Neurophysiologic study in idiopathic overactive bladder

Abstract

Aim: Idiopathic overactive bladder (OAB) is a prevalent, mystifying disorder with a questionable neurogenic background. We aimed to investigate the possible subtle neuropathic affection underlying its pathogenesis. Methods: A cross-sectional cut off study was carried out on a series of 38 females with idiopathic OAB and 22 healthy matched female volunteers. The following was performed: symptom score questionnaire, determination of pudendal nerve terminal motor latency (PNTML), sacral reflexes' latencies, pudendal somatosensory evoked potentials, and needle electromyography of the external anal and urethral sphincters. Results: A highly significant prolongation of PNTMLs and sacral reflexes latencies among the patients group was detected (P ≥ 0.001). Pudendal somatosensory evoked potentials showed non-significance among the two studied groups (P ≥ 0.05).External anal sphincter neuropathic affection was detected in 27 patients (71%) and external urethral sphincter neuropathic affection was detected in 30 patients (78.9%). The clitoral anal reflex showed the highest sensitivity and specificity among the neurophysiologic tests used in assessing the neuropathic affection (86.7 and 83%, respectively), followed by PNTML (83.3 and 80%, respectively). Conclusion: Pudendal neuropathy is the dominating possible attributing factor in the pathogenesis underlying idiopathic OAB. An integrated clinical, urodynamic, and electro-physiological assessment is recommended for evaluation of any overactive bladder patients. K E Y W O R D S detrusor overactivity, pelvic floor electromyography, pudendal nerve terminal motor latency, sacral reflexes

To Explore the Diagnostic Value of Bulbocavernosus Muscle Reflex and Pudendal Somatosensory Evoked Potentials for Diabetic Neurogenic Bladder

“…Somatosensory evoked potentials are one of the objective indicators used to examine neurosensory pathway lesions. It has been reported [ 8 ] that bulbocavernosus neuropathy might primarily contribute to idiopathic overactive bladder disorder, and pudendal somatosensory evoked potentials could detect neuropathy in the external urethral sphincter and anal sphincter. The bulbocavernosus muscle reflex is caused by stimulation of the pudendal nerve, through the gingival medullary reflex arc, causing contraction of the bulbocavernosus muscle, and its latency reflects the integrity of the reflex arc composed of the peripheral afferent nerve, gingival medullary, and efferent motor fibers [ 9 ].…”

Pelvic Floor Muscle Electromyography as a Guiding Tool During Lead Placement and (Re)Programming in Sacral Neuromodulation Patients: Validity, Reliability, and Feasibility of the Technique

“…Historically, the PFM response observed by stimulating the sacral spinal nerves has been labeled as a spinally mediated reflex contraction, as only latencies ranging from 33.3 to 198 ms were recorded (22,23). Interestingly, our study shows latencies around 4 ms, corresponding to the time needed to directly activate an efferent nerve, propagate the nerve signal, and activate the target muscle(s) (24). The reason why no direct efferent response was recorded in the past could be due to technical issues as EMG recordings were performed of the contralateral external anal sphincter (22,25) and double pulses were used to stimulate, thereby camouflaging any possible EMG response occurring during the beginning after lead stimulation (23).…”

Solifenacin/Mirabegron Induces an Acute Compliance Increase in the Filling Phase of the Capacity-Reduced Urinary Bladder: A Pressure-Volume Analysis in Rats

“…The urinary bladder collects and stores urine before its disposal by urination (De Groat and Yoshimura, 2001); and the pressure of the bladder, which is a highly compliant organ, is only slightly elevated in response to a considerable filling volume during storage (Sugaya et al, 2000). Impaired bladder compliance is deleterious because abnormally high intra-vesical pressure (IVP) not only obstructs urine flow to cause vesico-urethral reflux (Wu and Franco, 2017) but also overactivates the micturition neuraxis (Mills et al, 2000) to underlie the development of an overactive bladder (OAB) manifested by urinary urgency and/or frequency (Ali et al, 2019).…”