Abstract
PurposeTo investigate the relationship between displacement of pelvic floor landmarks observed with transperineal ultrasound imaging and electromyography of the muscles hypothesised to cause the displacements.Materials and MethodsThree healthy men participated in this study, which included ultrasound imaging of the mid-urethra, urethra-vesical junction, ano-rectal junction and bulb of the penis. Fine-wire electromyography electrodes were inserted into the puborectalis and bulbocavernosus muscles and a transurethral catheter electrode recorded striated urethral sphincter electromyography. A nasogastric sensor recorded intra-abdominal pressure. Tasks included submaximal and maximal voluntary contractions, and Valsalva. The relationship between each of the parameters measured from ultrasound images and electromyography or intra-abdominal pressure amplitudes was described with nonlinear regression.ResultsStrong, non-linear relationships were calculated for each predicted landmark/muscle pair for submaximal contractions (R2–0.87–0.95). The relationships between mid-urethral displacement and striated urethral sphincter electromyography, and bulb of the penis displacement and bulbocavernosus electromyography were strong during maximal contractions (R2–0.74–0.88). Increased intra-abdominal pressure prevented shortening of puborectalis, which resulted in weak relationships between electromyography and anorectal and urethravesical junction displacement during all tasks.ConclusionsDisplacement of landmarks in transperineal ultrasound imaging provides meaningful measures of activation of individual pelvic floor muscles in men during voluntary contractions. This method may aid assessment of muscle function or feedback for training.
Highlights
Ultrasound imaging (US) can visualise movement of pelvic floor structures in men[1,2,3,4,5] and women[6,7,8,9] during voluntary contractions and other tasks to investigate pelvic floor muscle activation
Non-linear relationships were calculated for each predicted landmark/muscle pair for submaximal contractions (R2–0.87–0.95)
The relationships between mid-urethral displacement and striated urethral sphincter electromyography, and bulb of the penis displacement and bulbocavernosus electromyography were strong during maximal contractions (R2–0.74–0.88)
Summary
Ultrasound imaging (US) can visualise movement of pelvic floor structures in men[1,2,3,4,5] and women[6,7,8,9] during voluntary contractions and other tasks (e.g. coughing [10]) to investigate pelvic floor muscle activation This non-invasive measure has great potential to provide a method for widespread clinical and experimental evaluation of pelvic floor muscle control in a range of conditions of continence that affect up to 40% of men at some stage in their life [11] (e.g. post-prostatectomy incontinence). Resolution of the issues related to use of ultrasound imaging to interpret muscle activation from pelvic floor muscles in men requires simultaneous recording of US and electromyography (EMG) of each pelvic floor muscle
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