Supplementation of cystometrography with simultaneous perineal floor and rectus abdominis electromyography.

A total of 26 patients with symptomatic voiding dysfunction underwent cystometrography concomitant with simultaneous perineal floor and rectus abdominis electromyography. Of the patients 20 had well defined neurological pathological conditions. Cystometrography/perineal electromyography revealed detrusor hyperreflexia with appropriate sphincter relaxation in 8 patients, with vesicosphincter dyssynergia in 10 and with pseudo-dyssynergia in 2. Rectus electromyography in these patients did not reveal electromyographic activity during the filling and expulsion phases of the cystometrogram. However, the 6 neurologically normal patients were noted to have detrusor areflexia with nonrelaxation of the sphincter on urodynamic examination. These patients characteristically attempted to void by abdominal straining, resulting in a concomitant increase in rectus and perineal electromyography activity. We conclude that the addition of rectus electromyography to the standard urodynamic methodology can improve significantly the recognition of intravesical pressure elevation owing to voluntary contraction of the abdominal musculature.