The role of electrophysiology in the evaluation of incontinence and prolapse.
OBJECTIVE
Apart from histopathology, electrophysiological methods are the only tests to reveal neuromuscular involvement in the absence of gross anatomical lesions. They have played a major role in establishing the neuromuscular lesion due to vaginal delivery as a risk factor for incontinence and pelvic organ prolapse, but there is no consensus on the usefulness of different methods. It is timely to reevaluate their validity, and their role in urogynecology.


RESULTS
The most important development is the move towards standardization of the diagnostic approach, based on computer assisted quantified techniques of concentric needle electromyography. Studies using less operator biased techniques have confirmed subtle pelvic floor muscle changes in parous women. Reports on usefulness of different tests as predictors of treatment outcome are controversial.


CONCLUSIONS
Standardization of concentric needle electromyography strengthened the position of this test as practical and informative. Neuromuscular changes following vaginal delivery have been reconfirmed, but the usefulness of particular electrophysiological tests in the individual patient needs to be further researched. Valid clinical neurophysiological methods remain valuable as research tools for incontinence and prolapse pathophysiology.
Vodusek
David B
DB
Division of Neurology, University Medical Centre, Ljubljana, Slovenia. david.vodusek@kclj.si
D004576:Electromyography; D005260:Female; D006801:Humans; D014549:Urinary Incontinence / Q000503:physiopathology*; D014596:Uterine Prolapse / Q000503:physiopathology*