title: Electrophysiological evaluation of the pudendal nerve and urethral innervation in female stress urinary incontinence.
abstract: OBJECTIVE
  Although still a matter of debate, stress urinary incontinence (SUI) may be accompanied by damage to urethral and pelvic floor innervations, thus promoting dysfunctions of the urethral support and sphincteric closure mechanisms. The aim of this study was to analyze the pelvic floor and urethral innervations through pelvic electrophysiological tests to identify whether neurological alterations interfere with urinary continence and urethral functional activity.
  
  
  METHODS
  This prospective study included 52 women, 33 with clinically and urodynamically proven SUI and 19 continent volunteers matched for age, height, parity, and number of vaginal deliveries by the propensity score method. The patients were divided according to the severity of urinary loss evaluated by measuring abdominal leak point pressure (ALPP). Pudendal nerve terminal motor latency (PNTML), pudendal somatosensory evoked potential (SSEP) latencies, urethral and clitoral sensory thresholds, and urethroanal reflex latency were tested.
  
  
  RESULTS
  SUI and control subjects did not differ in PNTML, SSEP latency, and clitoral sensory thresholds. However, reduced responsiveness to urethral electrosensitivity and prolonged urethroanal reflex latency were detected in most incontinent patients. In addition, urethral electrosensitivity was altered in suspected intrinsic sphincteric dysfunction.
  
  
  CONCLUSIONS
  Urethral afferent pathways can be altered in women with SUI and may play an important role in evoking intrinsic sphincteric dysfunction.
authors.affiliation: Division of Urology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil. gacavalcanti@bol.com.br
authors.forename: Geraldo
authors.initials: G
authors.lastname: de Aguiar Cavalcanti
authors.forename: Gilberto Mastrocola
authors.initials: GM
authors.lastname: Manzano
authors.forename: Karlo Faria
authors.initials: KF
authors.lastname: Nunes
authors.forename: Lydia Maria Pereira
authors.initials: LM
authors.lastname: Giuliano
authors.forename: Tatiane Almeida
authors.initials: TA
authors.lastname: de Menezes
authors.forename: Homero
authors.initials: H
authors.lastname: Bruschini
mesh_terms: D000328:Adult; D000368:Aged; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor / Q000294:innervation*; D060525:Pudendal Nerve / Q000503:physiopathology*; D012684:Sensory Thresholds; D014521:Urethra / Q000294:innervation* / Q000503:physiopathology*; D014550:Urinary Incontinence, Stress / Q000503:physiopathology*