Author/Editor     Podnar, Simon; Vodušek, David B
Title     Protocol for clinical neurophysiologic examination of the pelvic floor
Type     članek
Source     Neurourol Urodyn
Vol. and No.     Letnik 20, št. 6
Publication year     2001
Volume     str. 669-82
Language     eng
Abstract     Clinical neurophysiologic examination of the pelvic floor is performed worldwide, but there is no consensus on the choice of tests, nor on technical details of individual methods. Standardized methods are, however, necessary to obtain their valid application in different laboratories for the purpose of collection of normative data, comparison of patient data and organization of multi-center studies. It is proposed that in patients with suspected "lower motor neuron" type lesions concentric needle electromyography (CNEMG) is the most informative test to detect pelvic floor denervation/reinnervation, and the external anal sphincter (EAS) muscle is the most appropriate muscle to be examined (either in isolation when a selective lesion is suspected-or in addition to examination of other muscles). An algorithm consisting of standardized tests including a standardized approach to CNEMG examination of the EAS is presented. The proposed electrophysiologic assessment consists of a computer-assisted analysis of denervation and reinnervation features of the CNEMG signal, a qualitative assessment of retiex and voluntary activation of EAS motor units, and of electrical (armechanical) elicitation of the bulbocavernosus reflex in those patients in whom manual anogenital stimulation failed to elicit a robust response in the EAS. The proposed protocol could serve as a basis for further studies on validity, sensitivity and specificity of electrophysiologic assessment in patients with different types of "lower motor neuron" involvement of pelvic floor muscles and sacral dysfunction.
Descriptors     PELVIC FLOOR
ANUS
MOTOR NEURON DISEASE
MUSCLE DENERVATION
REFLEX
ELECTROMYOGRAPHY
ELECTRIC STIMULATION