Dissociation between electrical and mechanical bulbocavernosus reflexes
Dissociation between electrical and mechanical bulbocavernosus reflexes
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DOI：
10.1002/nau.10123
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发表时间：
2003-01-01
影响因子：
2
通讯作者：
Kerdraon, J
中科院分区：
文献类型：
--
作者：
Amarenco, G;Ismael, SS;Kerdraon, J
目的：记录机械刺激阴茎或阴蒂引起的球海绵体肌的反射运动反应，并比较正常人的左右反射通路，然后比较各种神经系统疾病的电反应和机械反应。研究方法：研究了两组患者：22例无神经系统疾病的患者被视为正常受试者; 25例神经系统疾病患者（3例多发性硬化症，6例脊柱裂，9例脊髓圆锥综合征，3例周围神经病变，2例腰骶病变，1例多系统萎缩，1例脊髓灰质炎）。在阴茎基部或阴蒂处顺向刺激阴茎背神经可诱发球海绵体肌电反射（EBCR）。机械球海绵体肌反射（MBCR）是由一个机电锤，直接在阴蒂区或阴茎头腹侧部分轻拍。对于EBCR和MBCR，球海绵体肌收缩在左侧和右侧连续记录，在视觉引导下插入针头。结果：平均左侧机械潜伏期为31.7毫秒（SD = 4.5），右侧为31.6毫秒（SD = 3.8）。反应的重现性极好（P < 0.0001）。左、右锁骨之间的平均差异为2 msec（SD = 1.2）。在神经系统组中，22例EBCR（6例右侧，9例左侧，7例双侧）和19例MBCR（8例右侧，9例左侧，2例双侧）被认为异常。神经系统病变（下运动神经元病变）患者的平均反射潜伏期比正常受试者在统计学上更长（P < 0.0001）。在15/25例（60%）病例中观察到MBCR和EBCR之间的准确一致性（病变侧），在3/25例（12%）病例中观察到不一致性（存在骶反射改变），在7/25例（28%）病例中，两种技术之间存在显著差异。结论：MBCR可以提供一个很好的替代电刺激，并可用于评估泌尿系统疾病时，神经病因是可疑的。然而，MBCR的假阴性的存在表明它可能更有用作为筛查试验。
Aims: To record reflex motor responses, elicited by mechanical stimulation of the penis or clitoris, in each bulbocavernosus muscles and to compare left and right reflex pathways in normal subjects, then to compare electrical and mechanical responses in various neurological diseases. Methods: Two groups of patients were studied: 22 patients without neurological disease considered as normal subjects; and 25 patients with neurological disease (three multiple sclerosis, six spina bifida, nine conus medullaris syndrome, three peripheral neuropathies, two lumbosacral lesions, one multi-system atrophy, and one syringomyelia). Electrical bulbocavernosus reflex (EBCR) was evoked by orthodromic stimulation of the dorsal nerve of the penis at the penile base or the clitoris. Mechanical bulbocavernosus reflex (MBCR) was elicited with an electromechanical hammer, tapping directly on the clitoris zone or on the ventral part of glans penis. For EBCR and MBCR, bulbocavernosus muscle contractions were successively recorded in the left and in the right side with a needle inserted under visual guidance. Results: Mean left mechanical latency was 31.7 msec (SD = 4.5) and right one 31.6 msec (SD = 3.8). The reproducibility of the responses was excellent (P < 0.0001). The mean difference between left and right latencies was 2 msec (SD = 1.2). In the neurological group, 22 EBCR (six right, nine left, seven bilateral) and 19 MBCR (eight right, nine left, two bilateral) were considered abnormal. The mean reflex latencies in patients with neurological lesions (lower motor neuron lesions) were statistically longer (P < 0.0001) than in normal subjects. Exact concordance (side of lesion) between MBCR and EBCR was observed in 15/25 cases (60%), poor concordance (presence of a sacral reflex alteration) in 3/25 (12%) cases, and in 7/25 (28%) cases there was a significant difference between the two techniques. Conclusions: MBCR may provide a good alternative for electrical stimulation and can be used to evaluate urinary disorders when a neurological etiology is suspected. However, the presence of false negatives with MBCR suggest that it may be more useful as a screening test.