Aims: Sacral neurophysiologic studies have demonstrated their utility in men with suspected neurogenic sacral dysfunction. However, no similar studies have been performed in women. The present study aimed to test the utility of sacral neurophysiologic assessment in women with chronic cauda equina lesions. Methods: Twenty-four women with clinical and radiological signs supportive of chronic cauda equina lesions, and a group of 60 control women without clinical symptoms or signs of sacral neuropathic lesion were included. Clinical examination, including testing of saddle sensation, and neurophysiologic testing, including quantitative anal sphincterEMGand clitoro-cavernosus reflex testing (on single and double electrical, and mechanical stimulation), were performed on each side separately. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Results: Respective sensitivities, specificities, positive predictive values, and negative predictive values were 63%, 92%, 83%, and 86% for quantitative anal sphincter EMG, 92%96%, 67%80%, 52%59%, and 95%96% for neurophysiologic testing of the clitoro-cavernosus reflex (using different stimulation techniques), and 96%100%, 62%75%, 50%55%, and 97%98% for their combinations. Conclusions: This study complements previous reports in men supporting the clinical utility of an neurophysiologic protocol that includes both quantitative anal sphincter EMG and sacral reflex studies for assessment of patients with suspected peripheral sacral lesions. Very high sensitivity and negative predictive value confirm high utility of sacral neurophysiologic studies in confirmation and exclusion of sacral neuropathic lesion.
COBISS.SI-ID: 1380268
Aims In several degenerative neurologic diseases degeneration of Onuf's nucleus has been demonstrated using histologic and electromyographic (EMG) methods. Although Huntington's disease (HD) patients also frequently complain of bladder and bowel symptoms, degeneration of Onuf's nucleus has not been systematically studied in this group. Methods From our inventory of patients with genetically confirmed HD, all patients willing and capable of participating in the study, which utilized several standard questionnaires, were included. The patients reporting bladder/bowel symptoms were also asked to participate in anal sphincter EMG and sacral reflex studies. Results Of 52 patients (23 men) with genetically confirmed HD, 34 reported bladder/bowel symptoms, and 16 (8 men) of them consented to anal sphincter EMG and sacral reflex studies. Complete pattern of urinary and fecal urgency with incontinence reported 6 (38%), and incomplete 3 (19%) patients, accompanied with episodic diarrhea in another 3 (19%) patients. No patient exhibited quantitative anal sphincter EMG or sacral reflex abnormalities. However, in 81% of patients, decreased tonic anal sphincter activity and/or decreased voluntary activation were found on qualitative EMG. Lower sacral sensory thresholds and shorter reflex latencies were also found in HD patients compared to controls. Conclusions We found no EMG signs of Onuf's nucleus degeneration in HD patients. The observed decreased anal sphincter tonic activity and voluntary activation, lower sacral sensory thresholds and shorter reflex latencies as well as the reported bladder/bowel symptoms, are probably caused by degeneration of other central nervous system structures.
COBISS.SI-ID: 30764761
The objective of this study was to report bladder dysfunction and cystometric findings in a systematically studied cohort of Huntington’s disease (HD) patients. In HD patients and asymptomatic HD gene carriers a urinary function questionnaire, neurologic assessment using the Unified Huntington’s Disease Rating Scale, and postvoid residual volume measurement were applied. All patients were also invited to cystometric studies. Urinary function data were compared to control men and women. The most common symptoms in 54 HD patients (24 men) were those of bladder overactivity (men/women 54 %/40 %), followed by urinary incontinence (29 %/43 %) and symptoms of disturbed bladder emptying (25 %/40 %). Using urinary function questionnaires severe bladder dysfunction was found in 4 %/0 %, moderate in 21 %/23 %, and mild in 25 %/30 % of HD men/women. Urinary symptoms interfered with daily life in 21 %/37 % and sexual life in 21 %/33 % of sexually active HD men/women. In 5 HD men and 1 woman, increased postvoid residual volume ([100 ml) was found. Compared to 49/55 control men/women urinary incontinence, and urgency were more common in HD men, but not in HD women (urinary incontinence reported 10 %/38 % of control men/women). Cystometry, performed in 12 HD patients and 1 of 10 asymptomatic HD gene carriers, demonstrated detrusor-sphincter dyssynergia in 5 (42 %), detrusor overactivity in 2 (17 %), and reduced detrusor capacity in 2 (17 %) HD patients. Our study demonstrated significant urinary symptoms in HD patients, which reduced their quality of life. Physicians helping HD patients should also consider this largely neglected aspect of the disease.
COBISS.SI-ID: 1938092