One session involved a standard “Brink” PFM test (Graded 0-5) and a subsequent perinometer-based objective assessment of “squeezing pressure”, both via a per rectal approach. Session 2 involved a “rapid response test” (RRT), where 10 maximal PFM contractions were performed as rapidly as possible under trans-abdominal RTUS imaging of the pelvic floor, with elapsed time recorded. A subsequent “sustained endurance test” (SET) required subjects to sustain a maximal PFM contraction, with task failure visually confirmed on RTUS and elapsed time recorded.
Between-observer reproducibility in 80 male subjects (68±7yrs) was subsequently determined for both the RRT and SET tests, in supine and standing postures. A modest but significant correlation was observed between manual DRE and perinometer measures (r=0.51, P<0.05), but DRE scores did not correlate with either RRT (r=0.02, P=0.91) or SET results (r=0.11, P=0.58). Similarly, perinometer scores did not correlate with either RRT (r=0.06, P=0.78) or SET (r=0.14, P=0.49). Both RRT (r=0.97, P<0.05) and SET (r=1.0, P<0.05) tests were highly reproducible with low coefficients of variation (5-12%).
We introduce two new tests of PFM function. Neither the RRT, devised to assess fast twitch fibre function, nor the SET, a test of slow twitch muscle endurance, correlated with the traditional DRE/Brink score. This suggests that our novel tests and the traditional DRE/Brink approach assess distinct functional parameters of the pelvic floor.
However, our tests are ecologically valid in terms of muscle fibre composition of the pelvic floor, highly reproducible irrespective of posture, non-invasive, objective, sensitive in terms of continuous timed assessment, provide real-time visual feedback to define task failure and can be quickly and easily adopted in the clinical setting. Results from the RRT and SET tests provide a baseline of PFM function, essential for devising individualised treatment plans for ED and UI in men.
