Impact of Radical Prostatectomy on Pelvic Floor Muscles: An Electromyography and Perineometric Assessment.

Gopi S1, Tiwari M2, Ragavan N3, Prasanna R4, Anrose M5

Research Type

Clinical

Abstract Category

Male Stress Urinary Incontinence (Post Prostatectomy Incontinence)

Abstract 45
Urology 2 - Male Stress Urinary Incontinence
Scientific Podium Short Oral Session 4
Thursday 18th September 2025
12:00 - 12:07
Parallel Hall 2
Basic Science Incontinence Pad Test Stress Urinary Incontinence Surgery
1. Apollo Hospitals, Department of Urology / Functional Urology,Chennai, India, 2. Apollo Hospitals, Department of Urology/UroOncology, Chennai, 3. Apollo Hospitals, Department of Urology / UroOncology,Chennai,, 4. Apollo Hopsitals, Department of Physiotherapy, 5. Apollo Hospitals, Department of Physiotherapy, Chennai, India
Presenter
Links

Abstract

Hypothesis / aims of study
Urinary incontinence (UI) affects  9-16% of patients undergoing radical prostatectomy (RP). 
Factors contributing to UI are multifactorial and  compromised function of the pelvic floor muscles (PFM) is  a significant component.
Slow (~70%) & fast twitch fibres (~30%) are an integral part of the PFM and is  responsible for maintaining tone and providing support for pelvic organs at rest as well as during sudden rise in intra-abdominal pressure. It also helps to provide adequate urethral closure pressure. 

Our objective was to evaluate the changes in the strength of Pelvic Floor Muscle and the nerve activity of the PFM induced by Radical Prostatectomy. 
The tools used were ElectroMyography(EMG) and Perineometer and the  assessment was to infer, if Pelvic Floor Muscle training (PFMT) improves any of the parameters.
Study design, materials and methods
Men undergoing Radical Prostatectomy  for Ca Prostate were voluntarily recruited to this non-randomized trial from  October 2022. Patients with prior pelvic RT and systemic or neurologic diseases were deemed ineligible to participate. Local ethics committee clearance was obtained. All participants were taught Pelvic Floor Muscle exercises(PFME) before surgery and  on the day of catheter removal.
 
Patients were advised to continue the PFME for three months. 
PFM evaluation was done before surgery, at catheter removal and  3 months after RP.

The assessment included Electromyography - EMG (INTELECT® NEO, Enovis™, USA) assessment using surface electrodes placed at the anal verge , base of the penis, perineum and Perineometer (PERITRON™, Technomed Systems, India) readings,  
To evaluate the improvement of the pelvic tone. 
Manual muscle testing (MMT) was performed by DRE  using the modified Oxford scale schema.
Results
Detailed Results in Table Form.
The number of patients  were 65.
The Mean Age was  65.6 yrs. 
Perineometer assessed quick contraction and hold in mmHg.
The EMG readings were at the base of penis, perineum and anal ring  in (uV). 
Perineometer readings at 3 months post op
 was statistically significant.p<0.001.
This study presents a comprehensive statistical analysis to evaluate changes in clinical outcomes across pre-operative and post-operative visits. Descriptive statistics were employed to summarize categorical data as frequency (percentage) and continuous data as Mean ± SD, with median (IQR) used for skewed distributions. Statistical significance was assessed using McNemar’s-Bowker test for changes between pre-operative and post-operative visits, and the Friedman test for differences over time. A significance threshold of p < 0.05 was applied. Key findings are presented across demographic factors, muscle manual testing (MMT),  EMG,  urinary continence, and types of incontinence, with statistically significant results highlighted in boldface. All analyses were performed using SPSS software (IBM, version 28.0). The results provide valuable insights into the effectiveness of interventions and their impact on patient outcomes over time.
Interpretation of results
Perineometer readings suggest a reduced perineal pressure immediately after RP with a substantial increase noted at 3 months. We
hypothesize that PFMT contributed to improvement in the potential of the muscle fibres.
EMG values at the base of the penis suggest increased action potential of the muscle fibres immediately after RP probably as a way to compensate for UI. This overactivity seems to settle to baseline at 3 months.
EMG readings at the perineum & anal ring show weakening of muscle activity & fall in anal sphincter pressures. These are in
contrast to the perineometer readings which show marked improvement. More research is needed to correlate this difference to
perineometer readings & to evaluate whether surface activity has any role in continence.
MMT values improved significantly at 3 months suggesting that PFMT has a significant role to play in UI.
Concluding message
This study objectively evaluates the impact of RP on the Pelvic Floor Muscle  and  provides insight into the recovery of muscle potential with PFMT.
Figure 1 Perineometer and EMG readings
Figure 2 Significant improvement in UI post-operatively, with a higher proportion of patients achieving "Pad Free" status and fewer requiring multiple pads.
References
  1. Pelvic Floor Muscle Training ...: A Narrative Review Donatella Giraudo et al. Urologia. 2023 Aug.
  2. Randomized Controlled Trial Effects of perioperative pelvic floor muscle training ..: a randomized clinical trial Gislano Lira et al. Int Braz J Urol. 2019 Nov-Dec.
  3. Supervised pelvic floor muscle exercise .. - a systematic review and meta-analysis Freerk T Baumann et al. Disabil Rehabil. 2022 Sep.
Disclosures
Funding None Clinical Trial Yes Public Registry No RCT No Subjects Human Ethics Committee Institutional Ethics Committee- Biomedical Research, Apollo Hospitals, Chennai Helsinki Yes Informed Consent Yes
08/07/2025 10:01:12