Pelvic floor muscle length changes with breathing in males: A preliminary report.

The study aimed to identify whether pelvic floor muscles modulate length with breathing, and if any length changes induced by breathing relate to abdominal cavity displacement and intra-abdominal pressure. To investigate these relationships, displacement of pelvic landmarks that related to pelvic floor muscle length using transperineal ultrasound imaging, breath volume, intra-abdominal pressure, abdominal and ribcage displacement, and abdominal and anal sphincter muscle electromyography were measured during quiet breathing and breathing with increased dead-space in ten healthy men. Pelvic floor muscle landmark displacement modulated with ribcage motion during breathing.

Evidence for increased tone or overactivity of pelvic floor muscles in pelvic health conditions: a systematic review.

Objective: Pelvic floor muscle tone, which includes active and passive components, is argued to be increased in many pelvic health conditions, including those involving pain. This study systematically reviewed evidence for increased pelvic floor muscle tone in pelvic health conditions.

Data Sources: Electronic databases (PubMed, CINAHL, and Embase) were searched up to May 31, 2021.

The relationship between pre- and postprostatectomy measures of pelvic floor muscle function and development of early incontinence after surgery.

Aims: 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.

Methods: 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.

Validation of shear wave elastography as a noninvasive measure of pelvic floor muscle stiffness.

Objectives: To investigate the validity of shear wave elastography (SWE) as a measure of stiffness of the puborectalis muscle by examining: (1) the relationship between puborectalis muscle stiffness and pelvic floor muscle (PFM) activation at different intensities; and (2) the relationship between puborectalis stiffness and pelvic floor morphometry during contractions at different intensities.

Methods: Fifteen healthy asymptomatic women performed 6-s isometric PFM contractions at different intensities (0, 10%, 20%, 30%, 50%, 75%, and 100% of maximal voluntary contraction) guided by intravaginal electromyography (EMG). Stiffness of the puborectalis muscle was measured using SWE by calculating the average shear modulus in regions of interest that contained puborectalis muscle fibers parallel to the transducer.

The influence of prostatectomy and body position on location and displacement of pelvic landmarks with pelvic floor muscle contraction.

Aims: To compare pelvic floor muscle (PFM) anatomy and function (i) between pre- and post-prostatectomy in standing, and (ii) between sitting and standing postprostatectomy.

Methods: Thirty-two men scheduled to undergo a prostatectomy volunteered to participate. Transperineal ultrasound imaging was used to visualize five anatomical pelvic landmarks that have been validated to reflex anatomy and activity of PFMs (pubic symphysis, anorectal junction [ARJ], mid-urethra [MU], bulb of penis [BP], and urethrovesical junction [UVJ]).

The repeatability of measurements of male pelvic floor anatomy and function made from transperineal ultrasound images of healthy men and those before and after prostatectomy.

Aims: To investigate the inter- and intratester repeatability of measurement of the location and displacement of five pelvic landmarks related to pelvic floor muscles with transperineal ultrasound (TPUS) imaging recorded from healthy men and men before and after prostatectomy.

Methods: TPUS images were selected from four different participant groups: healthy men, men awaiting prostatectomy, men 2 weeks after prostatectomy, and men 12 months after prostatectomy. On two separate occasions, two assessors with different levels of experience performed analysis of location and displacement of five pelvic landmarks in images made at rest and during voluntary contraction.

Novel insight into pressurization of the male and female urethra through application of a multi-channel fibre-optic pressure transducer: Proof of concept and validation.

Purpose: To confirm feasibility of recording pressure along the length of the urethra using a multi-sensor fibre-optic pressure catheter; to identify the spatial and temporal features of changes in pressure along the urethra at sites related to specific striated pelvic floor muscles; and to investigate the relationship between urethral pressures and activation of individual pelvic floor muscles estimated from ultrasound imaging.

Materials And Methods: Proof-of-concept study including one male (47 years old) and one female (33 years old). A multi-sensor fibre optic pressure catheter (10 mm sensor separation) was inserted into the urethra.

Influence of body position on dynamics of the pelvic floor measured with transperineal ultrasound imaging in men.

Aims: This paper aims to evaluate the feasibility of transperineal ultrasound imaging (TPUS) for visualizing the motion of pelvic landmarks associated with striated pelvic floor muscle contraction in men in standing; to compare the locations of pelvic landmarks between sitting and standing; and to compare the effects of different body positions on measures of pelvic floor muscle contraction.

Methods: Thirty-five men awaiting prostatectomy volunteered to participate. Participants performed three repetitions of submaximal pelvic floor contraction in sitting and again in standing.

Reconsideration of pelvic floor muscle training to prevent and treat incontinence after radical prostatectomy.

Urinary incontinence is common after radical prostatectomy. Pelvic floor muscle training provides a plausible solution. Although early trials provided promising results, systematic reviews have questioned the efficacy of this intervention.

Comparison of dynamic features of pelvic floor muscle contraction between men with and without incontinence after prostatectomy and men with no history of prostate cancer.

Aim: To compare features of pelvic floor muscle function between men with and without incontinence after prostatectomy and men with no history of prostate cancer.

Methods: The study included men with incontinence postprostatectomy (PPI; n = 20), continent men postprostatectomy (PPC; n = 23) and a control group (CC; n = 20). Transperineal ultrasound imaging recorded motion associated with contraction of the striated urethral sphincter (SUS), puborectalis (PR) and bulbocavernosus (BC) muscles during maximal voluntary contraction (MVC), submaximal efforts, evoked coughing and bearing down.

Activity of Deep and Superficial Pelvic Floor Muscles in Women in Response to Different Verbal Instructions: A Preliminary Investigation Using a Novel Electromyography Electrode.

Introduction: Verbal instructions are used clinically to encourage activation of the pelvic floor muscles (PFM). Whether separate layers of PFM activate differently in response to instructions remains unknown.

Aim: To test the hypotheses that (i) instructions that aimed to bias activity of a specific muscle layer would increase activation of the targeted layer to a greater extent than the other layer, (ii) activity of individual PFM layers would differ between instructions, and (iii) PFM activity would be symmetrical for all instructions.

Task-specific differences in respiration-related activation of deep and superficial pelvic floor muscles.

The female pelvic floor muscles (PFM) are arranged in distinct superficial and deep layers that function to support the pelvic/abdominal organs and maintain continence, but with some potential differences in function. Although general recordings of PFM activity show amplitude modulation in conjunction with fluctuation in intra-abdominal pressure such as that associated with respiration, it is unclear whether the activities of the two PFM layers modulate in a similar manner. This study aimed to investigate the activation of the deep and superficial PFM during a range of respiratory tasks in different postures.

Postprostatectomy incontinence is related to pelvic floor displacements observed with trans-perineal ultrasound imaging.

Aims: 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.

Methods: 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.

Female striated urogenital sphincter contraction measured by shear wave elastography during pelvic floor muscle activation: Proof of concept and validation.

Aims: Investigation of the function of the striated urogenital sphincter (SUS) is challenging because it is difficult to access and requires invasive measures. Ultrasound shear wave elastography (SWE) is a non-invasive real-time technique used to estimate tissue stiffness. As muscle stiffness can be used as an estimate of muscle force, SWE provides an opportunity to study contraction of the peri-urethral musculature.

Application of shear-wave elastography to estimate the stiffness of the male striated urethral sphincter during voluntary contractions.

Objectives: To investigate whether increases in stiffness can be detected in the anatomical region associated with the striated urethral sphincter (SUS) during voluntary activation using shear-wave elastography (SWE); to identify the location and area of the stiffness increase relative to the point of greatest dorsal displacement of the mid urethra (i.e. SUS); and to determine the relationship between muscle stiffness and contraction intensity.

Validity of Estimation of Pelvic Floor Muscle Activity from Transperineal Ultrasound Imaging in Men.

Purpose: To 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 Methods: Three 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.

Pattern of activation of pelvic floor muscles in men differs with verbal instructions.

Aims: To investigate the effect of instruction on activation of pelvic floor muscles (PFM) in men as quantified by transperineal ultrasound imaging (US) and to validate these measures with invasive EMG recordings.

Methods: Displacement of pelvic floor landmarks on transperineal US, intra-abdominal pressure (IAP) recorded with a nasogastric transducer, and surface EMG of the abdominal muscles and anal sphincter were recorded in 15 healthy men during sub-maximal PFM contractions in response to different verbal instructions: "tighten around the anus," "elevate the bladder," "shorten the penis," and "stop the flow of urine." In three men, fine-wire EMG recordings were made from puborectalis and bulbocavernosus, and trans-urethral EMG recordings from the striated urethral sphincter (SUS).

Dynamics of male pelvic floor muscle contraction observed with transperineal ultrasound imaging differ between voluntary and evoked coughs.

Coughing provokes stress urinary incontinence, and voluntary coughs are employed clinically to assess pelvic floor dysfunction. Understanding urethral dynamics during coughing in men is limited, and it is unclear whether voluntary coughs are an appropriate surrogate for spontaneous coughs. We aimed to investigate the dynamics of urethral motion in continent men during voluntary and evoked coughs.

A new method to quantify male pelvic floor displacement from 2D transperineal ultrasound images.

Objective: To develop a method to quantify displacement of pelvic structures during contraction of the pelvic floor muscles from transperineal ultrasound images in men and investigate the reliability of the method between days.

Methods: Ten healthy male volunteers (aged 28-41 years) attended 2 separate data collection sessions. Ultrasound images were recorded during voluntary pelvic floor muscle contractions in cine-loop (video) format with the transducer aligned in the midsagittal plane on the perineum.

Novel insight into the dynamics of male pelvic floor contractions through transperineal ultrasound imaging.

Purpose: Transperineal ultrasound imaging enables the minimally invasive assessment of pelvic floor muscle function. Although commonly used in women, the approach has rarely been reported in men. This approach has advantages because the midsagittal view visualizes a bony landmark and the entire urethral length.

Activation of the striated urethral sphincter to maintain continence during dynamic tasks in healthy men.

Aims: Function of the striated urethral sphincter (SUS) in men is debated. Current evidence is limited to electromyographic (EMG) recordings made with concentric needle electrodes in supine. Understanding of SUS function requires investigation of SUS EMG activity using new recording techniques in dynamic tasks.

Anal sphincter fatigue: is the mechanism peripheral or central?

Aims: Striated muscles of continence appear to exhibit marked fatigue during voluntary efforts. This is counterintuitive considering the high proportion of slow twitch muscle fibers. One explanation is that fatigue is due to central, rather than peripheral mechanisms.

A novel transurethral surface electrode to record male striated urethral sphincter electromyographic activity.

Purpose: Concentric needle and current transurethral surface recording techniques are unlikely to accurately record electromyography activity of the male striated urethral sphincter during dynamic tasks. Thus, we developed a novel transurethral surface electrode that could be fixed to the urethral mucosa with optimal orientation to record striated sphincter electromyography.

Materials And Methods: Four recording surfaces were placed at equal intervals circumferentially around the tip of a 6Fr pediatric urinary catheter.