The levator ani has a crucial role in supporting pelvic organs and in maintaining continence (Walz et al., 2010). A thickening of the levator ani in males is the puboperinealis. Puboperinealis originates from the pubis, borders the prostatourethral junction and attaches at the perineal body (Myers et al., 2000). A voluntary contraction of puborectalis and puboperinealis will result in the urethra being pulled forward and upward. This closes the urethra and prevents the flow of urine (Walz et al., 2010). Thus, an important action of the levator ani is to maintain continence in men and is responsible for the fast-stop mechanism during micturition (Myers et al., 2000; Walz et al., 2010). Additionally, on transperineal ultrasound the pelvic floor
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The urethral sphincter is made up of both smooth muscle and skeletal muscle which extends from the vesical orifice to the distal membranous urethra (Koraitim, 2008). The internal lissosphincter of smooth muscle has its greatest function at the vesical orifice. Conversely the external rhabdosphincter of skeletal muscle mainly has its function at the membranous urethra (Koraitim, 2008). The lissosphincter controls the passive or involuntary continence mechanism (Koraitim, 2008). This passive continence is maintained by an involuntary contraction of the lissosphincter’s circular muscle fibres resulting in closure of the vesical orifice and narrowing of the urethra (Koraitim, 2008). Following a RP urinary incontinence (UI) is common and can result from injury to the lissosphincter, thus resulting in the loss of passive continence (Koraitim, 2008). The research suggests that the whole length of the lissosphincter is not essential to maintain continence. However, there is a minimum threshold and an injury to the lissosphincter below the threshold will result in UI (Gudziak, McGuire, & Gormley, 1996; Koraitim, 2008). During a RP, urologists aim to minimise damage to the lissosphincter by performing a bladder neck sparing dissection of the prostate (Myers, …show more content…
Manassero et al. (2007) and Van Kampen et al. (2000) both found statistically significant improvements in the PFMT groups compared to the control groups, receiving no treatment. Both Van Kampen et al. (2000) and Manassero et al. (2007) had large sample sizes of 102 and 107 patients respectively. Both studies randomly allocated patients into the PFMT group or into the control groups. The use of an age and gender matched control group, in which no treatment was provided, allows the full effect of PFMT to be evaluated with minimal bias. Van Kampen et al. (2000) measured continence objectively with the 1h and 24h pad tests and the visual analogue scale (VAS). Obtaining objective outcome measures are important to evaluate precise improvements in symptoms of UI. For example the 24h pad test measures the exact amount of urine lost over a 24-hour period. Manassero et al. (2007) also provided objective (24h pad test and VAS) outcome measures in their study. At three months continence was achieved in 88% of the PFMT group versus 56% in the control group (Van Kampen et al., 2000). Additionally, duration (p = 0.0001) and degree of incontinence (p = 0.001) were significantly improved compared to the control group (Van Kampen et al., 2000). Manassero et al. (2007) found similar results at 3 months post RP. The percentage of men that remained
The urethral sphincter is made up of both smooth muscle and skeletal muscle which extends from the vesical orifice to the distal membranous urethra (Koraitim, 2008). The internal lissosphincter of smooth muscle has its greatest function at the vesical orifice. Conversely the external rhabdosphincter of skeletal muscle mainly has its function at the membranous urethra (Koraitim, 2008). The lissosphincter controls the passive or involuntary continence mechanism (Koraitim, 2008). This passive continence is maintained by an involuntary contraction of the lissosphincter’s circular muscle fibres resulting in closure of the vesical orifice and narrowing of the urethra (Koraitim, 2008). Following a RP urinary incontinence (UI) is common and can result from injury to the lissosphincter, thus resulting in the loss of passive continence (Koraitim, 2008). The research suggests that the whole length of the lissosphincter is not essential to maintain continence. However, there is a minimum threshold and an injury to the lissosphincter below the threshold will result in UI (Gudziak, McGuire, & Gormley, 1996; Koraitim, 2008). During a RP, urologists aim to minimise damage to the lissosphincter by performing a bladder neck sparing dissection of the prostate (Myers, …show more content…
Manassero et al. (2007) and Van Kampen et al. (2000) both found statistically significant improvements in the PFMT groups compared to the control groups, receiving no treatment. Both Van Kampen et al. (2000) and Manassero et al. (2007) had large sample sizes of 102 and 107 patients respectively. Both studies randomly allocated patients into the PFMT group or into the control groups. The use of an age and gender matched control group, in which no treatment was provided, allows the full effect of PFMT to be evaluated with minimal bias. Van Kampen et al. (2000) measured continence objectively with the 1h and 24h pad tests and the visual analogue scale (VAS). Obtaining objective outcome measures are important to evaluate precise improvements in symptoms of UI. For example the 24h pad test measures the exact amount of urine lost over a 24-hour period. Manassero et al. (2007) also provided objective (24h pad test and VAS) outcome measures in their study. At three months continence was achieved in 88% of the PFMT group versus 56% in the control group (Van Kampen et al., 2000). Additionally, duration (p = 0.0001) and degree of incontinence (p = 0.001) were significantly improved compared to the control group (Van Kampen et al., 2000). Manassero et al. (2007) found similar results at 3 months post RP. The percentage of men that remained