ABSTRACT
Stimulation of the phrenic nerve by applying an electrical impulse to the neck during fluoroscopy or real-time ultrasound (sonoscopy) of the diaphragm allows more precise functional evaluation than fluoroscopy and/or sonoscopy alone. This is especially true of patients who are unable to cooperate because they are on a ventilator, unconscious, or very young. The authors cite cases in which diaphragmatic paralysis was diagnosed by conventional methods but stimulation of the phrenic nerve demonstrated good diaphragmatic motion, leading to a change in prognosis in some cases and a change in therapy in others.
Subject(s)
Electric Stimulation , Phrenic Nerve , Respiratory Paralysis/diagnosis , Adult , Female , Fluoroscopy , Humans , Infant , Infant, Newborn , Male , Respiratory Paralysis/diagnostic imaging , Respiratory Paralysis/physiopathology , UltrasonographyABSTRACT
Bulbocavernosus reflex was evaluated clinically in 299 patients during a routine urodynamic evaluation and compared to the electromyographic demonstration of the reflex. The findings were correlated with the neurologic status of the patients. There were 127 patients who were normal neurologically, and 98 per cent of the male and 81 per cent of the female patients in this group had a normal bulbocavernosus reflex clinically. All of the male and 92 per cent of the female patients had a bulbocavernosus reflex demonstrated by electromyography. There were 73 patients with neurologic lesions involving the sacral spinal cord. All patients with a complete lesion had absent bulbocavernosus reflexes clinically and on electromyography, while 44 per cent of the patients with incomplete sacral lesions had an intact bulbocavernosus reflex clinically and 78 per cent had reflex demonstrated by electromyography. There were 99 patients with neurologic lesions of the spinal cord above the sacral outflow, and 90 per cent of this group had demonstrable bulbocavernosus reflexes clinically and 93 per cent had the reflex demonstrated by electromyography. It is concluded that the absence of a bulbocavernosus reflex in a male patient is indicative of a neurologic lesion involving the sacral spinal cord and is highly suggestive of such a lesion in a female patient. The presence of a normal bulbocavernosus reflex in either sex does not rule out the possibility of a significant lesion. The electromyographic demonstration of the bulbocavernosus reflex is more sensitive than the clinical one.
Subject(s)
Pelvis/innervation , Reflex , Spinal Cord Diseases/diagnosis , Adolescent , Adult , Aged , Child , Child, Preschool , Electromyography , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
Detrusor-external sphincter dyssynergia is characterized by involuntary contractions of the external urethral sphincter during detrusor contractions. A review of 550 consecutive patients who underwent urodynamic evaluation revealed that this condition was found only in patients who had involuntary detrusor contractions owing to well defined neurologic lesions of the suprasacral spinal cord. All patients with supracervical neurologic lesions had synergistic voiding patterns. We conclude that bladder-external sphincter dyssynergia is a neurologic condition owing to interruption of the spinal pathways connecting the pontine mesencephalic and the sacral micturition centers. In the absence of such a neurologic lesion one should be extremely cautious in making this diagnosis.
Subject(s)
Muscle Contraction , Urethra/physiopathology , Urinary Bladder, Neurogenic/physiopathology , Adolescent , Adult , Aged , Child , Child, Preschool , Electromyography , Female , Humans , Male , Middle Aged , Spinal Cord Diseases/diagnosis , Spinal Cord Diseases/physiopathology , UrodynamicsABSTRACT
We reviewed 54 cases of detrusor-external sphincter dyssynergia following complete urodynamic evaluations. All patients had well defined neurologic lesions of the suprasacral spinal cord. On the basis of urodynamic findings 3 types of dyssynergia were encountered: type 1 (30 per cent) was characterized by a crescendo increase in electromyographic activity that reached a maximum at the peak of the detrusor contraction, type 2 (15 per cent) consisted of clonic sphincter contractions interspersed throughout the detrusor contraction and type 3 (55 per cent) was characterized by a sustained sphincter contraction that coincided with the detrusor contraction. There was no correlation between the clinical neurologic level and the type of dyssynergia.
Subject(s)
Muscle Contraction , Urethra/physiopathology , Urinary Bladder, Neurogenic/physiopathology , Action Potentials , Adolescent , Adult , Child , Child, Preschool , Electromyography , Female , Humans , Male , Middle Aged , Spinal Cord Diseases/physiopathology , Urinary Bladder, Neurogenic/diagnosisABSTRACT
A thorough diagnostic evaluation was done on 27 impotent men. In addition to a detailed history and physical examination each patient underwent a psychiatric interview, Doppler penile blood pressure determination and measurement of the bulbocavernosus reflex latency time. Abnormalities in penile blood pressure were detected in 67 per cent of the patients, neurologic abnormalities were found in 41 per cent and psychiatric disorders were noted in 35 per cent. Of the 27 patients 48 per cent had a combination of neurologic, psychiatric and vascular abnormalities. A definite cause-and-effect relationship between these abnormalities and impotence has not been established.
Subject(s)
Erectile Dysfunction/diagnosis , Doppler Effect , Erectile Dysfunction/etiology , Erectile Dysfunction/psychology , Humans , Male , Penis/blood supply , Penis/innervationABSTRACT
We studied 42 patients with urinary incontinence who demonstrated uninhibited detrusor contractions during cystometry. Each patient underwent urodynamic evaluation before and after the parenteral administration of propantheline bromide. Of these 42 patients 33 (79 per cent) had a positive response to propantheline: total abolition of uninhibited bladder contractions or 200 per cent increase in bladder capacity. Of these 33 patients 26 were treated with the oral drug and all but 1 had complete clinical response. Urinary retention occurred in half of the patients. These patients were managed with intermittent self-catheterization in addition to oral propantheline. None of the patients who failed to respond to the parenteral medication had a favorable response to the orally administered drug.
Subject(s)
Propantheline/therapeutic use , Urinary Incontinence/drug therapy , Administration, Oral , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Propantheline/administration & dosage , Urodynamics/drug effectsABSTRACT
A total of 33 patients who demonstrated detrusor areflexia during cystometry underwent the bethanechol denervation supersensitivity test. In each instance the presence or absence of a neurologic lesion was documented carefully by complete neurologic evaluation. Of the 21 patients with a neurogenic bladder there was a falsely negative rate of 24 per cent. Of the 12 patients without a neurogenic bladder the falsely positive rate was 50 per cent. It is concluded that a positive bethanechol test is not by itself indicative of neurogenic bladder nor does a negative test exclude this diagnosis.
Subject(s)
Bethanechol Compounds , Urinary Bladder Diseases/diagnosis , Urinary Bladder, Neurogenic/diagnosis , Adult , Aged , Diagnosis, Differential , Diagnostic Errors , Female , Humans , Male , Middle AgedABSTRACT
Urodynamic evaluation was done 45 times on 41 consecutive patients with multiple sclerosis. Bladder symptoms correlated poorly with any single urodynamic finding and, accordingly, a comprehensive evaluation was necessary to define the underlying pathophysiology. Only 63 per cent of the patients with symptoms of urgency, frequency and urge incontinence actually were found to have uninhibited bladder contractions, while 73 per cent of the patients with obstructive symptoms had detrusor areflexia. Six patients (15 per cent) had a marked change in urodynamic findings upon repeat examination either because of a change in symptomatology or poor response to treatment. An additional 6 patients had vesicoureteral reflux. Bladder symptoms in multiple sclerosis patients should serve more to alert the clinician to the need for urodynamic testing than to mandate specific treatment.
Subject(s)
Multiple Sclerosis/physiopathology , Urethra/physiopathology , Urinary Bladder/physiopathology , Urodynamics , Urologic Diseases/physiopathology , Adult , Aged , Electromyography , Female , Humans , Male , Middle Aged , Multiple Sclerosis/complications , Pressure , Prospective Studies , Urinary Bladder Diseases/etiology , Urinary Bladder Diseases/physiopathology , Urologic Diseases/etiology , Vesico-Ureteral Reflux/etiology , Vesico-Ureteral Reflux/physiopathologyABSTRACT
The use of urodynamic evaluation as a diagnostic tool for evaluating subtle neurologic lesions involving the second, third, and fourth segments of the sacral spinal cord is redefined. Six illustrative cases are presented.
Subject(s)
Spinal Cord Diseases/diagnosis , Urodynamics , Adolescent , Adult , Arteriovenous Malformations/diagnosis , Female , Humans , Infant , Male , Meningeal Neoplasms/diagnosis , Meningioma/diagnosis , Middle Aged , Spinal Cord Compression/diagnosis , Spinal Cord Neoplasms/diagnosisABSTRACT
Twenty-two boys with myelodysplasia and incontinence were evaluated urodynamically. Three types of bladder function were noted, but each could not be correlated with any particular neuroligic level. The integrity of the external sphincter innervation was determined by electomyographic monitoring of periurethral striated muscle. Bladder sphincter dyssynergia was found in one of the boys with voluntary control, five with involuntary bladder contractions, and five with adynamic bladders who voided by Credé's method. A radiologically narrow external sphincter on voiding cystography could only be correlated with the bioelectric activity in children with dyssynergia. A narrow sphincter was also noted in three children with synergy and four with complete lower motor neuron lesions. Marked fibrosis was found to be the cause of narrowing of external sphincter area in these boys. Thus, urodynamic evaluation helped define the etiology of outlet obstruction when it was present in the boy with myelodysplasia. A classification of bladder sphincter function is proposed.
Subject(s)
Meningocele/physiopathology , Meningomyelocele/physiopathology , Urinary Bladder, Neurogenic/physiopathology , Urinary Incontinence/physiopathology , Urodynamics , Adolescent , Child , Evaluation Studies as Topic , Female , Humans , Infant , Male , Spinal Cord/abnormalities , Urethra/innervation , Urethra/physiopathology , Urinary Bladder/innervation , Urinary Bladder/physiopathologyABSTRACT
Sixteen women underwent complete urodynamic investigation of acute urinary retention. Simultaneous recordings of intravesical and rectal pressures allowed an easy distinction to be made between bladder contractions and abdominal straining. Needle electromyograms, viewed on an oscilloscope by an experienced electromyographer, permitted an exacting neurologic diagnosis. Although the cause was psychogenic in 7 patients, 9 others had subtle evidence of organic pathology, one of whom had a spinal cord tumor. A logical format for evaluating acute urinary retention is presented.
