The Role of Pelvic Neurophysiology Testing in the Assessment of Patients with Voiding Dysfunction

Abstract

Purpose of Review The role of pelvic neurophysiology testing in the evaluation of patients with lower urinary tract (LUT) symptoms is explored in this review. Recent Findings Different neurophysiology tests such as sphincter EMG and pudendal somatosensory evoked potentials are useful in evaluating the sacral somatic afferent and efferent innervation. S2 and S3 dermatomal evoked potentials assess individual sacral roots and are feasible to perform using standard neurophysiology machines. Summary The innervation of the LUT has a substantial contribution from splanchnic and somatic nerves arising from the sacral segments. Pelvic neurophysiology tests, which assess somatic nerve functions, are therefore a useful tool in assessing sacral nerve functions in patients presenting with unexplained voiding dysfunction. In this review, the commonly performed neurophysiology studies that assess the S2, S3 and S4 sacral afferent and efferent pathways are outlined, and their clinical applications reviewed.

Autonomic Nervous System Dysfunction Is Related to Chronic Prostatitis/Chronic Pelvic Pain Syndrome

“…They facilitate the movement of secretions from the ductal structures to the proximal urethra during ejaculation, which is innervated by sympathetic nerves ( Fig. 1 ) [ 11 12 13 14 15 16 17 ].…”

“…Interestingly, the sensory nerves of the pelvic organs are generally accompanied by sympathetic and parasympathetic nerves, including prostates, in the sensory passway. These originate in the inferior hypogastric nerve (pelvic nerve) and connect to the spinal cord [ 16 17 ]. The spinal cord segments controlling prostate sensation are T13-L1 and L5-S2 [ 18 ].…”

“…In contrast, bladder sympathetic and parasympathetic innervation originate at the spinal cord levels of L1-2 and S2-4. They have a typical spinal cord segment, indicating that the prostate has a complex relationship with the bladder and the other organs of the pelvis [ 16 17 ].…”