Transperineal Ultrasound Before and After Prostatectomy: Technical Approach and Description

Abstract

This study assessed the feasibility of dynamic transperineal ultrasound (TPUS) pre/post-radical prostatectomy (RP). Ninety-eight patients were scanned pre-operatively and at four time-points post-operatively. TPUS was performed in 98 patients using an abdominal transducer at rest, during pelvic floor contraction (PFC) and Valsalva (VS) maneuver in supine and standing positions. Urodynamic evaluations included bladder neck angle at rest/PFC/VS, and degree of bladder neck movement. Pre-operative and post-operative measurements were technically feasible in >85% (supine) and >90% (standing) of patients. TPUS offers a reliable non-invasive dynamic assessment of the pelvic floor post-prostatectomy and may prove a useful adjunct for guiding exercises to preserve continence.

Keywords: Valsalva maneuver; membranous urethral length; pelvic floor contraction; post-prostatectomy urinary incontinence; transperineal ultrasound.

Figure 1

Study design.

Figure 2

Superimposed images of the bladder neck (dashed lines) closing during PFC (A) and opening in VS (B) in the same patient. The resulting vector is indicated (arrow) for bladder ascent following PFC and bladder descend during VS. The letter B indicates the bladder. Images were acquired from the perineum, inferior to the prostate in the longitudinal/sagittal plane. The right‐hand side of the image is anterior and the left posterior to the patient.

Figure 3

Pre‐operative TPUS image in the longitudinal plane (A) and mp‐MR images in sagittal (B) and coronal plane (C). The images show the intravesical prostate protrusion assessed by the two techniques. The letter “B” indicates the bladder and the “P” the prostate. In figure part A, the right‐hand side of the image is anterior and the left posterior to the patient.

Figure 4

Box‐plot for distribution of average mean urethral length (MUL) over time. On the y axis the length of MUL in mm, on the x axis the different time points (pre‐operative in blue, 3 months post‐prostatectomy in orange, 6 months post‐prostatectomy in gray, 9 months post‐prostatectomy in yellow and 12 months post‐prostatectomy in light blue).

Figure 5

Post‐prostatectomy (12 months) TPUS images of a 62‐year‐old male at rest (A) and after PFC (B). Images show the elevation of urethra and the pelvic floor with a reduction of the angle of bladder neck. The letter B indicates the bladder. The right‐hand side of the image is anterior and the left posterior to the patient.

Figure 6

Post‐prostatectomy (12 months) TPUS images of a 62‐year‐old male at rest (A) and after VS maneuver (B). Images show the descendant of urethra and the pelvic floor with an increase of the angle of bladder neck. The letter B indicates the bladder. The right‐hand side of the image is anterior and the left posterior to the patient.

Figure 7

Average combined vector displacement during PFC (A) and in VS maneuver (B) in the supine and standing position.

Figure 8

Post‐prostatectomy (12 months) TPUS images of a 68‐year‐old incontinent male at rest (A) and after VS maneuver (B). Images show the descendant of urethra and the pelvic floor; in these patients leak of urine defined as urine detected in the urethral tract was detected (with arrows). The letter B indicates the bladder. The right‐hand side of the image is anterior and the left posterior to the patient.