Bulbocavernosus Reflex (2023)

Cited by (65)

  • Transurethral electrical stimulation for intraoperative bulbocavernosus reflex monitoring during spine surgery in females

    2022, Clinical Neurophysiology

    Intraoperative bulbocavernosus reflex (BCR) monitoring is more difficult in females than in males. This study was designed to compare the feasibility of transurethral electrical stimulation BCR (tu-BCR) monitoring with that of conventional BCR (c-BCR) monitoring during spine surgery in females.

    Twenty-four females were included. For stimulation in c-BCR monitoring, a pair of surface electrodes was placed on the genitals (cathode/anode: clitoris/adjacent labium). For stimulation in tu-BCR monitoring, a urethral catheter attached to a pair of electrodes was inserted into the urethra. BCRs were recorded from the external anal sphincter after a single train of four stimulation pulses.

    There was no postoperative urinary tract injury associated with urethral catheter insertion for tu-BCR. Tu-BCR monitoring had a significantly higher success rate of baseline recording than c-BCR monitoring (87.5% vs 66.7%, respectively, p=0.028). The specificities of tu-BCR and c-BCR monitoring were 100% and 87.2%, respectively. The sensitivity was not calculated because no patients had postoperative urinary or bowel dysfunction.

    Our data indicate that tu-BCR monitoring improved the success rate of baseline recording and specificity during spine surgery in females.

    Tu-BCR monitoring was more reliable than c-BCR monitoring during spine surgery in females.

  • “The Overactive Pelvic Floor (OPF) and Sexual Dysfunction” Part 1: Pathophysiology of OPF and Its Impact on the Sexual Response

    2021, Sexual Medicine Reviews

    Overactive pelvic floor (OPF) muscles are defined as muscles that do not relax, or may even contract, when relaxation is needed, for example, during micturition or defecation. Conditions associated with OPF are multifactorial and include multiple possible etiologies and symptom complexes. The complex interplay between biological and psychosocial elements can lead to the persistence of OPF symptoms along with psychological and emotional distress.

    (1) To review and contextualize, from a pathophysiologic perspective, the evidence for OPF, (2) to provide an overview of common clinical presentations and comorbidities of OPF, and (3) to discuss the effect of OPF on sexual function in men and women.

    Review of the updated literature on the pathophysiology of OPF was carried out. OPF-associated conditions were overviewed, with special emphasis on the impact on sexual function in men and women.

    Individuals with suspected OPF often present with a combination of gastrointestinal, gynecological, musculoskeletal, sexual, and urological comorbidities, mostly accompanied by psychoemotional distress. In both women and men, sexual function is significantly impaired by OPF and genitopelvic pain penetration disorders are often the primary manifestation of this condition. Women with OPF report less sexual desire, arousal, and satisfaction; more difficulty reaching orgasm; lower frequencies of intercourse; more negative attitudes toward sexuality; and more sexual distress than women without sexual pain. The most frequently reported sexual dysfunctions in men with OPF include erectile dysfunction, premature ejaculation, and ejaculatory pain.

    The complex pathophysiology of OPF involving multisystemic comorbidities and psychosocial factors emphasize the importance of a biopsychosocial assessment for guiding effective and personalized management.

    Padoa A, McLean L, Morin M, etal. “The Overactive Pelvic Floor (OPF) and Sexual Dysfunction” Part 1: Pathophysiology of OPF and Its Impact on the Sexual Response. Sex Med 2021;9:64–75.

  • Neuropeptide modulation of a lumbar spinal reflex: Potential implications for female sexual function

    2009, Journal of Sexual Medicine

    Neuropeptides are known to modulate female receptivity. However, even though receptivity is a spinal reflex, the role of neuropeptides within the spinal cord remains to be elucidated.

    The aims were to (i) investigate neuropeptides in the lumbosacral region; and (ii) determine how neuropeptides modulate glutamate release from stretch Ia fibers, touch sensation Aβ fibers and Aδ/C pain fibers.

    Neuropeptide modulation of the lumbosacral dorsal-root ventral-root reflex in vitro.

    Spinal cords were removed from Sprague-Dawley rats in compliance with UK Home Office guidelines. Hemisected cords were superfused with aCSF and the dorsal root (L4–S1) was stimulated to evoke glutamate release. A biphasic reflex response was evoked from the opposite ventral root consisting of a monosynaptic (Ia fibers) and polysynaptic (Aβ, Aδ/C fibers) component.

    The µ opioid receptor (MOR) agonist DAMGO inhibited the monosynaptic (EC50 0.02 ± 0.02 nM) and polysynaptic area (EC50 125 ± 167 nM) but not polysynaptic amplitude. Oxytocin and corticotrophin releasing factor (CRF) inhibited the monosynaptic amplitude (EC50, 1.4 ± 1.0 nM and EC50 4.3 ± 3.5 nM, respectively), polysynaptic amplitude (EC50 18.2 ± 28.0 nM and EC50, 9.5 ± 13.3 nM, respectively), and area (EC50 11.6 ± 13.0 nM and EC50, 2.8 ± 3.3 nM, respectively); effects that were abolished by oxytocin and CRF1 antagonists, L-368899 and 8w. Melanocortin agonists solely inhibited the monosynaptic component, which were blocked by the MC3/4 receptor antagonist SHU9119.

    These data suggest endogenous neuropeptides are released within the lumbosacral spinal cord. Melanocortin agonists, oxytocin, CRF, and DAMGO via MC4, oxytocin, CRF1, and MOR inhibit glutamate release but with differing effects on afferent fiber subtypes. Melanocortins, oxytocin, CRF, and DAMGO have the ability to modulate orgasm whereas oxytocin, CRF and DAMGO can increase pain threshold. Oxytocin and CRF may dampen touch sensation. Wilson LA, Wayman CP, and Jackson MV. Neuropeptide modulation of a lumbar spinal reflex: Potential implications for female sexual function. J Sex Med **;**:**–**.

  • Place-value of neurophysiologic tests in pelvic floor dysfunction

    2008, Neurophysiologie-Labor

    Funktionsstörungen des Beckenbodens sind außerordentlich häufig. So wird für Deutschland von über fünf Millionen Patienten mit Inkontinenz ausgegangen. Aktuell werden flächendeckend Kontinenzzentren etabliert, die eine komplette Diagnostik anbieten. Hierzu gehören selbstverständlicherweise auch die neurophysiologischen Untersuchungen, weshalb alle größeren Abteilungen diese Untersuchungen anbieten und beherrschen müssen. Dabei haben die einzelnen Untersuchungen eine sehr unterschiedliche Bedeutung und Aussagekraft. Als Screening -Untersuchung kann das EMG mit konzentrischer Nadelelektrode angesehen werden. Die Pudenduslatenz wird nur selten abgeleitet und untersucht die terminale Strecke des N. pudendus. Die Pudendus-SSEP sind einfach durchführbar und mittlerweile etabliert. Der Einsatz ist jedoch auf spezielle Fragestellungen die sensible Leitung betreffend beschränkt. Alle anderen neurophysiologischen Untersuchungen sind derzeit speziellen Fragestellungen vorbehalten.

    Dysfunctional disorders of the pelvic floor are very widespread. In Germany, more than five million people are believed to suffer from incontinence. At present, centers specializing in the field of continence and offering a full range of diagnostic measures are being established all over the country. Neurophysiological examinations are part of these measures, of course, which is why all big departments must provide for them and be familiar with them. Each of these individual examinations has its particular focus and relevance. An EMG with a concentric needle electrode, for instance, can be regarded as a screening test. The latency period of the pudendal nerve is rarely measured and determines the terminal distance of the pudendal nerve. Pudendal nerve SSEP is simple to carry out and has become an established procedure; its application, however, is restricted to particular investigations regarding sensory conduction. All other neurophysiological examinations are presently limited to specific exploration.

  • Anatomical and physiological characteristics of perineal muscles in the female rabbit

    2002, Physiology and Behavior

    Little information is available on the participation of the perineal striated muscles in female reproductive processes. Here, we describe the gross anatomy and innervation of two striated perineal muscles in the female rabbit, the bulbospongiosus (BSM) and ischiocavernosus (ISM), and analyze their reflex electromyographic (EMG) activity in response to stimulation of the perigenital skin and vaginal tract. Twenty-four mature chinchilla-breed rabbit does were used: 12 to describe the anatomy and innervation of the muscles, 9 to determine reflex EMG activity of the muscles in response to stimulation of the perigenital skin and specific levels of the vaginal tract and 3 to analyze the effect of contraction of the muscles on intravaginal pressure. Both muscles were well developed, with their fibers originating at the ischiadic arch and inserting onto the ligamentum suspensorium clitoridis. Branches of the clitoral and perineal nerves innervated the BSM and ISM, respectively. Bilateral electrical stimulation of these nerves provoked retraction of the clitoral sheath and an increase in intravaginal pressure at the level of the perineal vagina. Whereas neither muscle responded to stimulation of the perigenital skin, both were reflexively activated during mechanical stimulation of the inner walls of the perineal vagina. Prolonged cervical stimulation inhibited this reflex. Thus, in reproductive processes such as copulation and/or parturition, the contraction of these muscles may be induced during stimulation of the perineal vagina.

  • Intraoperative monitoring of the bulbocavernosus reflex: The method and its problems

    2001, Clinical Neurophysiology

    Objectives: This study evaluates the method of intraoperative neurophysiological monitoring of the bulbocavemosus reflex (BCR) with reference to stimulation and detection.

    Methods: The study was performed on a group of 65 patients, 53 men and 12 women, who underwent surgery for lower thoracic and lumbar spinal trauma, with no neurological deficit prior to or following surgery. Stimulating electrodes were placed on the dorsum of the penis or the clitoris. Single and double stimuli were used, as well as trains of 3, 4 and 5 stimuli. Detecting wire electrodes were introduced into the perianal region.

    Results: A single stimulus elicited the BCR in 50%, pairs in 75%, trains of 3 in 95%, and trains of 4 and 5 in 100% of patients. With placement of the detecting electrodes 2.5 cm deep to the skin, the BCR was detected in 13% of hemisphincters in women, and in 81% of hemisphincters in men. With controlled intramuscular placement of detecting electrodes, the BCR was detected in 97% of hemisphincters in men. With bifocal detection the BCR amplitudes were 30–312 mV (median 90), and interside amplitude ratio was 0.05–1 (median 0.66); with monofocal detection, amplitudes and interside amplitude ratio were 30–560 mV (median 200) and 0.15-1 (median 0.86), respectively.

    Conclusions: A train of 4 electrical stimuli is optimal in eliciting the BCR in anesthetized patients. The low rate of elicitability in women was most probably due to inefficient stimulation. Detection was improved by controlled intramuscular placement of electrodes. Monofocal detection yielded higher BCR amplitudes. Interside difference and interindividual variability of the BCR amplitude were considerable.

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    This is a prospective, randomized cohort study.

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Copyright © 1959 The American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

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