Premium
Clinical value of combined electrophysiological and urodynamic recordings to assess sexual disorders in spinal cord injured men
Author(s) -
Schmid D.M.,
Curt A.,
Hauri D.,
Schurch B.
Publication year - 2003
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.10125
Subject(s) - medicine , bulbocavernosus reflex , anesthesia , erectile dysfunction , sexual dysfunction , somatosensory evoked potential , reflex , spinal cord injury , pudendal nerve , lesion , spinal cord , surgery , psychiatry
Aims To assess the significance of combined neurophysiological and neurourological examinations for diagnosis of neurogenic male sexual dysfunction. Methods This is a prospective study of 32 spinal cord injured men. Each underwent clinical and neurophysiological examinations (sympathetic skin responses (SSR), pudendal somato‐sensory evoked potentials (P‐SSEP), bulbocavernosus reflex (BCR)) and neuro‐urological measurements (urodynamic examination (UE), reflex erections (RE), psychogenic erections (PE) and nocturnal penile tumescence recordings (NPTR)). Results Erectile dysfunction due to impairment of RE was associated with loss of BCR and detrusor areflexia ( P > 0.001), whereas that due to impairment of PE was associated with loss of perineal SSR ( P < 0.001). P‐SSEP corresponded in 94% with impairment of penile sensibility and duration of erections in NPTR. The NPTRs were less related to functional sexual impairment. NPTRs in complete and incomplete suprasacral (level > T10) spinal lesion showed sufficient erections despite strongly disturbed PE. NPTRs in lumbosacral lesion revealed significant reduction in or absent erections and underestimated the presence of well excitable PE. Conclusions Combined neurophysiologic and neurourologic testing provides highly relevant diagnostic informations about sexual dysfunction in men with spinal cord injury. Loss of the BCR and detrusor areflexia imply loss of somatic and parasympathetic reflex activity and correlate with loss of RE. Loss of PE correlates with loss of perineal SSR (sympathetic denervation). Neurourol. Urodynam. 22:314–321, 2003. © 2003 Wiley‐Liss, Inc.