阴茎海绵体反射的预测价值。

Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia.

Neurourol Urodyn. 2009;28(5):390-4. doi: 10.1002/nau.20661.

AIMS

To determine the predictive values and specificity of clinical and neurophysiologic testing of the penilo-cavernosus reflex.

METHODS

A group of 22 control men and a group of 53 men with chronic cauda equina lesions (patients) were studied. The penilo-cavernosus reflex was elicited clinically and measured neurophysiologically using single and double electrical stimulation. The sensory threshold, reflex threshold and stimulation strength in all controls, and latency of the response in all subjects, were compared to reference intervals. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios of the penilo-cavernosus reflex testing were calculated.

RESULTS

Sensitivity of the penilo-cavernosus reflex was 72-83% and 81-83%, specificity 52-57% and 90-91%, positive predictive value 83-97% and 95-96%, negative predictive value 52-57% and 66-68%, and likelihood ratios 1.9-2.8 and 8.3-9.0 for clinical (circumcised subjects: included/excluded; reflex pathologic when diminished/non-elicitable) and neurophysiologic testing (using three stimulation modalities), respectively. Specificities of the sensory threshold, reflex threshold and stimulation strength were approximately 90% or higher.

CONCLUSIONS

The present study demonstrated higher specificity, predictive values and likelihood ratios of neurophysiologic testing of the penilo-cavernosus reflex compared to clinical testing. The results support the use of clinical penilo-cavernosus reflex testing as an addition to bladder emptying difficulties and saddle sensory loss as criteria for patient referral for uro-neurophysiologic examination, and measurement of the reflex as a valuable part of such testing. Neurourol. Urodynam. 28:390-394, 2009. (c) 2008 Wiley-Liss, Inc.

目的

确定阴茎海绵体反射的临床及神经生理学检测的预测价值和特异性。

方法

对22名对照男性和53名患有慢性马尾神经损伤的男性（患者）进行研究。通过临床方法引出阴茎海绵体反射，并使用单电刺激和双电刺激进行神经生理学测量。将所有对照者的感觉阈值、反射阈值和刺激强度，以及所有受试者的反应潜伏期与参考区间进行比较。计算阴茎海绵体反射检测的敏感性、特异性、阳性和阴性预测值以及似然比。

结果

阴茎海绵体反射的敏感性在临床检测中（环切受试者：纳入/排除；反射减弱/未引出时为病理性反射）为72% - 83%和81% - 83%，特异性为52% - 57%和90% - 91%，阳性预测值为83% - 97%和95% - 96%，阴性预测值为52% - 57%和66% - 68%，似然比分别为1.9 - 2.8和8.3 - 9.0；在神经生理学检测中（使用三种刺激方式）。感觉阈值、反射阈值和刺激强度的特异性约为90%或更高。

结论

本研究表明，与临床检测相比，阴茎海绵体反射的神经生理学检测具有更高的特异性、预测值和似然比。结果支持将临床阴茎海绵体反射检测作为膀胱排空困难和鞍区感觉丧失之外的补充标准，用于患者转诊进行尿神经生理学检查，并且该反射的测量是此类检测的重要组成部分。《神经泌尿学与尿动力学》28:390 - 394，2009年。（c）2008威利 - 利斯公司。