[Suprapubic reflex. Electrophysiological study in normal patients].
BACKGROUND
In spinal cord injuries patients, tapping the suprapubic aera is a strong stimulus to ellicit detrusor contraction and can be used in the management of neurogenic bladder. This stimulation also determines a perineal muscles contraction. This striated response was mentionned in animal studies but never specifically analysed in men especially in normal subjects.


OBJECTIVE
Our objective was to describe pelvic floor responses with measurement of reflex latency following suprapubic mechanical stimulation.


METHODS
21 patients without neurological disease were studied. They were 14 women and 7 men. Mean age was 51 (SD=14,2). Motor responses were recorded with a needle electrode inserted in the left bulbocavernosus muscle. Stimulation was delivered with an electromechanical hammer, tapping directly on the suprapubic aera.


RESULTS
A polyphasic muscular response was always and easily elicited in all patients. Mean latency was 67,5 ms. (SD = 14,7). The reproducibility between the first and second mechanical responses was good with no statistical difference (r=0,966; p=0,0001).


CONCLUSIONS
Our study clearly demonstrates a suprapubic bulbocavernosus reflex (SBR). Many arguments can be retained for a polysynaptic reflex (polyphasic response, habituation and short latency of the reflex, mean latency in the habitual values of R2 responses following electrical stimulation of the dorsal nerve of the penis). We hypothetize that: the true stimulus is the stimulation of the bladder wall tenso-receptors; integration level of the SBR is the sacral segments and the efferent limb the pudendal nerve; afferent pathways could be vehicled by pelvic nerve fibers.


CONCLUSIONS
Competition between a preponderant (or exaggerated) SBR and a bladder contraction following suprapubic tapping, may constitute a real functional outlet obstruction giving incomplete or complete retention in some suprasacral bladders. In normal subjects, SBR can be considered as a continence reflex with increase of perineal tone following the stimulation of the bladder wall tenso-receptors during stress.
Amarenco
G
G
Service de rééducation neurologique et dexplorations périnéales, UPRES 2393, hôpital Rothschild, 33, bd de Picpus, 75571 cedex 12, Paris, France. gerard.amarenco@rth.ap-hop-paris.fr
Perrigot
M
M
Bayle
B
B
Parratte
B
B
Jaulmes
M
M
Sheikh Ismaël
S
S
Kerdraon
J
J
D000704:Analysis of Variance; D004599:Electric Stimulation Therapy; D004576:Electromyography; D004594:Electrophysiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009119:Muscle Contraction; D010264:Paraplegia / Q000150:complications; D011470:Prostatic Hyperplasia / Q000150:complications; D012018:Reflex / Q000502:physiology*; D013119:Spinal Cord Injuries / Q000150:complications; D001743:Urinary Bladder / Q000294:innervation* / Q000502:physiology; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D014549:Urinary Incontinence / Q000209:etiology / Q000534:rehabilitation; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000534:rehabilitation; D014555:Urination Disorders / Q000209:etiology / Q000534:rehabilitation*
Le réflexe pubo-caverneux. Démonstration électrophysiologique.