Reliability of electrophysiologic anal tests in predicting the outcome of sacral nerve modulation for fecal incontinence
Reliability of electrophysiologic anal tests in predicting the outcome of sacral nerve modulation for fecal incontinence
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DOI：
10.1007/s10350-004-0524-0
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发表时间：
2004-06-01
影响因子：
3.9
通讯作者：
Memeo, V
中科院分区：
文献类型：
--
作者：
Altomare, DF;Rinaldi, M;Memeo, V
引言：骶神经调节已被证明是一种新的有效治疗大便失禁。通过外周神经评估初步测试该程序的有效性。骶神经通路的完整性通常被认为是一个良好的反应的必要条件，但没有数据可以确认是否电生理肛门测试是预测的周围神经evaluation.METHODS的临床结果：82失禁患者进行了周围神经评价后，充分评价肛门直肠生理。进行单变量分析，阳性预测值，灵敏度和特异性进行了计算，为每个tests.Results：46例患者的周围神经评价结果成功，并进行了永久性植入的骶骨电刺激器。60例患者进行了肛门括约肌肌电图检查，68例患者进行了阴部神经末梢运动潜伏期检查，29例患者进行了骶诱发电位检查。肛门肌电图与周围神经评估结果有统计学相关性（P = 0.0004），阳性预测值为81%，敏感性为44%，特异性为81%。右侧阴部神经末梢运动潜伏期与结果不相关，但左侧阴部神经末梢运动潜伏期弱相关（P = 0.02），尽管两种测试的阳性预测值较低，敏感性与特异性较好。诱发骶骨电位没有相关的结果，并有一个低的阳性预测值，敏感性和specificity.CONCLUSIONS：简单的肛门括约肌肌电图可以预测结果的周围神经评价具有良好的阳性预测值和特异性大便失禁患者。其他更昂贵的电生理肛门试验不能提供更多的预后信息。
INTRODUCTION: Sacral nerve modulation has been demonstrated to be a new efficacious treatment for fecal incontinence. The effectiveness of the procedure is preliminarily tested by means of a peripheral nerve evaluation. Integrity of the sacral neural pathway is generally believed to be a necessary condition for a good response, but no data are available to confirm whether electrophysiologic anal tests are predictive of the clinical outcome of the peripheral nerve evaluation.METHODS: Eighty-two incontinent patients underwent the peripheral nerve evaluation after full evaluation of the anorectal physiology. Univariate analysis was performed, and the positive predictive value, sensitivity, and specificity were calculated for each of the tests.RESULTS: Forty-six patients had successful results to the peripheral nerve evaluation and were subjected to permanent implant of a sacral electrostimulator. Anal sphincter electromyography had been performed in 60 patients, whereas pudendal nerve terminal motor latency had been assessed in 68 and evoked sacral potentials in 29 patients. Anal electromyography was statistically related to the outcome of the peripheral nerve evaluation (P = 0.0004) with a positive predictive value of 81 percent, a sensitivity of 44 percent, and a specificity of 81 percent. Pudendal nerve terminal motor latency on the right side did not correlate with the outcome, but left pudendal nerve terminal motor latency was weakly correlated (P = 0.02), although both tests had a low positive predicting value and sensitivity vs. good specificity. Evoked sacral potentials did not correlate with the outcome and had a low positive predictive value, sensitivity, and specificity.CONCLUSIONS: Simple anal sphincter electromyography can predict the outcome of the peripheral nerve evaluation with good positive predictive value and specificity in patients with fecal incontinence. Other, more expensive, electrophysiologic anal tests do not add further prognostic information.