title: Electrophysiological assessment of sensations arising from the bladder: are there objective criteria for subjective perceptions?
abstract: OBJECTIVE
  Initial bladder filling sensation, first and strong desire to void are subjective perceptions that occur periodically during the urine storage mode of bladder function, representing sensory input from the lower urinary tract. To our knowledge methods for evaluating sensory bladder function are not available. We studied a simple electrophysiological procedure for the objective assessment of bladder sensations using sympathetic skin responses and surface pelvic floor electromyography.
  
  
  METHODS
  Informed consent was provided by 8 healthy male subjects, who were administered 20 mg. furosemide and 1 l. fluid to drink. Palmar and plantar sympathetic skin responses, and surface pelvic floor electromyogram were continuously recorded during bladder filling, voluntary pelvic floor contraction and voiding.
  
  
  RESULTS
  First desire to void evoked simultaneous sympathetic skin responses and pelvic floor contractions. This pattern appeared periodically with the desire to void sensation as well as with strong desire to void at maximum bladder capacity and it correlated well with the subjective sensation of the subjects. Voluntary pelvic floor contraction decreased the subjective intensity of the desire to void sensation as well as sympathetic skin response activity for the same short period. During voiding sympathetic skin responses almost complete absence of sympathetic skin responses was observed.
  
  
  CONCLUSIONS
  Sensations arising from the bladder induce combined activation of sympathetic skin responses and pelvic floor activity. This coherence indicates synchronized activation and inactivation of the autonomic and somatic pathways necessary for appropriate urine storage and coordinated voiding. Our observations may introduce a new approach for objectively assessing subjective sensations arising from the urinary tract.
authors.affiliation: Neurourogical Unit, ParaCare, Institute for Rehabilitation and Research, University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Reitz
authors.forename: D M
authors.initials: DM
authors.lastname: Schmid
authors.forename: A
authors.initials: A
authors.lastname: Curt
authors.forename: P A
authors.initials: PA
authors.lastname: Knapp
authors.forename: K
authors.initials: K
authors.lastname: Jensen
authors.forename: B
authors.initials: B
authors.lastname: Schurch
mesh_terms: D000328:Adult; D004231:Diuresis / Q000187:drug effects / Q000502:physiology; D004232:Diuretics / Q000494:pharmacology; D004558:Electric Stimulation; D004576:Electromyography; D005528:Foot; D005665:Furosemide / Q000494:pharmacology; D006225:Hand; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000502:physiology; D009119:Muscle Contraction / Q000502:physiology; D017773:Pelvic Floor / Q000502:physiology; D010465:Perception; D012016:Reference Values; D012018:Reflex / Q000502:physiology; D012677:Sensation; D012867:Skin / Q000294:innervation; D013564:Sympathetic Nervous System / Q000502:physiology; D001743:Urinary Bladder / Q000502:physiology*; D014554:Urination / Q000502:physiology*
chemical_list: D004232:Diuretics; D005665:Furosemide