Neurourology and Urodynamics 30:1329–1332 (2011) Assessing Muscle Function of the Male Pelvic Floor using Real Time Ultrasound Irmina Nahon, 1,2 * Gordon Waddington, 1 Roger Adams, 2 and Grace Dorey 1 Faculty of Health, University of Canberra, Canberra, Australia 2 Faculty of Health Sciences, University of Sydney, Sydney, Australia Aims: Following surgical removal of the prostate, there may be compromise to the function of the pelvic floor muscles causing continence problems. Assessing the pelvic floor muscles of male patients can be an invasive process that causes discomfort, making it worthwhile to evaluate alternatives to the conventional method of Digital Rectal Examination (DRE). Real time ultrasound (RTUS) has been used with female patients as an alternative to internal assessments. This paper examines the reliability and validity of assessing the male pelvic floor using abdominal RTUS. Methods: Twenty-eight men (mean age 66.2) with a history of treatment for prostate cancer were recruited to the study. They were assessed via DRE and RTUS. Findings from the procedures were correlated for evaluation of validity, and the RTUS readings were repeated by different therapists to assess reliability. Results: Measurements on screen correlated moderately with DRE findings (r ¼ 0.57, P ¼ 0.002), and RTUS was found to have good reliability (Intra-class Correlation Coefficient ¼ 0.90). Continent men had more movement of the bladder wall on RTUS than those who were incontinent (P ¼ 0.043). Scar tissue and an inability to maintain a moderately full bladder were found to cause the most difficulty in getting a complete picture of pelvic floor movement. Conclusions: RTUS can be used clinically to examine male pelvic floor function, and its use would be enhanced once it has been established by DRE that a true pelvic floor contraction is occurring. RTUS can give an indication of pelvic floor function as an alternative measurement method when DRE is contraindicated. Neurourol. Urodynam. 30:1329–1332, 2011. ß 2011 Wiley-Liss, Inc. Key words: assessment; male; pelvic floor muscles; real time ultrasound; validation INTRODUCTION The pelvic floor muscles forming a hammock at the base of the pelvis are important in the support of the abdomino-pelvic viscera. A number of methods of assessment of the function of this muscle group have been described, including clinical observation, digital palpation, electromyography, manometry, dynamometry, and magnetic resonance imaging. 1,2 Currently, the standard clinical method for assessing the pelvic floor muscle function in males is by digital rectal examination (DRE). How- ever, this examination can only be performed by clinicians trained in pelvic floor assessment and may be personally inva- sive for the patient. In a recent study on prostate cancer screen- ing, 8.2% of men rejected the use of a DRE, with shame being the most frequently reported reason. 3 Ultrasound may be an alterna- tive to DRE. Rehabilitive ultrasound is becoming more common in physiotherapy, and it has been proposed as a method to evaluate the morphology and function of the pelvic floor muscles. 4 The use of transabdominal ultrasound for assessment of muscle function of the pelvic floor has been described and employed previously with females. 5,6–8 Transabdominal ultra- sound records the movement of the levator plate by the levator ani which moves the bladder neck anteriorly while elevating the levator plate, thereby closing the urethra. 9 The use of bladder displacement as a marker for levator plate movement has been described by Thompson and O’Sullivan. 7 Real time ultrasound (RTUS) in assessment of the pelvic floor muscles can be applied trans-abdominally, trans-perinealy, or anally, and with females there is also the option of trans-vaginal application. One of the main reasons RTUS has become widely used in pelvic floor rehabilitation with female patients is that it is well-tolerated and seems to eliminate the need to intimately examine the pelvic floor, which can be a barrier for both the client and the therapist. Trans-abdominal RTUS is the only assessment option that does not require the removal of underwear, and this reason alone may be why it is the most preferred method with clients. Since the greater proportion of continence issues have been described in females, assessment in most of the pelvic floor RTUS studies available in the literature was performed with women. Indeed, only one published study that included men when describing assessment of pelvic floor function using ultrasound was found. 10 In this study, young males (23 years, SD 5) were assessed to determine whether their pelvic floor showed more elevation in standing rather than in crook lying. To date there have not been any studies that consider older men’s pelvic floor function, nor have there been any studies examining whether there is a difference in pelvic floor function between those who have incontinence problems and those who do not. Further, ultrasound imaging as an assessment method after surgery such as radical prostatectomy has not been evaluated. Therefore, the aim of the current study was to examine the reliability and validity of assessment of the pelvic floor conducted by trans- abdominal ultrasound in a group of men that included those with post-surgery continence problems, and to compare RTUS with the standard clinical assessment made by DRE. Conflicts of interest: none. Christopher Chapple led the review process. *Correspondence to: Irmina Nahon, MPT, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia. E-mail: Irmina.nahon@canberra.edu.au Received 3 August 2010; Revised 22 December 2010; Accepted 6 January 2011 Published online 11 May 2011 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/nau.21069 ß 2011 Wiley-Liss, Inc.