Nara Medical University, Department of Anesthesiology, Kashihara, Japan.
Nara Medical University, Department of Anesthesiology, Kashihara, Japan.
Clin Neurophysiol. 2022 Sep;141:9-14. doi: 10.1016/j.clinph.2022.06.009. Epub 2022 Jun 24.
Intraoperative bulbocavernosus reflex (BCR) monitoring is more difficult in females than in males. This study was designed to compare the feasibility of transurethral electrical stimulation BCR (tu-BCR) monitoring with that of conventional BCR (c-BCR) monitoring during spine surgery in females.
Twenty-four females were included. For stimulation in c-BCR monitoring, a pair of surface electrodes was placed on the genitals (cathode/anode: clitoris/adjacent labium). For stimulation in tu-BCR monitoring, a urethral catheter attached to a pair of electrodes was inserted into the urethra. BCRs were recorded from the external anal sphincter after a single train of four stimulation pulses.
There was no postoperative urinary tract injury associated with urethral catheter insertion for tu-BCR. Tu-BCR monitoring had a significantly higher success rate of baseline recording than c-BCR monitoring (87.5% vs 66.7%, respectively, p = 0.028). The specificities of tu-BCR and c-BCR monitoring were 100% and 87.2%, respectively. The sensitivity was not calculated because no patients had postoperative urinary or bowel dysfunction.
Our data indicate that tu-BCR monitoring improved the success rate of baseline recording and specificity during spine surgery in females.
Tu-BCR monitoring was more reliable than c-BCR monitoring during spine surgery in females.
在女性中，术中球海绵体反射（BCR）监测比男性更困难。本研究旨在比较经尿道电刺激 BCR（tu-BCR）监测与传统 BCR（c-BCR）监测在女性脊柱手术中的可行性。
纳入 24 名女性。在 c-BCR 监测中，一对表面电极放置在生殖器上（阴极/阳极：阴蒂/相邻阴唇）。在 tu-BCR 监测中，将附有一对电极的尿道导管插入尿道。在单个四脉冲刺激后，从肛门外括约肌记录 BCR。
tu-BCR 监测中，与尿道导管插入相关的术后尿路损伤为零。tu-BCR 监测的基线记录成功率明显高于 c-BCR 监测（分别为 87.5%和 66.7%，p=0.028）。tu-BCR 和 c-BCR 监测的特异性分别为 100%和 87.2%。由于没有患者术后出现尿或肠功能障碍，因此未计算敏感性。
我们的数据表明，tu-BCR 监测提高了女性脊柱手术中基线记录的成功率和特异性。
在女性脊柱手术中，tu-BCR 监测比 c-BCR 监测更可靠。
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