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Electrophysiological evaluation of the pudendal nerve and urethral innervation in female stress urinary incontinence

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Abstract

Introduction and hypothesis

Although still a matter of debate, stress urinary incontinence (SUI) may be accompanied by damage to urethral and pelvic floor innervations, thus promoting dysfunctions of the urethral support and sphincteric closure mechanisms. The aim of this study was to analyze the pelvic floor and urethral innervations through pelvic electrophysiological tests to identify whether neurological alterations interfere with urinary continence and urethral functional activity.

Methods

This prospective study included 52 women, 33 with clinically and urodynamically proven SUI and 19 continent volunteers matched for age, height, parity, and number of vaginal deliveries by the propensity score method. The patients were divided according to the severity of urinary loss evaluated by measuring abdominal leak point pressure (ALPP). Pudendal nerve terminal motor latency (PNTML), pudendal somatosensory evoked potential (SSEP) latencies, urethral and clitoral sensory thresholds, and urethroanal reflex latency were tested.

Results

SUI and control subjects did not differ in PNTML, SSEP latency, and clitoral sensory thresholds. However, reduced responsiveness to urethral electrosensitivity and prolonged urethroanal reflex latency were detected in most incontinent patients. In addition, urethral electrosensitivity was altered in suspected intrinsic sphincteric dysfunction.

Conclusions

Urethral afferent pathways can be altered in women with SUI and may play an important role in evoking intrinsic sphincteric dysfunction.

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Abbreviations

ALPP:

Abdominal leak point pressure

BMI:

Body mass index

SUI:

Stress urinary incontinence

PNTML:

Pudendal nerve terminal motor latency

SSEP:

Pudendal somatosensory evoked potentials

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Acknowledgments

This study was supported in part by a grant from FAPESP (99/11546-5), Sao Paulo, Brazil. The sponsor did not influence any aspect of the study.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Division of Urology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil

    Geraldo de Aguiar Cavalcanti

  2. Division of Neurology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil

    Gilberto Mastrocola Manzano, Karlo Faria Nunes & Lydia Maria Pereira Giuliano

  3. CNPq researcher, Therapeutic Innovations Post-Graduation Program (PPGIT) and PIMES, Federal University of Pernambuco (UFPE), Recife, Brazil

    Tatiane Almeida de Menezes

  4. Divisions of Urology, Federal University of Sao Paulo (UNIFESP) and University of Sao Paulo (USP), Sao Paulo, Brazil

    Homero Bruschini

  5. Rua de Apipucos, 235/2202, Recife, PE, Brazil, 52071-000

    Geraldo de Aguiar Cavalcanti

Authors
  1. Geraldo de Aguiar Cavalcanti
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  2. Gilberto Mastrocola Manzano
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  3. Karlo Faria Nunes
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  4. Lydia Maria Pereira Giuliano
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  5. Tatiane Almeida de Menezes
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  6. Homero Bruschini
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Corresponding author

Correspondence to Geraldo de Aguiar Cavalcanti.

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de Aguiar Cavalcanti, G., Manzano, G.M., Nunes, K.F. et al. Electrophysiological evaluation of the pudendal nerve and urethral innervation in female stress urinary incontinence. Int Urogynecol J 24, 801–807 (2013). https://doi.org/10.1007/s00192-012-1931-8

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  • DOI: https://doi.org/10.1007/s00192-012-1931-8

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