Videomanometry of the pelvic organs: A comparison of the normal lower urinary and gastrointestinal tracts

Abstract

Background : Both the lower urinary tract (LUT) and the caudal part of the lower gastrointestinal tract (LGIT) are innervated by the sacral spinal cord. We aimed to compare the normal physiology of the LUT and LGIT using the same videomanometry method. Methods : We recruited fifteen healthy volunteers (eight men and seven women; mean age, 60 years). The videomanometric measures included fluoroscopic images, subtracted bladder/rectal pressures, urethral/anal sphincter pressures, sphincter electromyography, and urinary/fecal flow. Results : During the resting phase, the urethral/anal sphincter pressures showed almost the same values (mean, 70 cmH 2 O and 68 cmH 2 O, respectively). During the storage phase, the volumes at first sensation and maximum capacity for the LGIT (129 mL and 320 mL) were slightly smaller than those for the LUT (170 mL and 405 mL). Compliance of the LGIT (65 mL/cmH 2 O) was almost as high as that of the LUT (99 mL/cmH 2 O). However, the LGIT showed spontaneous phasic rectal contractions (SPRC) that were never seen in the bladder. None of the subjects experienced leakage during bladder/rectal filling. During the evacuation phase, rectal contraction on defecation (14 cmH 2 O) was present, but was weaker than bladder contraction on micturition (42 cmH 2 O; P < 0.01). Abdominal strain on defecation (70 cmH 2 O) was greater than that on micturition (25 cmH 2 O; P < 0.01). Sphincter pressure increase on defecation (13 cmH 2 O) was greater than that on micturition ( − 52 cmH 2 O). An illustrative case of SPRC that were seen during urodynamic recording was shown. Conclusion : SPRC and abdominal strain are features of the LGIT, whereas micturition bladder contraction is a feature of the LUT. These features can aid in understanding the possible rectal 'artifacts' of videourodynamics and neurogenic pelvic organ dysfunction.

Sphincter EMG for Diagnosing Multiple System Atrophy and Related Disorders

“…The normal range of static anal pressure is more than 40 cmH2O, and that of anal squeeze pressure is more than 50 cmH2O. 22 The former is thought to reflect hypogastric adrenergic innervation, whereas the latter reflects somatic Onuf's nucleus innervation. 22 The subcutaneous EAS is easy to examine.…”

“…22 The former is thought to reflect hypogastric adrenergic innervation, whereas the latter reflects somatic Onuf's nucleus innervation. 22 The subcutaneous EAS is easy to examine. It is reached by inserting a needle about 1 cm from the anal orifice, to a depth of 3-6 mm.…”

“…The lower urinary tract and lower gastrointestinal tracts perform similar functions of storage and emptying. However, they differ profoundly with regard to anatomy (closed bag versus open-ended tube, respectively), luminal contents (liquid versus half-solid), and physiology (dysfunctional transport, rare ureter versus common bowel; smooth muscle contraction, bladder contraction only on emptying versus persistent spontaneous phasic rectal contraction; abdominal strain, minimal on urination versus strong on defecation) 22 . In addition, while the lower urinary tract requires an intact neuraxis for storage and emptying 12 , it has not been entirely clear to what extent the lower gastrointestinal tract needs the extra-enteric nervous system.…”

“…2) 12,22 . The lower urinary tract and lower gastrointestinal tracts perform similar functions of storage and emptying.…”

“…Two types of myoelectrical activity or pressure changes in the colon are documented. Slow phasic pressure waves are the most common manometric phenomenon 26 , and in humans are measured as spontaneous phasic rectal contraction 9,22 . The peristaltic reflex can be evoked by surface stroking or by circumferential stretching.…”