US National Multiple Sclerosis Society, Multiple Sclerosis Society of Great Britain and Northern Ireland, Novartis, UK National Institute for Health Research (NIHR), and NIHR UCLH/UCL Biomedical Research Centre.

ObjectiveTo assess the clinical, urodynamic and neurophysiologic features of patients with persisting bladder, bowel and sexual dysfunction following transverse myelitis in MOG-antibody disease.MethodsPatients with a history of MOG-antibody disease related transverse myelitis seen prospectively in a tertiary centre Uro-Neurology service between 2017 and 2019 were included. They received cross-sectional clinical assessment, completed standardised questionnaires on bladder, bowel and sexual symptoms and underwent urodynamic and pelvic neurophysiologic investigations.ResultsTwelve patients (9 males) were included with a total of 17 episodes of transverse myelitis. Mean age at first attack was 26 years (SD 9) and median follow-up duration was 50 months (IQR 32–87). Acute urinary retention requiring bladder catheterisation occurred in 14 episodes and was the first symptom in 10 episodes. Patients with lesions affecting the conus medullaris required catheterisation for significantly longer durations than those without a conus lesion (median difference 15.5 days, p = 0.007). At follow-up, all patients had recovered full ambulatory function, but persisting bladder and bowel dysfunction had moderate or severe impacts on quality of life in 55% and 36% respectively and 82% had sexual dysfunction. Pelvic neurophysiology demonstrated abnormal residual conus function in 6 patients. Urodynamic findings predominantly showed detrusor overactivity and/or detrusor-sphincter dyssynergia, indicative of a supraconal pattern of lower urinary tract dysfunction.ConclusionsPersisting urogenital and bowel dysfunction is common despite motor recovery. Although a proportion of patients had neurophysiologic evidence of residual conus abnormalities at follow-up, predominant urodyamic findings suggest that ongoing lower urinary tract dysfunction results from supraconal injury.

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.