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

Abstract

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. Women with urinary retention without≥stage 2 prolapse or obstruction have neurological investigation including vaginally and anally pudendal terminal nerve latency (PTNL) (>2.4ms considered abnormal) and EMG seen 7/2005-04/2010. (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). 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.