Advertisement

The Neurophysiological Testing

  • Giorgio Selvaggio
  • Roberto Cordella
Chapter
Part of the Urodynamics, Neurourology and Pelvic Floor Dysfunctions book series (UNPFD)

Abstract

Neurophysiological testing has an important role in the evaluation of patients affected by neurogenic or dysfunctional bladder. The tests present limits related to age and child compliance. Despite the utility the tests are not used routinely. Electromyography (EMG), somatosensory evoked potential (SSEP), and bulbocavernous reflex represent classic neurophysiological testing. The EMG should be used during cystometry, pressure/flow study, and noninvasive urodynamic study. In pediatric age it is registered in almost all of the patients through surface electrode. The study could be used to detect either detrusor sphincter dyssynergia in neurological patients or dyscoordination in functional patients. The SSEP provides information of the afferent conduction pathway from the peripheral nerves to the spinal cord and sensory cortex in response to electric stimuli at peripheral site. No relevant information is present in the literature regarding pudendal stimulation in pediatric age. The posterior tibial nerve SSEP is widely used, and it is a sensitive indicator of neurophysiological deterioration due to ischemia of the spinal cord in tethered cord. The bulbocavernous reflex (BCR) reflects the functional integrity of sacral sensory and motor nerve fibers and spinal segments, specifically from the second (S2) to the fourth sacral segment (S4). The integrity of this reflex arc can be clinically investigated by means of gentle squeezing the glans penis or the clitoris, evoking responses from the pelvic floor muscles, including the external anal sphincter. BCR has been also evoked through electrical stimulation, but limits related to the compliance of very young children for BCR need to be mentioned.

Keywords

Neurophysiological testing Urodynamic study Neuro-urology Electromyography Nerve somatosensory evoked potentials Bulbocavernous reflex Occult spina bifida Tethered cord Neurogenic bladder Lower urinary tract symptoms 

References

  1. 1.
    Blaivas JG, Sinha HP, Zayed AA, Labib KB. Detrusor-external sphincter dyssinergia: a detailed electromyiographic study. JUrol. 1981;125(4):545–8.Google Scholar
  2. 2.
    Van Batavia JP, Combs AJ, Hyun G, Bayer A, Medina-Kreppein D, Schlussel RN, Glassberg KI. Simplifying the diagnosis of 4 common voiding conditions using uroflow/electromyography, electromyography lag time and voiding history. J Urol. 2011;186(4 Suppl):1721–6.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Faasse MA, Nosnik IP, Diaz-Saldano D, Hodgkins KS, Liu DB, Schreiber J, Yerkers EB. Uro-flowmetry with pelvic floor electromyography: inter-rater agreement on diagnosis of pediatric non neurogenic voiding disorders. J Pediatr Urol. 2015;11(4):198.e1–6.CrossRefGoogle Scholar
  4. 4.
    Opsomer RJ, Guerit JM, Wese FX, Van Cangh PJ. Pudendal cortical somatosensory evoked potentials. J Urol. 1986;135:1216–8.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Vodusek DB. Evoked potential testing. Urol Clin North Am. 1996;23:427–46.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Cavalcanti GA, Bruschini H, Manzano GM, Nunes KF, Giuliano LM, Nobrega JA, Srougi M. Pudendal somatosensory evoked potentials in normal women. Int Braz J Urol. 2007;33(6):815–21.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kale SS, Mahapatra K. The role of somatosensory evoked potentials in spinal dysraphism-do they have a prognostic significance? Childs Nerv Syst. 1998;4(7):325–30.Google Scholar
  8. 8.
    Pang D. Tethered cord syndrome: newer concepts. In: Wilkins RH, Rengachary SS, editors. Neurosurgery update. New York: McGraw-Hill; 1991. p. 336–44.Google Scholar
  9. 9.
    Polo A, Zanette G, Manganotti P, Bertolasi L, De Grandis D, Rizzuto N. Spinal somatosensory evoked potentials in patients with tethered cord syndrome. Can J Neurol Sci. 1994;21(4):325–30.CrossRefPubMedGoogle Scholar
  10. 10.
    Sala F, Squintani G, Tramontano V, Arcaro C, Faccioli F, Mazza C. Intraoperative neuro physiology in tethered cord surgery: techniques and results. Childs Nerv Syst. 2013;29:1611–24.CrossRefPubMedGoogle Scholar
  11. 11.
    Valentini LG, Selvaggio G, Erbetta A, Cordella R, Pecoraro MG, Bova S, Boni E, Beretta E, Furlanetto M. Occult spinal dysraphism: lessons learned by retrospective analysis of 149 surgical cases about natural history, surgical indications, urodynamic testing, and intraoperative. Childs Nerv Syst. 2013;29:1657–69.CrossRefPubMedGoogle Scholar
  12. 12.
    Niu X, Wang X, Ni P, Huang H, Zhang Y, Lin Y, Chen X, Teng H, Shao B. Bulbocavernosus reflex and pudendal nerve somatosensory evoked potential are valuable for the diagnosis of cauda equina syndrome in male patients. Int J Clin Exp Med. 2015;8(1):1162–7.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Podnar S. Predictive value of the Penilo-Cavernosus reflex. Neurourol Urodyn. 2009;28:390–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Pedersen E, Harving H, Klemar B, Torring J. Human Anal Reflexes. J Neurol Neurosurg Psychiatry. 1978;41:813–8.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Pediatric SurgeryChildren’s Hospital “V.Buzzi”MilanItaly
  2. 2.Department of NeurosurgeryFondazione IRCCS Istituto Neurologico “Carlo Besta”MilanItaly

Personalised recommendations