Electrophysiological Assessment of Sensations Arising from the Bladder: Are there Objective Criteria for Subjective Perceptions?

Neurourogical Unit, ParaCare, Institute for Rehabilitation and Research, University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland.
The Journal of Urology (Impact Factor: 4.47). 02/2003; 169(1):190-4. DOI: 10.1097/01.ju.0000035362.27178.99
Source: PubMed


Initial bladder filling sensation, first and strong desire to void are subjective perceptions that occur periodically during the urine storage mode of bladder function, representing sensory input from the lower urinary tract. To our knowledge methods for evaluating sensory bladder function are not available. We studied a simple electrophysiological procedure for the objective assessment of bladder sensations using sympathetic skin responses and surface pelvic floor electromyography.
Informed consent was provided by 8 healthy male subjects, who were administered 20 mg. furosemide and 1 l. fluid to drink. Palmar and plantar sympathetic skin responses, and surface pelvic floor electromyogram were continuously recorded during bladder filling, voluntary pelvic floor contraction and voiding.
First desire to void evoked simultaneous sympathetic skin responses and pelvic floor contractions. This pattern appeared periodically with the desire to void sensation as well as with strong desire to void at maximum bladder capacity and it correlated well with the subjective sensation of the subjects. Voluntary pelvic floor contraction decreased the subjective intensity of the desire to void sensation as well as sympathetic skin response activity for the same short period. During voiding sympathetic skin responses almost complete absence of sympathetic skin responses was observed.
Sensations arising from the bladder induce combined activation of sympathetic skin responses and pelvic floor activity. This coherence indicates synchronized activation and inactivation of the autonomic and somatic pathways necessary for appropriate urine storage and coordinated voiding. Our observations may introduce a new approach for objectively assessing subjective sensations arising from the urinary tract.

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    • "Making use of the fMRI technique, the aim of this study was to investigate the brain structures involved in voluntary control of bladder function: in colloquial terms, to answer the question: bWhich areas in the brain are involved in the voluntary control of the micturition?Q Derived from earlier urology study (Reitz et al., 2003), it is hypothesized that these areas' activity triggered by pelvic floor muscle contraction will increase when bladder is full, since the filled bladder has almost no room for urine holding; therefore any pelvic floor muscle action would dramatically arouse desire to void and suppression of such desire, since it is not allowed to urinate in the scanner, thereby we have established a nonvoiding model (i.e., active pelvic floor muscle contraction with full bladder to induce stronger desire to void and micturition reflex inhibition, since the subject is not allowed to urinate) of inhibitory bladder control. The model involves the performance of repetitive pelvic floor muscle contraction in alternation with periods of rest under full (FBC)-and empty (EBC)-bladder conditions. "
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    ABSTRACT: For the diagnosis of neurogenic bladder, in addition to clinical assessment, neurophysiologic testing may be useful. Neurophysiologic tests are more useful in patients with sacral compared with suprasacral disorders. Anal sphincter electromyography (EMG) is the most useful diagnostic test, particularly for focal sacral lesions and atypical parkinsonism. Another clinically useful method that tests the sacral segments and complements EMG is the sacral (penilo/clitoro-cavernosus) reflex. Kinesiologic EMG is useful to demonstrate detrusor sphincter dyssynergia. Somatosensory-evoked potential and motor-evoked potential studies may be useful to diagnose clinically silent central lesions. The utility of cortical somatosensory-evoked potential in bladder/urethra stimulation is limited by technical difficulties that can be partially overcome by the concomitant recording of a palmar sympathetic skin response. Sympathetic skin response recorded from the saddle region is also useful for testing the lumbosacral sympathetic system. A clinically useful neurophysiologic test for evaluating the sacral parasympathetic system is still lacking. KeywordsElectromyography-Lower urinary tract-Motor-evoked potentials-Neurogenic bladder-Somatosensory-evoked potentials-Sympathetic skin response-Voiding
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