ELECTROPHYSIOLOGIC ASSESSMENTS IN PUDENDAL AND SACRAL MOTOR NERVES AFTER ILEAL J-POUCH-ANAL ANASTOMOSIS FOR PATIENTS WITH ULCERATIVE-COLITIS AND ADENOMATOSIS-COLI

PURPOSE: To clarify neurologic function with respect to external anal sphincter and puborectalis muscles after J configuration ileal J-pouch -anal anastomosis for patients with ulcerative colitis and adenomatosi s coli, we examined the terminal motor latency in the pudendal and sac ral motor nerve (S2-4). METHODS: Latency of the response in the extern al anal sphincter muscle following digitally directed transrectal pude ndal nerve stimulation (PNTML) and in the puborectalis muscle followin g transcutaneous magnetic stimulation of the cauda equina at the level s S2-4 (SMNLTSS) were measured in 12 patients with ileal J-pouch-anal anastomosis; they were divided into a group with continence (7 cases) and a group with soiling (5 cases). Results were compared with data ob tained from 12 patients before operation and 15 controls. RESULTS: Con duction delay of PNTML and SMNLTSS in patients with soiling was longes t, followed by delay in those without any soiling, then delay in patie nts before operation, and then controls. In addition, significant diff erences were also noted between conduction delay of PNTML in controls and those who are incontinent and experience soiling (P < 0.05 and P < 0.01, respectively), and there were significant differences also note d between conduction delay of PNTML in patients before operation and t hose who are incontinent and experiencing soiling (P < 0.05 and P < 0. 01, respectively). Conduction delay of PNTML and SMNLTSS were found in patients before operation rather than in controls. No significant dif ferences were noted between conduction delay of PNTML and SMNLTSS in p atients before operation and controls. Significant differences were al so noted between conduction delay of PNTML and SMNLTSS in patients who are incontinent and experiencing soiling (P < 0.01, respectively). CO NCLUSION: These findings support the hypothesis that soiling after thi s procedure may be partially caused by damage to pudendal and sacral m otor nerves (S2-4).