Sacral electrodiagnostics in clinical practice
Abstract
Background: Sacral electrodiagnostic (SED) studies are regarded as useful in patients with urinary, bowel or sexual dysfunction in whom peripheral sacral nervous system lesion is suspected. The aim of the present study was to present authors’ experience with the referral pattern and findings of the SED testing.
Methods: In the database of our neurophysiological laboratory, documentation of all examinees with SED studies performed by the author in the period from 1997–2002 was reviewed retrospectively. Neuropathic condition in the lower sacral segments was diagnosed using a quantitative electromyography (EMG) of the external anal sphincter (EAS) muscle. Data on examinees, specialties of referring doctors, referral diagnoses, symptoms and signs on neurological examination, and SED findings were evaluated using descriptive, bivariate and multivariate statistics.
Results: Altogether 193 patients (45% men), 7–83 years of age, were included. Urinary incontinence was reported by 99, urinary retention by 66 (both by 35), faecal incontinence by 73, constipation by 53 patients, sexual dysfunction by 49 (data available for 92 patients), and several sacral symptoms by 100 patients. On clinical examination 54 patients had signs of lower limb focal neuropathies, and 47 patients had perineal sensory loss. Pathological quantitative EMG of the EAS was found in 85 (44%) patients (cauda equina lesion in 28, multiple system atrophy in 10, etc.). On ordinal logistic regression analysis were significantly related to neuropathic EMG abnormalities particularly urinary retention and perineal sensory loss.
Conclusions: The present study revealed neuropathic abnormalities in slightly less than a half of patients referred to SED testing. No definite guidelines for referral to SED testing could be defined, but patients with urinary retention and perineal sensory loss seem more likely to prove to have neuropathic abnormalities in lower sacral segments.
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References
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