The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia.
School of Human Sciences (Exercise Science), The University of Western Australia, Perth, WA, Australia.
Neurourol Urodyn. 2022 Nov;41(8):1722-1730. doi: 10.1002/nau.25034. Epub 2022 Sep 6.
The aim of this study is to investigate (i) whether pelvic floor muscle (PFM) shortening can be enhanced by provision of training focused on striated urethral sphincter (SUS) with feedback before prostatectomy, (ii) whether PFM shortening during voluntary efforts and coughing before and after prostatectomy differs between men who do and do not report symptoms of urinary incontinence 1 month after prostatectomy, and (iii) the relationship between severity of incontinence after prostatectomy and features of pelvic floor function (muscle shortening) and urethral length before and after prostatectomy.
Sixty men referred for preoperative PFM training before radical prostatectomy participated. The International Continence Society Male Short Form questionnaire was used to quantify continence status. Transperineal ultrasound (US) imaging was used to record pelvic displacements related to activation of striated urethral sphincter, bulbocavernosus (BC) and puborectalis muscles during cough, "natural" voluntary contraction following pamphlet instruction, and trained voluntary contraction after formal physiotherapist instruction including US feedback.
Pelvic floor displacements following training differed between continent and incontinent men; continent participants demonstrated increased SUS shortening after training (compared with "natural"), but no difference was observed between trained and "natural" contractions for incontinent participants. Motion at ano-rectal junction during cough was reduced following surgery, but voluntary and involuntary activation of SUS or BC was not consistently affected by surgery.
Participants' capacity to improve function of the SUS with training appears related to postprostatectomy continence outcome.
本研究旨在探讨：（i）在前列腺切除术之前，通过提供针对横纹尿道括约肌（SUS）的训练并提供反馈，是否可以增强盆底肌（PFM）缩短；（ii）前列腺切除术之前和之后，在自愿用力和咳嗽时，是否会出现 PFM 缩短，以及是否存在差异，这些差异与前列腺切除术后 1 个月报告有尿失禁症状的男性和没有报告有尿失禁症状的男性有关；（iii）前列腺切除术后失禁的严重程度与盆底功能（肌肉缩短）和前列腺切除术前和术后尿道长度的特征之间的关系。
60 名接受根治性前列腺切除术的男性患者参加了术前 PFM 训练。使用国际尿控协会男性简短问卷来量化控尿状态。经会阴超声（US）成像用于记录在咳嗽、“自然”自愿收缩（根据小册子说明）以及在正式物理治疗师指导下进行的有针对性的自愿收缩期间，与横纹尿道括约肌、球海绵体肌（BC）和耻骨直肠肌激活相关的骨盆位移。
训练后，盆底位移在控尿组和失禁组之间存在差异；控尿组在训练后（与“自然”相比）SUS 缩短增加，但失禁组在训练和“自然”收缩之间没有差异。手术后，肛门直肠交界处在咳嗽时的运动减少，但 SUS 或 BC 的自愿和非自愿激活不受手术影响。
参与者改善 SUS 功能的能力似乎与前列腺切除术后的控尿结果有关。
