Gänzer H, Madersbacher H, Rumpl E
Division of Urology and Neurology, University Hospital, Innsbruck, Austria.
J Urol. 1991 Jul;146(1):118-23. doi: 10.1016/s0022-5347(17)37729-7.
In 21 healthy volunteers and 42 patients with either neurogenic bladder dysfunction (24), partial peripheral denervation of the bladder (12) or nonneurogenic bladder dysfunction (6) scalp-derived evoked potentials after stimulation of the vesicourethral junction (cortical evoked potentials) were recorded. In addition, evoked potentials from the posterior tibial nerve (tibial somatosensory evoked potentials) and from the pudendal nerve (pudendal somatosensory evoked potentials) were evaluated. The results obtained in normal subjects were reproducible and comparable to those reported in previous studies. Cortical evoked potentials of vesicourethral junction consisted of a prominent negativity with a mean latency of 95 msec. Tibial and pudendal somatosensory evoked potentials were similar and showed a typical W-shaped complex. In normal subjects stimulation of the vesicourethral junction was described as a stimulus-synchronous pulsation combined with a continuous burning feeling and sometimes with a desire to void. In 4 normal subjects no cortical evoked potentials of the vesicourethral junction could be obtained because of a decreased pain threshold. In regard to clinical value, the results demonstrate that in patients with lesions of the central nervous system (in the group with cauda equina and conus medullaris lesions, and in the group with suprasacral spinal cord lesions) the results of cortical evoked potentials of the vesicourethral junction and pudendal somatosensory evoked potentials widely correlate due to similar afferent nervous pathways within the central nervous system. However, in patients with partial peripheral denervation of the bladder with suspected additional secondary local detrusor damage the results of cortical evoked potentials obtained by stimulation of the vesicourethral junction differ mostly from the results of somatosensory evoked potentials obtained by stimulation of the pudendal nerve. The pattern obtained (increased sensory and pain threshold, normal cortical evoked potentials of the vesicourethral junction with normal latencies and normal or increased amplitude) is indicative of local detrusor damage. In 21 patients the ability to detect cortical evoked potentials of the vesicourethral junction was combined with the sensation of stimulus-synchronous pulsation, whereas in the other 21 patients the absence of this sensation during stimulation was combined with the absence of cortical evoked potentials. On the other hand, no correlation was found between the ability of obtaining cortical evoked potentials of the vesicourethral junction and the stimulus-induced sensation of pain and/or desire to void.(ABSTRACT TRUNCATED AT 400 WORDS)
对21名健康志愿者以及42名患有神经源性膀胱功能障碍（24例）、膀胱部分外周去神经支配（12例）或非神经源性膀胱功能障碍（6例）的患者，记录了刺激膀胱尿道连接部后的头皮诱发电位（皮质诱发电位）。此外，还评估了胫后神经诱发电位（胫后体感诱发电位）和阴部神经诱发电位（阴部体感诱发电位）。在正常受试者中获得的结果具有可重复性，且与先前研究报告的结果相当。膀胱尿道连接部的皮质诱发电位表现为一个明显的负波，平均潜伏期为95毫秒。胫后和阴部体感诱发电位相似，呈现典型的W形复合波。在正常受试者中，刺激膀胱尿道连接部被描述为一种与刺激同步的搏动，并伴有持续的灼痛感，有时还伴有排尿欲望。在4名正常受试者中，由于痛阈降低，未能获得膀胱尿道连接部的皮质诱发电位。关于临床价值，结果表明，在中枢神经系统病变患者（马尾和圆锥病变组以及骶上脊髓病变组）中，膀胱尿道连接部皮质诱发电位和阴部体感诱发电位的结果因中枢神经系统内相似的传入神经通路而广泛相关。然而，在怀疑有额外继发性局部逼尿肌损伤的膀胱部分外周去神经支配患者中，刺激膀胱尿道连接部获得的皮质诱发电位结果与刺激阴部神经获得的体感诱发电位结果大多不同。所获得的模式（感觉和痛阈增加，膀胱尿道连接部皮质诱发电位正常，潜伏期正常，幅度正常或增加）提示存在局部逼尿肌损伤。在21例患者中，检测到膀胱尿道连接部皮质诱发电位的能力与刺激同步搏动的感觉相关，而在另外21例患者中，刺激期间这种感觉的缺失与皮质诱发电位的缺失相关。另一方面，在获得膀胱尿道连接部皮质诱发电位的能力与刺激诱发的疼痛和/或排尿欲望之间未发现相关性。（摘要截选至400字）
