禁的男性。
确定了 5 个主成分，它们共同解释了 72.0%的数据。两个主成分分别代表（i）横纹尿道括约肌的激活和（ii）球海绵体肌和耻骨直肠肌的激活，在有和无尿失禁的参与者之间存在显著差异。这两个成分共同正确识别了 88.1%的尿失禁男性，特异性和敏感性分别为 91.3%和 84.2%。球海绵体肌和耻骨直肠肌功能不良可以通过良好的横纹尿道括约肌功能来补偿，但球海绵体肌和耻骨直肠肌对横纹尿道括约肌功能不良的补偿潜力较小。
盆底肌激活的动态特征，特别是在咳嗽和自主收缩期间横纹尿道括约肌的缩短，与前列腺切除术后的控尿状态有关。
