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: 3.75). 02/2003; 169(1):190-4. DOI: 10.1097/01.ju.0000035362.27178.99
Source: PubMed

ABSTRACT 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.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction. The aim of this work was to carry out a review of the literature on the clinical and paraclinical evaluation of bladder sensory (BS) to better understand BS disorders in nonneurological patients. Methods. Thirty-three articles were selected from the Med line Database between 1992 and 2012 using the following key words: "sensory/sensitivity bladder evaluation", "sensory/ sensitivity bladder scale", "sensory/sensitivity bladder questionnaire", "urodynamic bladder sensory", "urgency questionnaire" and "Overactive Bladder (OAB) questionnaire". Results. Evaluation of BS by asking questions during cystonnetry is validated (LE 2). The sensation of the desire to void progresses linearly with bladder filling (LE 2). Many symptoms and quality of life questionnaires related to BS anomalies have been proposed. Bladder diaries, frequency/volume curves (LE 2) and clinical algorithms (LE 3) could be an alternative to evaluate BS. Conclusion. Current evaluation only provides a partial view of BS. A multidimensional approach should lead to better understanding of BS disorders.
    Progrès en Urologie 06/2014; 24(8):495-500. DOI:10.1016/j.purol.2014.02.002 · 0.77 Impact Factor
  • [Show abstract] [Hide abstract]
    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
    Current Bladder Dysfunction Reports 06/2010; 5(2):79-86. DOI:10.1007/s11884-010-0048-5
  • [Show abstract] [Hide abstract]
    ABSTRACT: Chronic pelvic pain is a response of the nervous system to somatic and visceral pathology. Involving multiple pain pathways, it is unlikely to be confined to one organ system or to one mechanism. An understanding of the complex neuroanatomy and pathophysiologic mechanisms is essential to the treatment of patients presenting with this disorder.
    12/2007: pages 3-17;