Sensory evoked cortical potentials of the lower urinary tract in healthy men

Knüpfer, Stephanie C.; Liechti, Martina D.; Lely, Stéphanie van der; Gregorini, Flavia; Schubert, Martin; Wachter, Stefan De; Kessler, Thomas M.; Mehnert, Ulrich

doi:10.1002/nau.23600

Cited by 8 publications

(27 citation statements)

References 25 publications

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“…Using the standard bipolar Cz–Fz approach, the shape and latencies of LUTSEPs (P1, N1, P2) and pudendal SEPs (P40, N50, P65, N85) correspond well to results of previous studies (Gregorini et al 2015 , 2013 ; Knüpfer et al 2018 ; Pelliccioni et al 2014 ).…”

Section: Discussionsupporting

confidence: 86%

“…In accordance with our hypothesis and the bipolar recording, decreasing map strength was observed for higher stimulation frequencies with significantly lower amplitudes over the central areas for N1 and P2. Following our previous publications on bipolar LUTSEPs, lower stimulation frequencies might be more suitable for stimulation of the LUT slow fibers while higher frequencies might lead to fiber refractoriness (Gregorini et al 2015 , 2013 ; Knüpfer et al 2018 ; van der Lely et al 2019b ). The observed alterations in scalp topographical distribution across conditions could be based on two causes.…”

Section: Discussionmentioning

confidence: 81%

“…Previous studies of our group showed that stimulation at a relatively slow frequency of 0.5 Hz led to more reproducible cortical SEPs in contrast to faster frequencies (Gregorini et al 2013 ; Knüpfer et al 2018 ; van der Lely et al 2019b ). In addition to age, gender, body weight, and body height, also different stimulation parameters and urine production during stimulation should be considered for LUTSEP analysis (Gerstenberg et al 1991 ; Knüpfer et al 2018 ; van der Lely et al 2019a ).…”

Section: Introductionmentioning

confidence: 77%

“…While tibial and pudendal nerve stimulation are well established in clinical practice, the measurement of SEPs in response to repetitive electrical stimulation of the LUT has not yet progressed so far. The latter, however, has proven feasible in healthy subjects (Ganzer et al 1991 ; Gerstenberg et al 1991 ; Gregorini et al 2015 , 2013 ; Knüpfer et al 2018 ) and patients (Hansen et al 1989 ; Sarica et al 1996 ) with location-specific lower urinary tract sensory evoked potential (LUTSEP) latencies and amplitudes. Previous studies of our group showed that stimulation at a relatively slow frequency of 0.5 Hz led to more reproducible cortical SEPs in contrast to faster frequencies (Gregorini et al 2013 ; Knüpfer et al 2018 ; van der Lely et al 2019b ).…”

Section: Introductionmentioning

confidence: 99%

“…The latter, however, has proven feasible in healthy subjects (Ganzer et al 1991 ; Gerstenberg et al 1991 ; Gregorini et al 2015 , 2013 ; Knüpfer et al 2018 ) and patients (Hansen et al 1989 ; Sarica et al 1996 ) with location-specific lower urinary tract sensory evoked potential (LUTSEP) latencies and amplitudes. Previous studies of our group showed that stimulation at a relatively slow frequency of 0.5 Hz led to more reproducible cortical SEPs in contrast to faster frequencies (Gregorini et al 2013 ; Knüpfer et al 2018 ; van der Lely et al 2019b ). In addition to age, gender, body weight, and body height, also different stimulation parameters and urine production during stimulation should be considered for LUTSEP analysis (Gerstenberg et al 1991 ; Knüpfer et al 2018 ; van der Lely et al 2019a ).…”

Section: Introductionmentioning

confidence: 99%

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Scalp Topography of Lower Urinary Tract Sensory Evoked Potentials

et al. 2020

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Impaired lower urinary tract (LUT) afferents often cause LUT symptoms. Assessment of LUT afferent pathways is possible using bipolar cortical sensory evoked potential (SEP) recordings with the active electrode at the vertex during electrical stimulation in the LUT. This study aimed to investigate the topographical distribution and microstates of lower urinary tract sensory evoked potentials (LUTSEPs) using different stimulation frequencies. Ninety healthy subjects (18–36 years old, 40 women) were randomly assigned to one of five stimulation locations [bladder dome; trigone; proximal, membranous (men only) or distal urethra]. Cycles of 0.5 Hz/1.1 Hz/1.6 Hz electrical stimulation were applied using a custom-made catheter. Cortical activity was recorded from 64 surface electrodes. Marker setting was performed manually on an individual subject-level for the P1, N1, and P2 components of vertex recordings. N1 and P2 topographies presented with central negativities and positivities around the vertex. Regarding topographical distribution, Randomization Graphical User interface (RAGU) analyses revealed consistent frequency effects and microstates for N1/P2. Higher stimulation frequencies resulted in decreasing map strength for P1, N1, and P2. LUTSEP topographies suggest central generators in the somatosensory cortex, which are not detectable in a bipolar set-up. The observed frequency effect indicates fiber refractoriness at higher frequencies. The multichannel approach allows more comprehensive assessment of LUTSEPs and might therefore be sensitive to pathological changes. Examinations in patients with LUT symptoms are needed to further investigate this biomarker.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Scalp Topography of Lower Urinary Tract Sensory Evoked Potentials

et al. 2020

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Quantitative electrical pain threshold assessment in the lower urinary tract

Lely

Liechti

Bachmann

et al. 2019

Neurourology and Urodynamics

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Aims: Assessing the reliability of electrical pain threshold (PT) and evaluating the impact of stimulation frequency at different locations in the healthy lower urinary tract (LUT). Methods: Ninety subjects (age: 18.3-35.8 years, 40 females, 50 males) were randomly allocated to one stimulation site (bladder dome [BD], trigone, proximal, membranous (only males), or distal urethra). Using 0.5 Hz/1.1 Hz/ 1.6 Hz electrical stimulation (square wave, pulse width:1 ms), current perception thresholds (CPTs), PTs and tolerance thresholds were assessed at two visits. Analyses were performed using linear mixed models, intraclass correlation coefficients (ICC) and Bland-Altman method.Results: PTs vary in relation to stimulation frequency, location and between genders. PT decreased with higher stimulation frequency. The highest PTs were measured at the BD and membranous urethra with males reporting higher PTs than females. Reliability of PT assessments according to ICC was good to excellent across all frequencies, locations, and genders (ICC = 0.61-0.97), except for BD and distal urethra in females showing poor to fair reliability (BD: all frequencies, distal urethra: 0.5 Hz).Conclusions: PTs can be safely and reliably assessed from bladder and urethral locations. Semi-objective PT assessment may provide additional information on functionality and sensitivity of the LUT slow fiber afferents and complement findings from urodynamic investigations and CPT assessments. In conclusion, the developed methodology may open new opportunities for using electrical stimulation paradigms for LUT PT assessments and diagnostics. All this allows a more precise, location-specific characterization of pain origin and pain reaction towards therapy. K E Y W O R D S afferent nerve fibers, electrical stimulation, humans, lower urinary tract, neurophysiology, pain threshold Stéphanie van der Lely and Martina D. Liechti shared the firstauthorship.

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Systematic Evaluation of Lower Urinary Tract Sensations to Improve Management of LUTS: ICI‐RS 2024

de Rijk,

Hentzen,

Selai

et al. 2024

Neurourology and Urodynamics

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AimsLower urinary tract (LUT) sensations form an essential part of diagnostic criteria for many LUT symptoms, additionally LUT sensations are used to evaluate the effectivity of therapeutic interventions. The accurate measurement of LUT sensations, however, is severely hampered by the subjective nature of these sensations.MethodsThis paper summarizes the discussions from the 2024 meeting of the International Consultation for Incontinence‐Research Society (ICI‐RS 2024) regarding systematic evaluations of LUT sensations and the design of more objective tools to measure these.ResultsHere, we discuss factors that influence sensations that are under the control of the caregiver/investigator, the signaling of sensations from the LUT toward the central nervous system, and currently used diagnostic tools to measure LUT sensations. Recent methodological advances to objectively measure factors that correspond with changes in LUT sensations are introduced along with recommendations for future research to optimally enable objective assessment of processes underlying LUT sensations.ConclusionsAdvancing the objective measurement of LUT sensations will require interdisciplinary collaboration, integrating insights from neuroscience, engineering, and clinical practice. Such efforts hold the potential to transform patient care by enabling more precise diagnostics and personalized therapeutic strategies.

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Sensory evoked cortical potentials of the lower urinary tract in healthy men

Cited by 8 publications

References 25 publications

Scalp Topography of Lower Urinary Tract Sensory Evoked Potentials

Scalp Topography of Lower Urinary Tract Sensory Evoked Potentials

Quantitative electrical pain threshold assessment in the lower urinary tract

Systematic Evaluation of Lower Urinary Tract Sensations to Improve Management of LUTS: ICI‐RS 2024

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