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[下尿路功能障碍的神经学诊断]

[Neurological diagnosis of lower urinary tract dysfunction].

作者信息

Kliesch Uta, Reitz André

机构信息

Neurologie Zentralschweiz AG, Maria-Hilf-Strasse 9, 6430, Schwyz, Schweiz.

KontinenzZentrum AG Zürich, Witellikerstrasse 40, 8032, Zürich, Schweiz.

出版信息

Urologie. 2025 Feb;64(2):149-156. doi: 10.1007/s00120-024-02495-0. Epub 2025 Jan 14.

DOI:10.1007/s00120-024-02495-0
PMID:39806173
Abstract

BACKGROUND

Neurophysiological investigations are infrequently utilized in the diagnostic workup of lower urinary tract symptoms (LUTS).

OBJECTIVE

To determine the potential contributions of neurophysiological assessments in the diagnostic process of LUTS and their integration into systemic neurological and psychosomatic disorders.

MATERIALS AND METHODS

This study elucidates the role of neurophysiological tests specific to pelvic floor diagnostics, namely pudendal nerve somatosensory-evoked potentials (SEP) and external anal sphincter electromyography (EMG), through the presentation of two clinical case reports.

RESULTS

When combined with clinical history, physical examination, and urodynamic studies, pudendal SEP and external anal sphincter EMG facilitate both diagnostic precision and the topographic localization of LUTS. This allows, particularly in conjunction with supplementary imaging modalities such as magnetic resonance imaging (MRI), for a definitive diagnosis and, consequently, the formulation of individualized, targeted therapeutic strategies.

CONCLUSION

The increased application of specific neurophysiological methods in the diagnostic evaluation of LUTS is warranted, particularly in complex cases. This approach not only enhances diagnostic accuracy but also aligns with the goal of developing personalized, specific, and resource-efficient therapeutic interventions.

摘要

背景

神经生理学检查在膀胱过度活动症(LUTS)的诊断检查中很少使用。

目的

确定神经生理学评估在LUTS诊断过程中的潜在作用,以及它们如何融入系统性神经和身心疾病的诊断中。

材料与方法

本研究通过两个临床病例报告,阐明了盆底诊断特有的神经生理学测试的作用,即阴部神经体感诱发电位(SEP)和肛门外括约肌肌电图(EMG)。

结果

当与临床病史、体格检查和尿动力学研究相结合时,阴部SEP和肛门外括约肌EMG有助于提高LUTS的诊断准确性和定位。这尤其与诸如磁共振成像(MRI)等辅助成像方式相结合时,能够实现明确诊断,从而制定个性化、有针对性的治疗策略。

结论

在LUTS的诊断评估中,尤其是在复杂病例中,增加特定神经生理学方法的应用是有必要的。这种方法不仅提高了诊断准确性,还符合开发个性化、特定且资源高效治疗干预措施的目标。

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[Neurological diagnosis of lower urinary tract dysfunction].[下尿路功能障碍的神经学诊断]
Urologie. 2025 Feb;64(2):149-156. doi: 10.1007/s00120-024-02495-0. Epub 2025 Jan 14.
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本文引用的文献

1
Diagnostic and Prognostic Value of External Anal Sphincter EMG Patterns in Multiple System Atrophy.肛门外括约肌肌电图模式在多系统萎缩中的诊断和预后价值。
Mov Disord. 2022 May;37(5):1069-1074. doi: 10.1002/mds.28938. Epub 2022 Feb 4.
2
Lower urinary tract electrical sensory assessment: a systematic review and meta-analysis.下尿路电感觉评估:系统评价和荟萃分析。
BJU Int. 2022 Aug;130(2):166-180. doi: 10.1111/bju.15574. Epub 2021 Oct 28.
3
Bulbocavernosus reflex and pudendal nerve somatosensory evoked potential are valuable for the diagnosis of cauda equina syndrome in male patients.
球海绵体反射和阴部神经体感诱发电位对男性马尾神经综合征的诊断有重要价值。
Int J Clin Exp Med. 2015 Jan 15;8(1):1162-7. eCollection 2015.
4
Sex differences in pudendal somatosensory evoked potentials.阴部躯体感觉诱发电位的性别差异。
Tech Coloproctol. 2014 Jun;18(6):565-9. doi: 10.1007/s10151-013-1105-9. Epub 2013 Dec 20.
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Pudendal somatosensory evoked potentials in normal women.正常女性的阴部体感诱发电位
Int Braz J Urol. 2007 Nov-Dec;33(6):815-21. doi: 10.1590/s1677-55382007000600010.
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Bilateral vs. unilateral electromyographic examination of the external anal sphincter muscle.肛门外括约肌的双侧与单侧肌电图检查
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Comparison of quantitative techniques in anal sphincter electromyography.肛门括约肌肌电图定量技术的比较
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Standardization of anal sphincter EMG: technique of needle examination.肛门括约肌肌电图标准化:针电极检查技术
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Recovery of bladder function in patients with acute spinal cord injury: significance of ASIA scores and somatosensory evoked potentials.急性脊髓损伤患者膀胱功能的恢复:美国脊髓损伤协会(ASIA)评分和体感诱发电位的意义
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