Salinas Casado J, Vírseda Chamorro M, Samblas García R, Esteban Fuertes M, Aristizábal Agudelo J M, Blázquez Izquierdo J, Delgado Martín J A, Resel Estévez L
Servicio de Urología, Hospital Universitario San Carlos, Universidad Complutense, Madrid, España.
Arch Esp Urol. 1997 Mar;50(2):173-82.
The present study was conducted to determine the usefulness of the perception and stimulation thresholds of the penile dorsal nerve in the diagnosis of neurogenic impotence.
A study was conducted to determine the neuroandrologic profile in 130 patients. According to the results of the neuroandrologic profile, they were classified as patients without neurogenic impotence (44 pts.; 34%) or with neurogenic impotence (86 pts.; 66%). The perception and stimulation thresholds (expressed in milliAmperes) were determined in all patients. Furthermore, the perineal sensation was clinically tested. Both thresholds were also studied in relation to a demonstrated neurologic lesion (sympathetic, parasympathetic, afferent pudendal, efferent pudendal and suprasacral lesions).
Assessment of the perineal sensation demonstrated a high specificity and a low sensitivity in the diagnosis of neurogenic impotence. A significant difference was observed between both groups for the perception (confidence interval of difference between the neurogenic and non-neurogenic group; from 0.02 to 4.95 mA) and stimulation thresholds (from 2.0 to 11 mA). Morever, the stimulation threshold was significantly higher in patients with alteration of the perineal sensation). Significant differences in the perception threshold were also demonstrated between patients with and without demonstration of efferent lesion, and in the stimulation threshold between patients with and without demonstration of pudendal afferent, pudendal efferent and sympathetic lesion. These differences are attributed to the presence of mixed lesions. However, given the width of the interval of normal values, it was not possible to find a useful cut-off point in both sensory thresholds. It could only be determined that the maximum value of the perception threshold in healthy subjects should be less than 9.45 mA.
The sensorial thresholds of the electrical stimulation of the penile dorsal nerve and the data from the physical examination of perineal sensation are not useful for the diagnosis of neurogenic impotence. It is necessary to carry out a complete neuroandrologic profile.
进行本研究以确定阴茎背神经的感觉和刺激阈值在神经源性阳痿诊断中的效用。
对130例患者进行研究以确定其神经泌尿学特征。根据神经泌尿学特征结果，将他们分为无神经源性阳痿患者（44例；34%）和有神经源性阳痿患者（86例；66%）。测定所有患者的感觉和刺激阈值（以毫安表示）。此外，对会阴感觉进行临床检测。还研究了这两个阈值与已证实的神经病变（交感神经、副交感神经、阴部传入神经、阴部传出神经和骶上神经病变）的关系。
会阴感觉评估在神经源性阳痿诊断中显示出高特异性和低敏感性。两组在感觉阈值（神经源性组与非神经源性组之间差异的置信区间；从0.02至4.95毫安）和刺激阈值（从2.0至11毫安）方面观察到显著差异。此外，会阴感觉改变的患者刺激阈值显著更高。在有和无传出神经病变的患者之间，感觉阈值也存在显著差异，在有和无阴部传入神经、阴部传出神经和交感神经病变的患者之间，刺激阈值也存在显著差异。这些差异归因于混合病变的存在。然而，鉴于正常数值区间较宽，在两个感觉阈值中都无法找到有用的截断点。只能确定健康受试者感觉阈值的最大值应小于9.45毫安。
阴茎背神经电刺激的感觉阈值以及会阴感觉体格检查的数据对神经源性阳痿的诊断无用。有必要进行完整的神经泌尿学评估。
