Abstract
To explore information hidden in the electromyographic (EMG) signals of the urethral sphincter that may be of prognostic significance for patients with primary bladder neck obstruction (PBNO), 41 patients with voiding difficulty were divided into four groups: 1) patients with primary bladder neck obstruction (PBNO) with successful (Group 1, n = 14) and 2) unsuccessful (Group 2, n = 8) surgical outcomes, 3) patients with detrusor overactivity (Group 3, n = 7), and 4) patients with detrusor-external sphincter dyssynergia (Group 4, n = 12). All patients underwent baseline urodynamic studies (preoperative for Group 1 and Group 2) for comparison. The results demonstrated that, despite no significant difference in urodynamic parameters between Group 1 and Group 2, the large-scale multiscale entropy (MSE) of preoperative EMG (i.e., MSELS(EMG)) of Group 1 was significantly higher than that of Group 2 without notable difference between Group 1 and Group 3 (i.e., patients with normal sphincter function). Moreover, the MSELS(EMG) and small-scale MSE of preoperative EMG (i.e., MSESS(EMG)) of Group 2 were notably higher than those of Group 4 (i.e., patients with abnormal sphincter function), while both MSELS(EMG) and MSESS(EMG) of Group 3 were notably higher than those of Group 2. In conclusion, using MSE analysis for assessing preoperative urethral sphincter EMG signals successfully distinguished between PBNO patients with subsequent successful surgery from those with surgical failure possibly due to subtle functional impairment of the urethral sphincter that cannot be detected by routine urodynamic studies. The results, therefore, highlight the potential clinical significance of this analytical tool in guiding urologists regarding their choice of medical versus surgical treatment for this patient population.
Highlights
Urodynamics, which examines the pressure-flow relationship between the bladder and the urethra, including the assessment of post-void residual volume, uroflowmetry, multichannel cystometry for evaluating the pressure in the rectum and in the bladder, fluoroscopy of the bladder and bladder neck during voiding, urethral pressure profilometry for evaluating the strength of sphincter contraction, and electromyography (EMG) measurement of electrical activity of external urethral sphincter (EUS), are routine physiological assessment tools for identifying the causes of urinary symptoms such as incontinence, frequency, or urgency in urination
With the knowledge that neuromuscular dysfunction plays a major role in the etiology of Primary bladder neck obstruction (PBNO) [5], the aim of the present study attempted to identify the subtle information hidden in EMG signals of the external urethral sphincter that are of prognostic significance for surgical candidates with PBNO using Multiscale entropy (MSE) analysis
Entropy 2015, 17, 8089–8098 obstruction (BOO) in video urodynamic study (VUDS) were retrospectively collected as negative controls (Group 3, n = 7), while those with complete spinal cord injury and voiding dysfunction diagnosed as having detrusor overactivity (DO) with detrusor-external sphincter dyssynergia (DESD) were retrospectively enrolled as positive controls (Group 4, n = 12)
Summary
Urodynamics, which examines the pressure-flow relationship between the bladder and the urethra, including the assessment of post-void residual volume, uroflowmetry, multichannel cystometry for evaluating the pressure in the rectum and in the bladder, fluoroscopy of the bladder and bladder neck during voiding, urethral pressure profilometry for evaluating the strength of sphincter contraction, and electromyography (EMG) measurement of electrical activity of external urethral sphincter (EUS), are routine physiological assessment tools for identifying the causes of urinary symptoms such as incontinence, frequency, or urgency in urination. Despite a success rate of the surgical treatment for the disorder as high as 87% [7], the outcome remains unsatisfactory for a significant proportion of patients for whom pre-operative urodynamic studies failed to provide useful guidance for treatment. With the knowledge that neuromuscular dysfunction plays a major role in the etiology of PBNO [5], the aim of the present study attempted to identify the subtle information hidden in EMG signals of the external urethral sphincter that are of prognostic significance for surgical candidates with PBNO using MSE analysis
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