阴茎勃起障碍病人神经诱发电位146例临床分析

本文对１４６例阴茎勃起障碍病人的阴部神经诱发电位进行了检测分析，其中骨盆骨折３１例，腰椎骨折１１例，盆腔手术９例，高血压１６例，糖尿病１７例，严重手淫６２例。分析结果：阴部皮层体感神经诱发电位，骶髓反射时和生殖皮层运动诱发电位总体异常率在骨盆骨折，腰椎损伤，盆腔手术，高血压，糖尿病及严重手淫组分别为５１．６１％，５４．５５％，７７．７７％，３１．２５％，４７．０５和３２．２６％，超强度电流刺激在骨     

皮层诱发电位在脊髓损伤诊断中的价值

作者应用Ｄｉｓａ Ｎｅｕｒｏ２０００型肌电图仪，检测脊髓损伤３１２例，刺激上下肢周围神经，皮层接收，获得皮层诱发电位（ＣＥＰ）。主要为陈旧性脊髓损伤，上肢刺激正中神经与尺神经，部分病例为桡神经；下肢刺激胫后神经、腓总神经与股神经。安全截瘫１７９例，损伤平面以下各神经ＣＥＰ均未引出者９７．８％，假阳性２．２％。不全截瘫１３３例，损伤平面以下各神经ＣＥＰ的潜时与波幅有改变，有２例未查股神经，３例严重不     

阴茎温度敏感性测定评估经尿道前列腺切除术后阴茎的小神经纤维损伤

良性前列腺增生患者经尿道手术 (ＴＵＲＰ)后导致阴茎勃起功能障碍的发生率在 4 %～ 35%之间 ,与年龄和术前已经存在的勃起不良有关。为了判断ＴＵＲＰ对阴茎的小神经纤维损伤情况 ,作者调查了 18例行ＴＵＲＰ手术的前列腺增生患者 ,其中 13例不存在神经病变的危险因素 ,另有 2例病人患糖尿病 ,3例病人患下肢动脉炎。所有 18例病人均在术前和术后一月测定阴茎的温度感觉阈、生物震感阈 ,阴茎交感神经的皮肤反应 ( ｐｅｎｉｌｅｓＳｙｍｐａｔｈｅｔｉｃＳｋｉｎＲｅｓｐｏｎｓ ｅｓ ,ｐＳＳＲｓ) ,阴部神经躯体感觉诱发电位 ( ｐＳＥＰｓ)。…     

神经管闭合不全的手术疗效探讨

对手术治疗的４０例神经管闭合不全患者的神经功能状态做临床评价及胫后神经皮层体感诱发电位（ＣＳＥＰ）测量，发现手术前后神经缺陷的临床评分有显著差异（Ｐ＜０．００２）。行胫后神经ＣＳＥＰ检查的２０例患者，１６例手术后双下肢胫后神经ＣＳＥＰＰ４０峰潜伏期明显缩短（Ｐ＜０．０００５）；另４例手术前５根胫后神经ＣＳＥＰ波形消失而术后恢复（Ｐ＜０．０１）。说明手术是一有效的治疗方法，不仅可阻止神经缺陷的发展，而且使神经缺陷得到改善。     

胫后神经皮层体感诱发电位在脊髓纵裂中应用价值的探讨

对２９例脊髓纵裂患者（手术组２０例，非手术组９例）行胫后神经皮层体感诱发电位（ＰＴＮＣＳＥＰ）测量研究，２０例正常儿童为对照组，结果显示：患病组ＰＴＮＣＳＥＰ明显异常，两下肢间的ＰＴＮＣＳＥＰ有显著性差异（Ｐ＜０．０５）；手术组患者手术后ＰＴＮＣＳＥＰ明显改善（Ｐ＜０．０５），非手术组患者随访发现ＰＴ－ＮＣＳＥＰ无改善（Ｐ＞０．０５）。结果表明：ＰＴＮＣＳＥＰ是一敏感、客观、可靠的诊断工具，可用来判断脊髓纵裂神经损害的程度及机理，评价手术效果，指导手术治疗     

体感诱发电位皮层成份在监测脊柱手术中的作用

目的：评价监测体感染诱发电位（ＳＥＰ）Ｎ２０、Ｐ４０波在脊柱手术时的方法及意义。方法：对２２例脊柱手术病人进行上肢或下肢ＳＥＰ监测并进行术后随访。结果：１０例病人的Ｎ２０、Ｐ４０波潜延长大于１ｍｓ,波幅降低大于５０％,３例波形完全消失,但只有１例术后神经症状加重。结论：脊柱手术时仅则上肢或下肢ＳＥＰ皮层成份意义较小,需做多形式监测;判断时除既往异常标准外,需注意ＳＥＰ异常持续的时间及潜伏期无明显变     

脊髓纵裂手术前后胫后神经体感诱发电位分析

２０例脊髓纵裂患者手术前后进行了两下肢胫后神经皮层体感诱发电位（ＣＳＥＰ）检查，并选择了２０例正常人作为对照组，结果发现手术组与对照组ＣＳＥＰ有显著性差异，手术治疗后患者ＣＳＥＰ的Ｐ４０峰潜伏期及波幅明显改善，患者两下肢间的ＣＳＥＰ亦有明显差异。表明ＣＳＥＰ是一敏感、客观、可靠的诊断指标，可用来判断神经损害的程度，评价手术疗效。文中并讨论了神经缺陷的机理。     

皮节体感诱发电位在腰椎间盘突出症中的诊断作用

目的 探讨皮节体感诱发电位（ＤＳＥＰ）在腰椎间盘突出症中的诊断作用。方法 对３９例 有Ｌ５和Ｓ１神经损害表现的腰椎间航空出症的患者进行胫后神经体感诱发电位（ＳＥＰ）和Ｌ５Ｓ１ＤＳＥＰ检查,测定其Ｎ４０的峰潜伏期。结果 胫后神经ＳＥＰ检测的异常率为３８．５％,其中多 水平突出的异常率明显高于单水平突出的异常率（Ｐ＝－．００８）;而Ｌ５Ｓ１ＤＳＥＰ检测的异常率达８５．７％,比胫后神经ＳＥＰ检测的异常率     

腰_5、骶_1皮节刺激节段性体感诱发电位对腰骶神经根病变诊断的价值探讨

１９９２年６月～１９９３年６月对１００例临床诊断腰椎间盘突出的患者进行下肢常规（胫后神经）皮层体感诱发电位（ＣＳＥＰ）检查，同时进行Ｌ_５、Ｓ_１皮节刺激节段性体感诱发电位（ＤＳＥＰ）检查，发现ＤＳＥＰ可提高常规胫后神经ＣＳＥＰ诊断的敏感性及准确性，防止其局限性，为临床诊断提供更可靠依据。     

磁刺激运动诱发电位在腰骶神经根病应用研究

作者采用磁刺激腰骶部运动诱发电位（ＭＥＰ）和磁刺激窝Ｆ波相结合的方法测定运动神经根传导时间（ＭＲＣＴ）．随机抽查５０名正常受试者在胫骨前肌（ＴＡ）和比目鱼肌（ＳＯＬ）记录出可靠的运动神经传导时间（ＭＮＣＴ）和ＭＲＣＴ；同样方法记录和观察４０例手术证实单例Ｌ５或Ｓ１神经根受压患者ＭＮＣＴ和ＭＲＣＴ的改变，同时进行节段性皮神经刺激皮层体感诱发电位（ＳＥＰ）对比．结果显示：病人组ＭＮＣＴ与正常组相比无显著性差异，而ＭＲＣＴ则有显著性差异．异常率为８５％，其明显高于ＳＥＰ的异常率４５％．因此，无痛无创的磁刺激ＭＥＰ对腰骶神经根病有很大的使用价值，而且磁刺激优于电刺激．     

Penile sensory disorders in erectile dysfunction: results of a comprehensive neuro-urophysiological diagnostic evaluation in 123 patients

A total of 123 patients with complaints of erectile dysfunction and no clinically overt neurological disease underwent a comprehensive neuro-urophysiological diagnostic evaluation. The results were compared with those obtained in 50 healthy volunteers. Data gathered consisted of somatosensory evoked potentials from the posterior tibial nerve (tibial evoked potential) and from the dorsal penile nerve (pudendal evoked potential). Also, 2 sacral reflex latencies were measured (bulbocavernosus reflex and urethro-anal reflex). A total of 58 patients (47%) had at least 1 abnormal neuro-urophysiological measurement. Neuro-urophysiological abnormalities were found more frequently in older patients. The tibial evoked potential was abnormal in 30 patients (24%), pudendal evoked potential in 21 (17%), bulbocavernosus reflex in 26 (21%) and urethro-anal reflex in 32 (26%). It was concluded that somatosensory disturbances constitute an important part of neuro-urophysiological abnormalities. Our results suggest a relationship between erectile dysfunction and subclinical, age-related (penile) sensory disorders. Our study corroborates the importance of penile sensibility for erectile (patho)physiology as suggested by others and supports the concept of sensory deficit impotence as an important cause of erectile dysfunction.     

Neurophysiological evaluation in detrusor instability

Different and complex neuronal systems are involved in the control of continence. Detrusor overactivity has been divided by the International Continence Society into two functional subgroups: a) detrusor instability and b) detrusor hypereflexia. Only in the latter group has neurological damage been shown, but pathophysiological mechanisms are still unknown. In order to complete a full investigation of sensory and motor pathways 12 female patients affected by idiopathic detrusor instability (mean age 60.2 years; range 49–73) and 13 age-matched healthy women were studied. All patients were submitted to a subtracted cistometrogram (CMG), anal sphincter electromyography (EMG) with a bipolar coaxial needle, sacral reflex analysis after stimulation of the dorsal nerve of the clitoris, tibial and pudendal somatosensory evoked potentials, motor evoked potentials after magnetic cortical coil stimulation, and recording from anal sphincter and abductor brevis hallucis muscles. All patients had normal neurophysiological tests, and no significant differences between patients and controls could be seen. Our data confirms the absence of both clinical and subclinical damage of central sensory or motor pathways in detrusor instability; an alteration of suprasegmental mechanisms cannot be excluded.     

Penile and perianal pudendal nerve somatosensory evoked potentials in the diagnosis of erectile dysfunction.

Neurophysiologic examinations in differential diagnosis of erectile dysfunction comprise electromyogramme of the pelvic floor, pudendal nerve terminal motor latency (PNTML) and evaluation of pudendal somatosensory evoked potentials (SSEP). We focused our interest on comparing diagnostic importance of penile and perianal pudendal nerve SSEP. We examined 20 patients suffering from erectile dysfunction and 20 patients without any manifestation of impotence. The stimulus was administered using penile ring electrodes at the base of the penis (cathode) and distally on the penis shaft (anode), as well as a perianal surface electrode applied at 3 o'clock in lithotomy position and 5 cm laterally on the gluteal skin. The potentials were recorded with intradermal needle electrodes at C(z)-2 cm (different) and F(z) (indifferent). 500 stimuli were averaged for a single tracing. The stimulus strength was set at an average of 3-4 times the stimulus threshold. Cortical latency of P 40 ranged from 39.0 to 45.6 ms (penile) and from 33.6 to 43.2 ms (perianal) in the control group, in the patient group latencies ranged from 38.8 to 51.6 (penile) and 34.0 to 44.8 ms (perianal). In two patients no potential was recordable after perianal stimulation, one patient showed a marked prolongation of the penile response with a normal perianal latency. Penile and perianal latencies of P 40 were significantly prolonged in the patient group compared to the control group (P<0.05). The combination of penile and perianal pudendal SSEP may provide valuable additional information in differential diagnosis of erectile dysfunction, especially allowing to identify different sites of neurogenic lesions. In contrast to perianal pudendal SSEP, penile stimulation may help to discover pathologic changes in the distal course of the pudendal nerve, especially the dorsal nerve of the penis.     

A combined urodynamic and electrophysiological study of diabetic cystopathy

AIMS: The aim of this study is to compare urodynamics and electrophysiological studies in the diagnosis of diabetic cystopathy. MATERIALS AND METHODS: In this prospective study are included twenty six patients with diabetes mellitus diagnosed at least since 5 years; 17 patients with diabetes type II and 9 with type I. They were divided in two groups in respect to lower urinary tract symptoms (LUTS) and signs suggestive of lower urinary tract dysfunction (LUTD) according to the ICS standardization. Patients with LUTS/LUTD were included in Group A and patients without LUTS/LUTD in Group B. Patients underwent different studies: urodynamic, somatosensory evoked potentials (SSEP) of tibial and pudendal nerves, bulbocavernosus reflex (BCR), bulbocavernosus muscles' electromyography and motor evoked potentials after transcranial magnetic stimulation to indirectly investigate bladder's innervation. RESULTS: Abnormal urodynamics were found in 13 patients of group A (92.9%) and in 5 of group B (47.1%). This difference was statistically significant (P=0.009). Abnormally prolonged latency of P40 of tibial SSEP was found in 11 patients of group A (78.6%) and in 4 of group B (33.3%) and this difference was also statistically significant (P=0.04). Differences between the two groups concerning: i) peripheral polyneuropathy; ii) pudendal SSEP, iii) dysfunction of central nervous system and iv) abnormal BCR were not statistically significant. CONCLUSION: The study of tibial SSEP is an easily performed test and it is well correlated to abnormal urodynamics in diabetic patients with and without LUTD/LUTS.     

Application of pudendal evoked potentials in diagnosis of erectile dysfunction

Aim: Extensive neurophysiological investigations were carried out in I00 healthy subjects and 84, patients with penile erectile dysfunction.     

Standardized evaluation of erectile dysfunction in 95 consecutive patients

We investigated 95 patients referred for erectile dysfunction by penile blood pressure measurement, the intracavernous papaverine test and Doppler investigation of the penile arteries. Furthermore, penile cutaneous perception threshold, bulbocavernosus reflex latency and somatosensory cortical evoked potentials of the pudendal nerve were measured. In selected cases cavernosometry, cavernosography and corpus cavernosum electromyography were performed. Doppler investigation of the cavernous arteries after papaverine injection was more reliable than penile blood pressure measurement in the diagnosis of arteriogenic erectile dysfunction. Decreased sensibility of the penis may be the sole factor responsible for inability to sustain an erection. Erectile dysfunction may be provoked by impaired function of the pudendal nerve. Penile cutaneous perception threshold measurement and corpus cavernosum electromyography are mandatory in the evaluation of neurogenic etiology. Cavernosometry and cavernosography are reliable methods in the determination of abnormal drainage from the corpus cavernosum.     

Peripheral neuropathy: an underdiagnosed cause of erectile dysfunction

OBJECTIVES

? To assess the prevalence of peripheral neuropathy in patients with erectile dysfunction (ED). ? To evaluate the reliability of clinical tests such as the five‐item version of the International Index of Erectile Function (IIEF‐5) and the Neuropathy Symptom Score (NSS) classification system in predicting the concurrence of peripheral neuropathy.

PATIENTS AND METHODS

? We studied 90 patients who were consecutively recruited from the Department of Andrology of the Central Hospital of Asturias. ? Anamnesis included questions about risk factors related to ED. ? The severity of ED was classified according to IIEF‐5 scores and symptoms of peripheral neuropathy were assessed using the NSS. ? Neurophysiological tests included electromyography, nerve conduction studies, evoked potentials from pudendal and tibial nerves as well as bulbocavernosus reflex. ? Small fibre function was assessed using quantitative sensory tests and sympathetic skin response. Statistical analysis was performed using the SPSS‐11 program.

RESULTS

? Patients with more severe symptoms of peripheral neuropathy showed lower (worse) IIEF‐5 scores (P= 0.015) and required more aggressive therapies (P < 0.001). ? Neurophysiological exploration confirmed neurological pathology in 68.9% of patients, of whom 7.8% had myelopathy and 61.1% peripheral neuropathy. ? Polyneuropathy was found in 37.8% of the patients, of whom 8.9% had pure small fibre polyneuropathy, and pudendal neuropathy was diagnosed in 14.4%. ? No association between neurophysiological diagnosis and IIEF‐5 score was detected, but a statistical association was found between neuropathy and NSS scores.

CONCLUSIONS

? Up to now, the impact of peripheral neuropathy in the pathogenesis of ED has been underestimated. The combination of anamnesis and an ad hoc neurophysiological protocol showed its high prevalence and provided a more accurate prognosis. ? In future, clinical practice should optimize the assessment of pelvic small fibre function.     

Growth factor therapy and neuronal nitric oxide synthase

Trauma to the cavernous nerve is a known cause of erectile dysfunction, with lengthy and often incomplete recovery. Using rat models, we have previously shown that injury to the cavernous nerves or ligation of pudendal arteries causes a significant decrease of neuronal nitric oxide synthase (nNOS) in the dorsal nerve of the penis and intracavernosal tissue as well as loss of erectile response to neurostimulation. Intracavernous injection of vascular endothelial growth factor or brain-derived neurotrophic factor facilitates the recovery of nNOS and erectile function. Studies are underway to elucidate the molecular mechanism of cavernous nerve regeneration and the potential of using growth factors to enhance the recovery of erectile function in patients after radical pelvic surgery. International Journal of Impotence Research (2004) 16, S38-S39. doi:10.1038/sj.ijir.3901214     

The effect of tracheal intubation and surgical stimulation on median nerve somatosensory evoked potentials during anaesthesia

This study was designed to determine whether alterations in the median nerve somatosensory evoked potentials occur during the stimuli of tracheal intubation and skin incision. Twenty-two patients scheduled for elective surgery and who required tracheal intubation were studied. Median nerve somatosensory evoked potentials were recorded, analysed and stored approximately every 40 seconds. Anaesthesia was induced with thiopentone and vecuronium used for neuromuscular blockade; the trachea was intubated 2 minutes after induction. Fentanyl 1.5 micrograms/kg was administered subsequently. Evoked potential monitoring was continued until at least 2 minutes after surgical incision. Induction of anaesthesia was associated with an increase in evoked potential latency of 0.8 msec and reduction in amplitude of 1.7 microV. Small, statistically insignificant changes occurred between induction of anaesthesia and tracheal intubation. Surgical incision was accompanied by a statistically significant mean decrease in evoked potential latency of 0.5 msec and a statistically significant increase in evoked potential amplitude of 0.6 microV. The fact that surgical stimulation produced an activating effect on evoked potentials suggests that they may be used as a measure of the neurophysiological effects of anaesthesia.     

Electrophysiological correlates of sensory innervation of the vesico-urethral junction and urethra in man

To investigate urethral sensory innervation in man, cerebral evoked potentials (CEPs) and bulbocavernous reflex (BCR) were recorded by stimulation of vesico-urethral junction (VUJ), prostatic and distal urethra, and penile skin. A specially produced catheter with a pair of electrodes was used for bipolar stimulation along the lower urinary tract. In comparison to the potentials evoked by distal urethral stimulation, the shape differences and protracted latency of CEPs to VUJ stimulation suggest that the distal and proximal urethra are innervated by different peripheral afferents. Similarities of CEPs and BCR latencies produced by prostatic urethral and VUJ stimulation indicate that the sensory innervation of the prostatic urethra is provided by pelvic nerve afferents. The remaining distal parts of the urethra are innervated by pudendal nerves. This is indicated by shape similarities and latency characteristics of both CEPs and BCR when the distal urethra and glans skin are stimulated.