Clinical relevance of neurological evaluation in patients suffering urinary retention in the absence of subvesical obstruction

• Published in: Archives of gynecology and obstetrics Vol. 296; no. 5; pp. 1017 - 1025
• Main Authors: Schwertner-Tiepelmann, N., Hagedorn-Wiesner, A., Erschig, C., Beilecke, K., Schwab, F., Tunn, R.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-11-2017; Springer Nature B.V
• Subjects: Adult; Age; Chemotherapy; Diabetes; Electromyography; Electrophysiology; Endocrinology; Female; Gynecology; Human Genetics; Humans; Images in Obstetrics and Gynecology; Medicine; Medicine & Public Health; Middle Aged; Obstetrics/Perinatology/Midwifery; Odds Ratio; Perineum - innervation; Peripheral Nervous System Diseases - complications; Pudendal Nerve; Retention; Treatment Outcome; Urinary Retention - physiopathology; Vagina - innervation; Electronically stimulated pudendal nerve latency (ESPL); Pudendal terminal nerve latency (PTNL); No outlet obstruction; Electromyography (EMG); Retention; No prolapse
• ISSN: 0932-0067; 1432-0711
• DOI: 10.1007/s00404-017-4519-1

Purpose
Clinical relevance of neurological evaluation in patients suffered urinary retention in the absence of subvesical obstruction. Determining whether (1) women complaining residual bladder volume without prolapse and obstruction always suffer pudendal nerve damage; (2) neurogenic damage can be linked to patients history/clinical examination; (3) therapy alters regarding to neurological findings; and (4) electromyography (EMG) of musculus sphincter ani externus (MSAE) can be omitted with electronically stimulated pudendal nerve latency (ESPL) as the standard investigation.
Methods
Women with urinary retention without ≥stage 2 prolapse or obstruction have neurological investigation including vaginally and anally pudendal terminal nerve latency (PTNL) (>2.4 ms considered abnormal) and EMG seen 7/2005-04/2010.
Results
(1) 148/180 (82.2%) suffered at least moderate neurogenic damage and (2) severe neurogenic damage occurs with urge odds ratio (OR) = 3.1 or age (OR = 3.2). Correlations: spasticity with therapy changes (OR = 11.1), latencies. (a) Anally: (i) right and peripheral neuropathy (PNP) (OR = 2.5), chemotherapy (OR = 5.0); (ii) left and PNP (OR = 3.9), chemotherapy (OR = 4.8); (iii) left or right with PNP (OR = 3.9), chemotherapy (OR = 6.8); and (iv) left and right with chemotherapy (OR = 5.0). (b) Vaginally: (i) right with age >60 (OR = 3.2), radical operation (OR = 10.6); (ii) left with diabetes mellitus (OR = 2.5); and (iii) left or right with age (OR = 3.3), radical operation (OR = 8.7). (3) 19.6% therapy changes (36 patients). (4) Neither EMG nor ESPL can be replaced one by another (
p
 = 0.12 anal,
p
 = 0.05 vaginal).
Conclusion
Red flags are neurogenic damage, age >60, chemotherapy, PNP, radical operation or diabetes. In unclear situations, EMG and ESPL need to be performed to gain relevant information.