Kaiser T, Jost W H, Osterhage J, Derouet H, Schimrigk K
Neurologische Klinik der Universität des Saarlandes, Homburg Saar, Germany.
Int J Impot Res. 2001 Apr;13(2):89-92. doi: 10.1038/sj.ijir.3900520.
Neurophysiologic examinations in differential diagnosis of erectile dysfunction comprise electromyogramme of the pelvic floor, pudendal nerve terminal motor latency (PNTML) and evaluation of pudendal somatosensory evoked potentials (SSEP). We focused our interest on comparing diagnostic importance of penile and perianal pudendal nerve SSEP. We examined 20 patients suffering from erectile dysfunction and 20 patients without any manifestation of impotence. The stimulus was administered using penile ring electrodes at the base of the penis (cathode) and distally on the penis shaft (anode), as well as a perianal surface electrode applied at 3 o'clock in lithotomy position and 5 cm laterally on the gluteal skin. The potentials were recorded with intradermal needle electrodes at C(z)-2 cm (different) and F(z) (indifferent). 500 stimuli were averaged for a single tracing. The stimulus strength was set at an average of 3-4 times the stimulus threshold. Cortical latency of P 40 ranged from 39.0 to 45.6 ms (penile) and from 33.6 to 43.2 ms (perianal) in the control group, in the patient group latencies ranged from 38.8 to 51.6 (penile) and 34.0 to 44.8 ms (perianal). In two patients no potential was recordable after perianal stimulation, one patient showed a marked prolongation of the penile response with a normal perianal latency. Penile and perianal latencies of P 40 were significantly prolonged in the patient group compared to the control group (P<0.05). The combination of penile and perianal pudendal SSEP may provide valuable additional information in differential diagnosis of erectile dysfunction, especially allowing to identify different sites of neurogenic lesions. In contrast to perianal pudendal SSEP, penile stimulation may help to discover pathologic changes in the distal course of the pudendal nerve, especially the dorsal nerve of the penis.
用于勃起功能障碍鉴别诊断的神经生理学检查包括盆底肌电图、阴部神经终末运动潜伏期（PNTML）以及阴部躯体感觉诱发电位（SSEP）评估。我们重点关注比较阴茎和肛周阴部神经SSEP的诊断重要性。我们检查了20例勃起功能障碍患者和20例无阳痿表现的患者。刺激通过阴茎根部的环形电极（阴极）和阴茎体远端的电极（阳极）施加，以及在截石位3点位置和臀侧皮肤外侧5厘米处施加肛周表面电极。使用皮内针电极在C（z）-2厘米（不同）和F（z）（无关）处记录电位。单次描记平均500次刺激。刺激强度设定为平均刺激阈值的3 - 4倍。对照组中P40的皮层潜伏期在阴茎刺激时为39.0至45.6毫秒，在肛周刺激时为33.6至43.2毫秒；患者组中潜伏期在阴茎刺激时为38.8至51.6毫秒，在肛周刺激时为34.0至44.8毫秒。两名患者在肛周刺激后无电位可记录，一名患者阴茎反应明显延长而肛周潜伏期正常。与对照组相比，患者组中阴茎和肛周P40潜伏期显著延长（P<0.05）。阴茎和肛周阴部SSEP联合检查在勃起功能障碍的鉴别诊断中可能提供有价值的额外信息，尤其有助于识别神经源性病变的不同部位。与肛周阴部SSEP不同，阴茎刺激可能有助于发现阴部神经远端尤其是阴茎背神经的病理变化。
