Predictive values of the anal sphincter electromyography

Podnar, Simon

doi:10.1002/nau.20728

Cited by 4 publications

(4 citation statements)

References 5 publications

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“…The present study confirmed my previous observations [6,8,9] that the penilo‐cavernosus reflex is more difficult to elicit clinically in circumcised men. Furthermore, the study also showed a similar result in men with persistent foreskin retraction.…”

Section: Discussionsupporting

confidence: 92%

“…assessment of perianal sensation) [6]. On performing sacral reflex testing in daily clinical practice it was, however, my impression that the penilo‐cavernosus reflex [7] is much more difficult to elicit in circumcised men, even when they have no other clinical signs indicative of a possible sacral neurogenic lesion [6,8,9]. A similar observation was also made in non‐circumcised men with permanent retraction of the foreskin behind the glans penis.…”

Section: Introductionmentioning

confidence: 91%

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Clinical elicitation of the penilo‐cavernosus reflex in circumcised men

Podnar

2011

BJU International

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What ' s known on the subject? and What does the study add? It is known that foreskin, but not glans penis, contains a high density of fi ne-touch mechanoreceptors. Clinically the penilo-cavernosus refl ex provides information on function of the sacral nerves. The study demonstrated that in the majority of circumicised men this refl ex cannot be elicited clinically, but can be measured neurophysiologically. OBJECTIVE• To test clinical observations that the penilo-cavernosus refl ex is much more diffi cult to elicit in circumcised men. PATIENTS AND METHODS• Men consecutively referred for uroneurological or uro-neurophysiological examination were prospectively included.• Those with possible sacral neuropathic lesions were excluded.• A history was obtained, and a clinical neurological examination was performed.• The penilo-cavernosus refl ex was tested clinically and neurophysiologically using electrical and mechanical stimulation.• Refl ex elicitability scores in groups of circumcised men, men with foreskin retraction and a control group of uncircumcised men were compared using the Mann -Whitney U test. RESULTS• The refl ex was clinically non-elicitable in 73%, 64% and 8% of 30 circumcised men, 15 men with foreskin retraction, and 29 control men, respectively.• The scored refl ex elicitability was signifi cantly ( P < 0.001 ) higher in control men than in the other two groups clinically, but not neurophysiologically. CONCLUSION• The study confi rmed the lower clinical and similar neurophysiological elicitability of the penilo-cavernosus refl ex in circumcised men and in men with foreskin retraction. This fi nding needs to be taken into account by urologists and other clinicians in daily clinical practice. KEYWORDSbulbocavernosus refl ex , circumcision , foreskin , neuropathic lesion , penis Study Type -Aetiology (case series) Level of Evidence 4

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 91%

Clinical elicitation of the penilo‐cavernosus reflex in circumcised men

Podnar

2011

BJU International

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“…No optimal set of diagnostic criteria with satisfactory sensitivity and specificity for detecting neuropathic disorders of the EAS has been identified because a higher number of diagnostic criteria for muscle abnormality and more stringent normative limits may increase test specificity but reduce its sensitivity (Podnar, 2004a). Sensitivity ranges from 21 to 70%, specificity from 74 to 99%, positive predictive value from 58 to 99%, and negative predictive value from 47 to 90%, depending on the normative limits chosen and the number of MUP parameters considered (Podnar, 2009a). Compared with the automated multi-MUP technique, the interference pattern (IP) analysis with the turns/amplitude (T/A) method has lower sensitivity, particularly for detecting neuropathic changes (i.e., sensitivity 29%), and its use is less supported by the evidence (Podnar et al, 2002b).…”

Section: Pelvic Floor Electromyography (Emg)mentioning

confidence: 99%

Neurophysiology of the pelvic floor in clinical practice: a systematic literature review

Bianchi¹,

Squintani²,

Osio³

et al. 2017

Functional Neurology

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“…It has been shown in patients with cauda equina lesions that a combination of quantitative EMG of the EAS muscle (sensitivity, 73%) and neurophysiologic testing of the penilo-cavernosus reflex (sensitivity, 81%-83% using different stimulation techniques) yields a sensitivity of 94% to 96% and increases the diagnostic yield of the clinical examination to virtually 100% [42]. Specificity and predictive values of both tests were also shown to be high [45,46]. There are no validated techniques for distinguishing cauda equina lesions from more distal lesions.…”

Section: Focal Sacral Lesionsmentioning

confidence: 99%

Neurophysiologic Testing in Neurogenic Bladder Dysfunction: Practical or Academic?

Podnar

2010

Curr Bladder Dysfunct Rep

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For the diagnosis of neurogenic bladder, in addition to clinical assessment, neurophysiologic testing may be useful. Neurophysiologic tests are more useful in patients with sacral compared with suprasacral disorders. Anal sphincter electromyography (EMG) is the most useful diagnostic test, particularly for focal sacral lesions and atypical parkinsonism. Another clinically useful method that tests the sacral segments and complements EMG is the sacral (penilo/clitoro-cavernosus) reflex. Kinesiologic EMG is useful to demonstrate detrusor sphincter dyssynergia. Somatosensory-evoked potential and motor-evoked potential studies may be useful to diagnose clinically silent central lesions. The utility of cortical somatosensoryevoked potential in bladder/urethra stimulation is limited by technical difficulties that can be partially overcome by the concomitant recording of a palmar sympathetic skin response. Sympathetic skin response recorded from the saddle region is also useful for testing the lumbosacral sympathetic system. A clinically useful neurophysiologic test for evaluating the sacral parasympathetic system is still lacking.

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Predictive values of the anal sphincter electromyography

Cited by 4 publications

References 5 publications

Clinical elicitation of the penilo‐cavernosus reflex in circumcised men

Clinical elicitation of the penilo‐cavernosus reflex in circumcised men

Neurophysiology of the pelvic floor in clinical practice: a systematic literature review

Neurophysiologic Testing in Neurogenic Bladder Dysfunction: Practical or Academic?

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