Background: While surgery can successfully remove the cancerous prostate, the preferred management for most men with a diagnosis of prostate cancer, the side effects of surgery can be devastating and impact quality -of-life in the life after surgery. Urinary incontinence (UI) is the side effect that will impact immediately, although most men will have no conception of what this may mean: leaking 500 ml or more of urine in 24 hours day and night, necessitating big pads and limiting physical activity, which impacts social life, intimacy and self- esteem.
There is a long history of pelvic floor muscle training (PFMT) assisting women to overcome stress urinary incontinence. The same principles can be applied to men with UI after radical prostatectomy, but their different anatomy has necessitated a re-evaluation of how this muscle training could work and how best to teach men.
Methods: This presentation will describe the pre-operative evaluation of bladder function and PFMT using transperineal ultrasound (TPUS), an innovative technique pioneered in Australia. Factors which are predictive of a good outcome will be described and a best-practice management program for UI described, specific to males. The groundbreaking use of TPUS to enhance men’s awareness of these hidden muscles will be described and illustrated, together with the evolving research finessing our understanding of the interaction of this muscle complex in men.
Impact on practice: The incorporation of TPUS in continence rehabilitation has transformed men’s experience, providing confidence that they can positively contribute to their recovery and enhancing motivation.
Discussion: International fora such as this are helping to raise awareness of TPUS as an innovate and effective intervention to help reduce the impact of UI after prostate cancer surgery. This is an exciting niche area of physiotherapy where high-quality research is improving men’s outcomes.