Chuangyu Qu

Anal Sphincter Electromyogram for Dysfunction of Lower Urinary Tract and Pelvic Floor

The electromyogram (EMG) is a diagnostic tool that measures and records the electrical activity produced by skeletal muscles. The anal sphincter and urethral external sphincter are skeletal muscle in nature. There are two kinds of EMG in widespread use in the field of urodynamic investigation: surface (patch) and intramuscular (fine-wire) EMG. In our laboratory, the fine-wire electrode is introduced by aid of a needle, we called it needleguided wire electrode, or simply as wire electrode (Xu et al, 2007). Sphincter EMG studies the bioelectric potentials generated in the distal striated sphincter mechanism. Such studies are performed at two different levels of sophistication, each with distinct goals and requiring different instrumentation. The first, termed kinesiologic studies, are commonly performed in the urodynamic laboratory and simply examine sphincter activity during bladder filling and voiding. The second are neurophysiologic tests, which require considerable expertise and elaborate equipment and are designed to examine the integrity of innervation of the muscle. However, clinically the most important information obtained from sphincter EMG is whether there is coordination or discoordination between the external sphincter and the bladder. Surface patch electrodes are placed on the skin/mucosa overlying the muscle of interest and thus pick up the potentials produced by various muscles in the vicinity. Wire electrodes are preferable because they are placed directly into the muscle of interest, allowing for the detection of activity in individual motor units. EMG of the anal sphincter derived from transdermal route, being combined with simultaneous recording of uroflow rate, and bladder, abdominal pressure and then detrusor pressure (=bladder pressure–abdominal pressure) during both bladder storage and voiding phases, can give rise to a general essential data about functional states of the main elements (i.e. detrusor and sphincter) of lower urinary tract and the pelvic floor. Sphincter dysfunction, either overactive or underactive, may occur in patients with either neurogenic or non-neurogenic lower urinary tract dysfunctions (LUTD). Recently, the European Association of Urology published its guideline (2008 version) on neurogenic LUTD, which is categorized into detrusor and sphincter levels, and the location of lesions is no longer emphasized (Stohrer et al, 2009). Although several classification systems have been proposed for neurogenic LUTD, the recommendations for a functional classification for

Relationship between urodynamic patterns and lower urinary tract symptoms in Chinese women with a non-neurogenic bladder

Objective To investigate the urodynamic study (UDS) patterns, obstruction status, continence status, and their correlations among neurologically intact women with lower urinary tract symptoms (LUTS) through an epidemiological and logistic regression analyses. Methods We retrospectively analyzed the UDS data of 3265 neurologically intact women with LUTS (2002–2014). Five UDS patterns were identified: normo-active detrusor/sphincter (NA, or DSI, detrusor/sphincter intact), idiopathic detrusor overactivity (IDO), idiopathic sphincter overactivity (ISO), IDO + ISO, and detrusor underactivity (DUA). Analyses of UDS pattern distribution and stratification were performed (based on a modification of the European Urological Association-Madersbacher classification system), and their correlations with bladder outlet obstruction (BOO) and stress urinary incontinence (SUI) status were evaluated via logistic regression analysis. Results NA, IDO, IDO + ISO, ISO, and DUA were noted in 927 (28.4%), 678 (20.8%), 320 (9.8%), 689 (21.1%), and 651 (19.9%) cases, respectively. Moreover, storage, storage + voiding, and voiding symptoms were noted in 62.4%, 21.1%, and 16.5% cases, respectively, whereas BOO and SUI were observed in 12.1% and 29.0% cases, respectively. The risk factors for BOO included NA, IDO, ISO, and IDO + ISO, whereas the protective factors against BOO included storage symptoms, SUI, storage + voiding symptoms, and complaint duration within 1–12 months. NA was the only risk factor for SUI, whereas BOO, storage + voiding symptoms, IDO, and storage symptoms were protective factors for SUI. Conclusion Five UDS patterns were identified among neurologically intact women with LUTS. Functional abnormalities of the detrusor and/or sphincter were the main causes of LUTS, and were correlated with the BOO or SUI status. Thus, the UDS pattern can provide additional information regarding the risk factors for BOO or SUI status, as compared to symptomatic typing.