Department of Urology, Antwerp University Hospital (UZA), Edegem, Belgium.
Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium.
Neuromodulation. 2020 Dec;23(8):1172-1179. doi: 10.1111/ner.13177. Epub 2020 Jun 19.
To assess the validity, reliability, and feasibility of electromyography (EMG) as a tool to measure pelvic floor muscle (PFM) contractions during placement and (re)programming of the tined lead electrodes in sacral neuromodulation (SNM) patients.
Single tertiary center, prospective study conducted between 2017 and 2019 consisting of three protocols including a total of 75 patients with overactive bladder (wet/dry) or nonobstructive urinary retention. PFM EMG was recorded using the multiple array probe (MAPLe), placed intravaginally. All stimulations (monophasic pulsed square wave, 210 μsec, 14 Hz) were performed using Medtronic's standard SNM stimulation equipment. During lead implantation, all four lead electrodes were stimulated with fixed increasing stimulation intensities (1-2-3-5-7-10 V). During lead electrode (re)programming, five bipolar lead electrode configurations were stimulated twice up to when an electrical PFM motor response (EPFMR), sensory response, and pain response were noted (i.e., the threshold), respectively. Additionally, amplitude and latency of the EPFMRs were determined. Validity, reliability, and feasibility were statistically analyzed using the intraclass correlation coefficient, weighted Cohen's kappa and linear regression, respectively.
Validity: EPFMRs were strongly associated with visually detected PFM motor responses (κ = 0.90). Reliability: EPFMR amplitude (ICC = 0.99) and latency (ICC = 0.93) showed excellent repeatability. Feasibility: linear regression (EPFMR threshold = 0.18 mA + 0.76 * sensory response threshold) showed an increase in the sensory response threshold is associated with a smaller increase in EPFMR threshold, with the EPFMR occurring before or on the sensory response threshold in 83.8% of all stimulations.
Measuring PFM contractions with EMG during placement and (re)programming of lead electrodes in SNM patients is valid, reliable, and feasible. Therefore, the use of PFM EMG motor responses could be considered as a tool to assist in these procedures.
评估肌电图（EMG）作为一种工具在测量骶神经调节（SNM）患者中的阴部肌肉（PFM）收缩的有效性、可靠性和可行性，包括在植入和（重新）编程带刺电极时。
这是一项 2017 年至 2019 年在一家三级中心进行的前瞻性研究，包括三个方案，共纳入 75 例逼尿肌过度活动（湿/干）或非梗阻性尿潴留患者。使用阴道内放置的多阵列探头（MAPLe）记录 PFM EMG。所有刺激（单相脉冲方波，210 μsec，14 Hz）均使用美敦力的标准 SNM 刺激设备进行。在植入电极时，以固定的递增刺激强度（1-2-3-5-7-10 V）刺激四个电极。在重新编程电极时，分别以 5 V 刺激 5 种双极电极配置，直到记录到阴部肌肉电运动反应（EPFMR）、感觉反应和疼痛反应（即阈值）。此外，还确定了 EPFMR 的幅度和潜伏期。使用组内相关系数、加权 Cohen's kappa 和线性回归分别对有效性、可靠性和可行性进行了统计学分析。
有效性：EPFMR 与视觉检测到的 PFM 运动反应具有很强的相关性（κ=0.90）。可靠性：EPFMR 幅度（ICC=0.99）和潜伏期（ICC=0.93）表现出极好的可重复性。可行性：线性回归（EPFMR 阈值=0.18 mA+0.76*感觉反应阈值）表明，感觉反应阈值的增加与 EPFMR 阈值的增加呈负相关，在所有刺激中，83.8%的 EPFMR 发生在感觉反应阈值之前或之上。
在 SNM 患者的电极植入和（重新）编程过程中使用 EMG 测量 PFM 收缩是有效、可靠和可行的。因此，PFM EMG 运动反应可被视为辅助这些手术的一种工具。
