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01.05.2013 | Original Article

Electrophysiological evaluation of the pudendal nerve and urethral innervation in female stress urinary incontinence

verfasst von: Geraldo de Aguiar Cavalcanti, Gilberto Mastrocola Manzano, Karlo Faria Nunes, Lydia Maria Pereira Giuliano, Tatiane Almeida de Menezes, Homero Bruschini

Erschienen in: International Urogynecology Journal | Ausgabe 5/2013

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Abstract

Introduction and hypothesis

Although still a matter of debate, stress urinary incontinence (SUI) may be accompanied by damage to urethral and pelvic floor innervations, thus promoting dysfunctions of the urethral support and sphincteric closure mechanisms. The aim of this study was to analyze the pelvic floor and urethral innervations through pelvic electrophysiological tests to identify whether neurological alterations interfere with urinary continence and urethral functional activity.

Methods

This prospective study included 52 women, 33 with clinically and urodynamically proven SUI and 19 continent volunteers matched for age, height, parity, and number of vaginal deliveries by the propensity score method. The patients were divided according to the severity of urinary loss evaluated by measuring abdominal leak point pressure (ALPP). Pudendal nerve terminal motor latency (PNTML), pudendal somatosensory evoked potential (SSEP) latencies, urethral and clitoral sensory thresholds, and urethroanal reflex latency were tested.

Results

SUI and control subjects did not differ in PNTML, SSEP latency, and clitoral sensory thresholds. However, reduced responsiveness to urethral electrosensitivity and prolonged urethroanal reflex latency were detected in most incontinent patients. In addition, urethral electrosensitivity was altered in suspected intrinsic sphincteric dysfunction.

Conclusions

Urethral afferent pathways can be altered in women with SUI and may play an important role in evoking intrinsic sphincteric dysfunction.

Milson I, Altman D, Lapitan MC et al (2009) Epidemiology of urinary (UI) and faecal (FI) incontinence and pelvic organ prolapse (POP). In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence. Health Publications, Paris, pp 35–111

Thind P, Lose G (1994) The effect of bilateral pudendal blockade on the adjunctive urethral closure forces in healthy females. Scand J Urol Nephrol 28:249–255PubMed

Ashton-Miller JA, Howard D, DeLancey JOL (2001) The functional anatomy of the female pelvic floor and stress continence control system. Scand J Urol Nephrol Suppl 207:1–7PubMedCrossRef

Hale DS, Benson JT, Brubaker L, Heidkamp MC, Russell B (1999) Histologic analysis of needle biopsy of urethral sphincter from women with normal and stress incontinence with comparison of electromyographic findings. Am J Obstet Gynecol 180:342–348PubMedCrossRef

Smith ARB, Hosker GL, Warrell DW (1989) The role of pudendal nerve damage in the aetiology of genuine stress incontinence in women. Br J Obstet Gynaecol 96:29–32PubMedCrossRef

Vereecken RL, De Meirsman J, Puers B, Van Mulders J (1982) Electrophysiological exploration of the sacral conus. J Neurol 227:135–144PubMedCrossRef

Varma JS, Fidas A, McInnes A, Smith AN, Chisholm GD (1988) Neurophysiological abnormalities in genuine female stress urinary incontinence. Br J Obstet Gynaecol 95:705–710PubMedCrossRef

Fidas A, MacDonald HL, Elton RA, McInnes A, Brown A, Chisholm GD (1988) Neurophysiological measurements in patients with genuine stress incontinence of urine and the relation of neurogenic defects to the presence of spina bifida occulta. Br J Urol 62:46–50PubMedCrossRef

Abrams P, Cardozo L, Fall M et al (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21:167–178PubMedCrossRef

10.

McGuire EJ, Cespedes RD, O’Connell HE (1996) Leak-point pressures. Urol Clin North Am 23:253–62PubMedCrossRef

11.

Cavalcanti GA, Manzano GM, Giuliano LM, Nóbrega JA, Srougi M, Bruschini H (2006) Pudendal nerve latency time in normal women via intravaginal stimulation. Int Braz J Urol 32:705–712PubMedCrossRef

12.

Cavalcanti GA, Bruschini H, Manzano GM, Giuliano LM, Nóbrega JA, Srougi M (2007) Urethral sensory threshold and urethro-anal reflex latency in continent women. Int Urol Nephrol 39:1061–1068CrossRef

13.

Rosenbaum PR, Rubin DB (1983) The central role of the propensity score in observational studies for causal effects. Biometrika 70:41–55CrossRef

14.

Cameron AC, Trivedi PK (2005) Microeconometrics: methods and application. Cambridge University Press, New YorkCrossRef

15.

Barnick CGW, Cardozo LD (1993) Denervation and re-innervation of the urethral sphincter in the aetiology of genuine stress incontinence: an electromyographic study. Br J Obstet Gynaecol 100:750–753PubMedCrossRef

16.

Bakas P, Liapis A, Karandreas A, Creatsas G (2001) Pudendal nerve terminal motor latency in women with genuine stress incontinence and prolapse. Gynecol Obstet Invest 51:187–190PubMedCrossRef

17.

Karantanis E, Fowler CJ, Moore K, Stanton S (2003) The perineal compound muscle action potential and symptom severity in women with stress incontinence. Proceedings of the International Continence Society (ICS) 33rd Annual Meeting, p 93

18.

Vodusek DB, Amarenco G, Podnar S (2009) Clinical neurophysiological tests. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence. Health Publications, Paris, pp 523–540

19.

Chiappa KH (1997) Principles of evoked potentials. In: Chiappa KH (ed) Evoked potentials in clinical medicine. Lippincott-Raven, Philadelphia, pp 1–30

20.

Cavalcanti GA, Bruschini H, Manzano GM et al (2007) Pudendal somatosensory evoked potentials in normal women. Int Braz J Urol 33:815–821PubMedCrossRef

21.

Delodovici ML, Fowler CJ (1995) Clinical value of the pudendal somatosensory evoked potential. Electroenceph Clin Neurophysiol 96:509–515PubMedCrossRef

22.

Wyndaele JJ (1993) Is abnormal electrosensitivity in the lower urinary tract a sign of neuropathy? Br J Urol 72:575–579PubMedCrossRef

23.

De Laet K, De Wachter S, Van Meel T, Wyndaele JJ (2010) How do different tests evaluate sensation in the lower urinary tract? Scand J Urol Nephrol 44:158–164PubMedCrossRef

24.

Catarin MV, Manzano GM, Nóbrega JA, Almeida F, Srougi M, Bruschini H (2008) The role of membranous urethral afferent autonomic innervation in the continence mechanism after nerve sparing radical prostatectomy: a clinical and prospective study. J Urol 180:2527–2531PubMedCrossRef

25.

Hosker G, Rosier P, Gajewski J, et al (2009) Dynamic testing. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence. Health Publications, Paris, pp 413–522

26.

Gajewski JB (2001) Leak point pressure. In: Corcos J, Schick E (eds) The urinary sphincter. Marcel Dekker, New York, pp 303–310

27.

Opsomer RJ (2001) Electrophysiological evaluation of genitourinary nervous pathways. In: Corcos J, Schick E (eds) The urinary sphincter. Marcel Dekker, New York, pp 423–435

28.

Kessler TM, Studer UE, Burkhard FC (2007) Increased proximal urethral sensory threshold after radical pelvic surgery in women. Neurourol Urodyn 26:208–212PubMedCrossRef

Titel: Electrophysiological evaluation of the pudendal nerve and urethral innervation in female stress urinary incontinence
verfasst von: Geraldo de Aguiar Cavalcanti
Gilberto Mastrocola Manzano
Karlo Faria Nunes
Lydia Maria Pereira Giuliano
Tatiane Almeida de Menezes
Homero Bruschini
Publikationsdatum: 01.05.2013
Verlag: Springer-Verlag
Erschienen in: International Urogynecology Journal / Ausgabe 5/2013
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-012-1931-8

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Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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