Effect of voluntary attention on urethral pressure

[Effects of attention and desire to void on sensory evoked cortical potentials following perineal stimulation]

OBJECTIVE

Cortical somatosensory evoked potentials (SEP) are usually used to test the integrity of lemniscal pathways and thus provide arguments for the neurogenic etiology of sensory symptoms. For example, PES by perineal stimulation (SEP-P) has been shown to be altered in incontinence or neurogenic sexual dysfunction. We wanted to verify the integrity, structure and amplitude of far-field responses of PES-P in two conditions, the first without feeling the need to urinate (S0), the second with urgency (US).

METHODS

SEP-P were recorded in ten patients without neurological pathology in both conditions S0 and US after stimulation of the dorsal nerve of the penis/clitoris. Three consecutive responses each averaged over 1000 passages at a frequency of 3Hz were recorded.

RESULTS

Seven men and 3 women were included. All patients had normal SEP-P in terms of amplitude and latency of the P40 complex and fully reproducible especially for late responses. These early P40 responses were identical in both S0 and US states. Conversely, the far-field potentials, i.e. the late responses, were different in the two states, with a significant decrease (P<0.008 paired T-test) in the amplitude of cortical responses in the US state.

CONCLUSION

We observe that the late components of SEP-P were altered by the need to urinate urgently with sustained and selective attention to this need. These late components of SEP-P could be useful to better specify the attentional mechanisms involved in the continence-voiding cycle and to specify pathological sensory dysfunctions (urgency, painful bladder, frequency…).

LEVEL OF EVIDENCE

4.

Is urethral pressure profilometry a useful diagnostic test for stress urinary incontinence?

Urethral pressure profilometry is commonly used as a diagnostic test for stress urinary incontinence. The objective of this article is to review the published literature on urethral pressure profilometry to summarize its usefulness. MEDLINE was used to search the published English literature from 1966 to October 2000 for full-length original research articles on urethral pressure profilometry and stress urinary incontinence in women. Terms related to urethral pressure profilometry are defined consistently but techniques are not standardized, introducing variation in test results. Reproducibility of urethral pressure profilometry parameters is poor, both because of biological variation and variation within the test procedure itself (related in part to lack of standardization). Parameters of urethral pressure profilometry do not distinguish between continent and incontinent women and do not characterize the severity of incontinence or urethral incompetence. It is, therefore, concluded that urethral pressure profilometry is not a useful diagnostic test for stress urinary incontinence in women. Its use in clinical management is not supported by current evidence.

Urethral pressure variation in women with vulvar vestibulitis syndrome

OBJECTIVES

It is hypothesized that patients with vulvar vestibulitis syndrome will demonstrate increased urethral pressure variability.

STUDY DESIGN

Twelve patients with confirmed vulvar vestibulitis syndrome were compared with two groups: 13 patients with chronic pelvic pain matched for age and race and 23 asymptomatic unmatched patients. Urodynamic variables studied included maximum urethral pressure, functional urethral length, bladder capacity, and urethral pressure variability. During urethral pressure measurement each patient was given a standard mental exercise.

RESULTS

Urethral pressure variability was significantly greater in patients with vulvar vestibulitis than in those with chronic pain or in asymptomatic controls (Wilcoxon test, p < 0.001). Use of a multiple regression model that controlled for age, race, and parity showed that diagnostic group predicted a significant degree of urethral pressure variability (F = 8.18, p < 0.001).

CONCLUSIONS

Vulvar vestibulitis syndrome is associated with increased urethral pressure variability, and variation in muscular tone of the urethra is the probable source of this variability. However, the possible relationship with the pathogenesis of vulvar vestibulitis syndrome is unknown at present.