Neurophysiological Measurements in Primary Adult Enuretics

Abstract

The nerve supply of the lower urinary tract was studied in 25 primary adult enuretics by full urodynamic assessment and neurophysiological measurements. The latter consisted of the measurement of static EMG, sensory thresholds and sacral reflex latencies (SRL). All patients were normal on clinical neurological examination. All neurophysiological measurements were within normal limits in only three patients and the remaining 22 had at least one abnormal response. The commonest abnormality was a high or even absent urethral sensory threshold. These defects in sensory and motor innervation correlated with the clinical dysfunction. It was concluded that this is a valuable method for the detection of nerve defects in the lower urinary tract, especially when the clinical neurological examination is normal.

Electrophysiological observations on the human pudendo-anal reflex.

“…Hence, it has been used in the investigation of patients with neurogenic disorders of the urinary bladder and of sexual function. "628 29 Many of these patients often have radiological evidence of lumbo-sacral spinal dysraphism.39 Similar observations have been made in some patients with intractable constipation of idiopathic origin. 40 Electrophysiological measurement of the pudendoanal reflex latency provides a simple and reliable method of evaluating pelvic floor neuropathy.…”

“…In three of these patients the reflex could not be elicited despite several attempts. No differences were apparent in the duration of the reflexly evoked anal sphincter response between the Blinn also described a simultaneous reflex contraction ntial duration (ms) of the anal sphincter in response to this stimulus.10 tion between the mean This was variously termed the sacral evoked potenxternal anal sphincter tial,'9 sacral evoked response,28 sacral reflex,22 29 pudendo-anal reflex.…”

Urethral sensory threshold and urethro-anal reflex latency in continent women

“…If supramaximal stimuli are not possible (or not desirable) another physiological (biological) definition of the stimulus is preferable [15]. Galloway et al [29] and Fidas et al [34] established the stimulus intensity as being three-times the urethral sensory threshold. This method of establishing the stimulus intensity could cause insufficient stimulus if the threshold obtained is very low, or high stimulus intensity if the threshold is high.…”

Bladder–anal reflex

“…Bradley pioneered the use of the urethral^anal re£ex (UAR) [Bradley, 1972], and a similar method was used by other investigators [Fidas et al, 1985]. In conjunction with the clitoralâ nal re£ex (CAR) or penile^anal (bulbocavernosus) re£ex testing, a high incidence of abnormalities (i.e., the absence or prolonged latency of the re£exes) has been found in patients with cauda equina or conus medullaris lesions as well as in women with urinary retention or incontinence [Ertekin et al, 1979;Fidas et al, 1985Fidas et al, , 1987aFidas et al, ,b, 1989Galloway and Tannish, 1985]. An additional sacral re£ex may be obtained by stimulating the bladder instead of the urethra or clitoris and recording at the anal sphincter, called the bladder^anal re£ex (BAR).…”