Therapeutic interventions for patients with prostate cancer undergoing radical prostatectomy: A focus on urinary incontinence, erectile dysfunction and Peyronie’s disease.

Abstract

This study examines the impact of posture and measures of urinary incontinence relating to two non-invasive, real-time, ultrasound-based tests. Using real-time ultrasound with transperineal and transabdominal approaches, we previously assessed pelvic floor muscle function in men and found the rapid response and sustained endurance tests possessed strong reliability in both supine and standing postures, and for both ultrasound approaches. However, questions remained pertaining to the relationship of the tests to other outcome variables, including measures of urinary incontinence. Participants (n=95) undergoing radical prostatectomy were assessed to determine the relationship between incontinence and pelvic floor muscle function, as seen on ultrasound. The presence and severity of incontinence was measured via 24-hour pad weight. When related to pad weight, the transabdominal protocol produced weak to moderate correlations between the rapid response test in standing (r=0.43) and supine (r=0.46), and the sustained endurance test in standing (r= –0.56) and supine (r=–0.56). Similar results were found using the transperineal approach. All Bland-Altman analyses showed no significant difference (p>0.05) between the two postures, for either test or scan approach. While the plots also demonstrate no heteroscedasticity or proportional bias, with the bias being close to 0, the magnitude of variation in difference scores suggests different outcomes for tests performed in standing compared to supine postures. We present two simple tests that provide objective, non-invasive, and reproducible assessment of pelvic floor muscle function in men that relate to the clinical outcome of urinary leakage.