Pulse article: How do you do the international standards for neurological classification of SCI anorectal exam?

Study design Retrospective, cross-sectional.Objectives To determine the capacity of the ice water test (IWT) to predict erectile function during the early phase of spinal cord injury (SCI). Setting France. Methods This was a retrospective, cross-sectional study. Data from patients with SCI were included if they presented with neurogenic shock causing erectile dysfunction AND detrusor underactivity, and had undergone the following evaluations during the first 6 months post SCI (E1), and again at least 2 years later (E2): a complete neurological examination, urodynamic evaluation with the IWT, and evaluation by the Erection Hardness Score (EHS, from 0 to 4). Patients with cauda equina syndromes were excluded. Results Data from 62 patients with SCI were included, 37 with a positive IWT and 25 with a negative IWT. E1 was performed at 3.2 months ± 1.9, and E2 at 2.0 years ± 2.9 post SCI. At E2, 95% of patients with an initial positive IWT had reliable erections (EHS 3 or 4), compared with 0% of patients with a negative IWT. Neurogenic detrusor overactivity was found in 89% of patients with a positive IWT compared with 8% with a negative IWT. The IWT had a good sensitivity and negative predictive value: 100% for erectile function, and respectively 94 and 92% for bladder function. ConclusionThe IWT is a reliable and predictive test of erectile potential in patients with sacral and suprasacral SCI.

Section: Discussionmentioning

confidence: 99%

Use of the ice water test as an early predictor of recovery of erectile function in patients with spinal cord injury

Hadiji

Prévinaire

Soler³

2020

“…Examiners who see individuals with spinal cord injury may come from a variety of medical specialties with varying training experiences, including neurology, physiatry, neurosurgery, urology, and medicine. Inconsistency exists in this examination and this is important to eliminate such inconsistencies [20].…”

Section: Discussionmentioning

confidence: 99%

International standards to document remaining autonomic Function in persons with SCI and neurogenic bowel dysfunction: Illustrative cases

Goetz

Emmanuel

Krogh

2018

“…The bulbocavernosus reflex (BCR) and anal reflexes are the most commonly clinically used somato-somatic sacral reflexes [1]. While not a required part of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) [2], or the International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) [3], the BCR is described as an important test most especially in differentiating an UMN from a LMN injury [4,5]. Here we describe these two sacral reflexes and explain the reasons for our recommendation for use of the anal reflex as the primary test for assessment of sacral reflex status in clinical spinal cord injury (SCI) practice.…”

Section: Introductionmentioning

confidence: 99%

Anal reflex versus bulbocavernosus reflex in evaluation of patients with spinal cord injury

Kirshblum

Eren

2020

The examination of sacral reflexes provides an important method to differentiate an upper motor neuron vs lower motor neuron spinal cord injury (SCI). Two common sacral mediated reflexes used as part of the neurological assessment include the bulbocavernosus reflex (BCR) and anal reflex. As the clinical information from these tests are similar, we suggest that the anal reflex provides a better first option as a non-invasive clinical assessment of sacral reflex status in clinical practice in SCI as the testing for the anal reflex is less intrusive and already being performed as part of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) by pinprick stimulation of the S4-5 dermatome.