Protocol for clinical neurophysiologic examination of the pelvic floor

Clinical neurophysiologic examination of the pelvic floor is performed worl dwide, but there is no consensus on the choice of tests, nor on technical d etails of individual methods. Standardized methods are, however, necessary to obtain their valid application in different laboratories for the purpose of collection of normative data, comparison of patient data and organizati on of multi-center studies. It is proposed that in patients with suspected "lower motor neuron" type lesions concentric needle electromyography (CNEMG ) is the most informative test to detect pelvic floor denervation/reinnerva tion, and the external anal sphincter (EAS) muscle is the most appropriate muscle to be examined (either in isolation when a selective lesion is suspe cted-or in addition to examination of other muscles). An algorithm consisti ng of standardized tests including a standardized approach to CNEMG examina tion of the EAS is presented. The proposed electrophysiologic assessment co nsists of a computer-assisted analysis of denervation and reinnervation fea tures of the CNEMG signal, a qualitative assessment of reflex and voluntary activation of EAS motor units, and of electrical (or mechanical) elicitati on of the bulbocavernosus reflex in those patients in whom manual anogenita l stimulation failed to elicit a robust response in the EAS. The proposed p rotocol could serve as a basis for further studies on validity, sensitivity and specificity of electrophysiologic assessment in patients with differen t types of "lower motor neuron" involvement of pelvic floor muscles and sac ral dysfunction. Neurourol. Urodynam. 20:669-682,2001. (C) 2001 Wiley-Liss, Inc.