|The lower urinary tract function relies on neural control. Micturition is controlled by neural circuits in the brain and spinal cord that coordinate the activity of the smooth muscle in the bladder and striated muscle in the urethra.In the diagnosis of micturition and pelvic floor disorders, common urodynamic, pelvic floor and anorectal investigations are more and more combined with studies to investigate neurological abnormalities. Neurological studies can greatly improve the quality of the diagnosis.The integrity of the neural circuit can be tested by clinical examination:
Free Run EMG
Free Run or Kinesiology EMG: Sphincter electromyo-graphy (EMG) is the recording of electrical potentials generated by depolarization of the striated muscles involved in the active continence mechanism. The method yields information on the voluntary control of the sphincter muscles and the coordination between the detrusor and the sphincter apparatus during bladder filling and during micturition.
Sphincter EMG may be used for recording of the activity in the urethral striated sphincter, the anal sphincter or the pelvic floor muscles – or all sphincters simultaneously. Routine EMG as part of urodynamic studies usually employs 1 or 2 channels for recording from the urethral and/or anal sphincter muscle. Furthermore Free Run EMG offers excellent functionality to measure Corpus Cavernosum EMG (ccEMG).
Motor Nerve Conduction
The purpose of the Motor Nerve Conduction test is to measure the nerve conduction velocity of the dorsal nerve of the penis. To make this recording, the dorsal nerve of the penis is stimulated on the dorsum of the glans penis. Recording takes place on the dorsum of the penis and at its base. The distance between the recording electrodes is divided by the difference in the latency between the dorsal and the base response to calculate conduction velocity.
Pudendal Nerve Stimulation
Pudendal Nerve Stimulation (PNS) or Pudendal Nerve Terminal Motor Latency (PNTML) has diagnostic and prognostic value in the care of patients with fecal incontinence and in other patients with pelvic floor dysfunction in whom it is important to identify and quantify the nature of neuromuscular injury.
PNS is a common and simple study that measures the latency through a direct reflex between stimulator site and recording site. The St. Marks probe is used for latency measurement between stimulator site and recording site (anal sphincter). Pudendal nerve conduction measures the reflex via the brain.
PNS can also be used for urinary incontinence studies when the sphincter is stretched after childbirth.
The Sacral Reflex or Bulbo Cavernosum Reflex program offers stimulation of the dorsal nerve of the penis or clitoris and records reflexes via the brain taken from pelvic floor muscles structures. The latency from stimulation to response is measured. The Sacral Reflex can also be used for measurement of Vesico-Urethral or Vesico-Anal Reflexes and Anal Sphincter responses.
The Sensory Threshold* program offers stimulation only. It gives you a visual detection of the reaction on a stimulus on penis, clitoris or vesical impulse.