Cortical Evoked Potentials Obtained After Stimulation of the Lower Urinary Tract

Abstract Purpose of Review The role of pelvic neurophysiology testing in the evaluation of patients with lower urinary tract (LUT) symptoms is explored in this review. Recent Findings Different neurophysiology tests such as sphincter EMG and pudendal somatosensory evoked potentials are useful in evaluating the sacral somatic afferent and efferent innervation. S2 and S3 dermatomal evoked potentials assess individual sacral roots and are feasible to perform using standard neurophysiology machines. Summary The innervation of the LUT has a substantial contribution from splanchnic and somatic nerves arising from the sacral segments. Pelvic neurophysiology tests, which assess somatic nerve functions, are therefore a useful tool in assessing sacral nerve functions in patients presenting with unexplained voiding dysfunction. In this review, the commonly performed neurophysiology studies that assess the S2, S3 and S4 sacral afferent and efferent pathways are outlined, and their clinical applications reviewed.

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Cerebral potentials and bulbocavernosus reflex to stimulation of the lower urinary tract in diabetics

Electroencephalography and Clinical Neurophysiology ◽

10.1016/0013-4694(91)90332-x ◽

1991 ◽

Vol 79 (5) ◽

pp. S27

Keyword(s):

Urinary Tract ◽

Lower Urinary Tract ◽

Bulbocavernosus Reflex ◽

Stimulation Of ◽

Lower Urinary

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Stimulation of the pelvic nerve increases bladder capacity in the prostaglandin E2 rat model of overactive bladder

AJP Renal Physiology ◽

10.1152/ajprenal.00116.2017 ◽

2017 ◽

Vol 313 (3) ◽

pp. F657-F665 ◽

Cited By ~ 9

Author(s):

Christopher L. Langdale ◽

James A. Hokanson ◽

Arun Sridhar ◽

Warren M. Grill

Keyword(s):

Urinary Tract ◽

Overactive Bladder ◽

Rat Model ◽

Lower Urinary Tract ◽

Bladder Capacity ◽

Pelvic Nerve ◽

Lower Urinary Tract Function ◽

Tract Function ◽

Stimulation Of ◽

Lower Urinary

Overactive bladder (OAB) syndrome is a highly prevalent condition that may lead to medical complications and decreased quality of life. Emerging therapies focusing on selective electrical stimulation of peripheral nerves associated with lower urinary tract function may provide improved efficacy and reduced side effects compared with sacral neuromodulation for the treatment of OAB symptoms. Prior studies investigating the effects of pelvic nerve (PelN) stimulation on lower urinary tract function were focused on promoting bladder contractions, and it is unclear whether selective stimulation of the PelN would be beneficial for the treatment of OAB. Therefore our motivation was to test the hypothesis that PelN stimulation would increase bladder capacity in the prostaglandin E2 (PGE2) rat model of OAB. Cystometry experiments were conducted in 17 urethane-anesthetized female Sprague-Dawley rats. The effects of intravesical PGE2 vs. vehicle and PelN stimulation after intravesical PGE2 on cystometric parameters were quantified. Intravesical infusion of PGE2 resulted in decreased bladder capacity and increased voiding efficiency without a change in bladder contraction area under the curve, maximum contraction pressure, or contraction duration. Bladder capacity was also significantly decreased compared with vehicle (1% ethanol in saline) confirming that the change in bladder capacity was mediated by PGE2. PelN stimulation reversed the PGE2-induced change in bladder capacity and increased the external urethral sphincter electromyogram activity at a specific stimulation condition (amplitude of 1.0 times threshold at 10 Hz). These results confirm that the urodynamic changes reported in conscious rats are also observed under urethane anesthesia and that PelN stimulation is a novel and promising approach for the treatment of the symptoms of OAB.

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