64. Predictive value of neurophysiological testing and the importance of multidisciplinary approach in the pelvic floor disorders

Abstract

To evaluate the sensitivity/specificity and predictive value of neurophysiological battery in pelvic floor disorders and underlines the importance of a multidisciplinary approach. From 2008 to 2014, 72 patients came to our attention for urinary (41/72), ano-rectal (25/72), erectile (12/72) disturbances. 47 subjects with suspected pudendal neuralgia were included as controls. All subjects were submitted to neurological/perineal examination and neurophysiological battery. In selected cases, other exams (video-urodynamics, defecography, pelvic floor MRI, etc.) were performed in order to clarify the pathophysiology of the disorders. Upper and lower limits of normal values were collected and compared to patients’ data. Sensitivity, specificity, positive and negative predictive values were also calculated for each one neurophysiological test. 35/72 patients were affected by neurological disease (20 LMND, 15 UMND), while 22 presented urological/ anorectal disorders. CNEMG and sacral reflexes detected the higher sensitivity and predictive value for LMND. Multidisciplinary approach and neurophysiological testing were essential to explain the pathophysiology of symptoms in patients with a clear diagnosis. Multidisciplinary approach actually detects a key role in the management of pelvic floor disease, while a specific protocol is optimal in order to increase the sensitivity and predictive value of neurophysiological tests in perineal disorders.