Real-Time Ultrasound for Pelvic Floor Rehabilitation in Older Men with Prostate Disease

Introduction:

Urinary incontinence further exacerbated by prostate diseases are detrimental to quality of life and functional independence, Real-time Ultrasound (RTUS) provides an objective and non-invasive Pelvic Floor Muscle (PFM) retraining for continence management with older men. RTUS guided PFM rehabilitation in an older male patient with urinary incontinence secondary to prostatic enlargement provides baseline PFM function.

Methods:

Mandatory fluid fasting with only maximal 250 ml of H2O consumption to expand the bladder as required for transabdominal RTUS imaging. A male prostate cancer patient awaiting prostatectomy presented with urinary incontinence from stress, urge, and void symptoms requiring a 45-degree cephalad angulation for imaging PFM contractions. Parameters measured were maximum lift amplitude, contraction duration, and repetition capacity. RTUS biofeedback guided an Individualised pre-surgical rehabilitation protocol focused on reducing compensatory abdominal muscle dominance and decreasing intra-abdominal pressure to isolate levator ani and coccygeus during retraining, optimising isolated PFM activation.

Results:

RTUS assessment revealed significantly impaired PFM function, maximum lift amplitude 4.5mm, contraction duration one second, with complete inability to perform repetitions or sustained holds. RTUS visualisation identified excessive abdominal muscle dominance causing bearing-down compensation patterns. RTUS-guided retraining with visual biofeedback enabled immediate technique correction, by reducing compensatory strategies and facilitating isolated levator ani and coccygeus activation, and Objective measurements established quantifiable baseline for post-surgical continence outcome comparison, consistent with evidence supporting pre-prostatectomy PFM training for improved post-operative continence recovery.

Conclusion(s):

RTUS provides clinically actionable data beyond subjective patient-reported outcomes, enabling therapist and patient to identify and correct compensatory strategies in real time. The quantified 4.5mm amplitude baseline creates a measurable outcome for post-surgical comparison, supporting evidence-based continence rehabilitation pathways. Limitations include the single-case observational design, absence of follow-up post-prostatectomy data, and the resource and training requirements for RTUS in clinical settings.