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409
Non-instrumented uroflowmetry with concomitant perineal surface electromyography: Does surface EMG help diagnose learned voiding dysfunction in women when coupled with free uroflow?
Hegde, A1
1: Center for Urogynecology and Pelvic Health
Introduction: Learned voiding dysfunction (DV) is characterized by involuntary intermittent contractions of periurethral striated sphincter/levator muscles during voiding in neurologically normal women’ and has a prevalence rate of 10.5 – 36.3% (1). Routinely used non-invasive screening tests such as uroflowmetry and post-void residual (PVR) do not provide information about pelvic floor/external sphincter activity. Though electromyography (EMG) is coupled with urodynamics, the results may be exaggerated as urodynamics is invasive and does not simulate normal voiding. Similarly videourodynamics is invasive and not widely available (2). Though uroflowmetry-EMG is used as a diagnostic tool in children, it has yet not been studied in women (1).
Objective: To evaluate whether combining non-instrumented uroflowmetry with simultaneous wireless perineal surface EMG (with voiding performed privately in the restroom using a commode with recording obtained remotely using bluetooth) helps in the diagnosis of DV in women
Methods: A prospective pilot study was conducted in 26 neurologically normal women with voiding symptoms (hesitancy, weak stream, interrupted flow, incomplete bladder emptying, straining to void or urinary retention) with/without frequency/urgency at our center in 2016-17. All patients underwent detailed history and examination (urogynecological and neurological), PVR (thrice), urine culture, upper tract USG imaging and 3-day bladder diary. Anatomical causes were ruled out with cystoscopy. When patients had full bladder, perineal surface electrodes were applied bilaterally and attached to the portable, wireless, Goby Roam (Laborie Goby, ON, Canada). They then voided in private in the rest room using a standard commode and non-invasive uroflowmetry with perineal surface EMG recording was obtained through bluetooth remotely. Multichannel urodynamics with air-charged transducers (T-Doc) was then performed in all patients who were normal anatomically.
Results: The median [interquartile range (IQR)] age and BMI were 34 (26.5) years and 23 (3.76) kg/m2 respectively. 5 (19.2%) patients were on clean intermittent catheterization 3-4 times a day out of which 4 (15.4%) patients could not void at all. All patients had normal urine culture and upper tract ultrasound imaging. Median (IQR) PVR was 125 (325) ml. The median (IQR) diurnal and nocturnal micturition episodes were 17 (9) and 3 (2) respectively. Cystoscopy revealed proximal-mid urethral scarring leading to stenosis in one patient. In all patients except the one with urethral stenosis on cystoscopy, sporadic accelerations-deceleration pattern of pelvic floor EMG was obtained on attempt to void during both the non-instrumented uroflow/EMG testing and urodynamics. During multichannel urodynamics, 5 (19.2%) patients could not void despite making an attempt and 4 (15.4%) patients had abdominal straining to void. There was urethral relaxation prior to void in 21 (80.8%) patients. Thus, 5 (19.2%) patients had both pelvic floor and external sphincter dyssynergia during void.
Conclusion: Non-instrumented uroflowmetry with surface EMG recording is a simple, non-invasive screening test that provides essential information about pelvic floor-external activity during voiding while simulating normal voiding conditions to the extent possible. This is critical in learned voiding dysfunction patients in whom privacy and voiding circumstances are essential determinants of their voiding patterns.
References: 1. Curr Urol Rep(2014) 15: 436.
- Curr Urol Rep (2012) 13: 356-62.
Disclosure:
Work supported by industry: no.
409
Non-instrumented uroflowmetry with concomitant perineal surface electromyography: Does surface EMG help diagnose learned voiding dysfunction in women when coupled with free uroflow?
Hegde, A1
1: Center for Urogynecology and Pelvic Health
Introduction: Learned voiding dysfunction (DV) is characterized by involuntary intermittent contractions of periurethral striated sphincter/levator muscles during voiding in neurologically normal women’ and has a prevalence rate of 10.5 – 36.3% (1). Routinely used non-invasive screening tests such as uroflowmetry and post-void residual (PVR) do not provide information about pelvic floor/external sphincter activity. Though electromyography (EMG) is coupled with urodynamics, the results may be exaggerated as urodynamics is invasive and does not simulate normal voiding. Similarly videourodynamics is invasive and not widely available (2). Though uroflowmetry-EMG is used as a diagnostic tool in children, it has yet not been studied in women (1).
Objective: To evaluate whether combining non-instrumented uroflowmetry with simultaneous wireless perineal surface EMG (with voiding performed privately in the restroom using a commode with recording obtained remotely using bluetooth) helps in the diagnosis of DV in women
Methods: A prospective pilot study was conducted in 26 neurologically normal women with voiding symptoms (hesitancy, weak stream, interrupted flow, incomplete bladder emptying, straining to void or urinary retention) with/without frequency/urgency at our center in 2016-17. All patients underwent detailed history and examination (urogynecological and neurological), PVR (thrice), urine culture, upper tract USG imaging and 3-day bladder diary. Anatomical causes were ruled out with cystoscopy. When patients had full bladder, perineal surface electrodes were applied bilaterally and attached to the portable, wireless, Goby Roam (Laborie Goby, ON, Canada). They then voided in private in the rest room using a standard commode and non-invasive uroflowmetry with perineal surface EMG recording was obtained through bluetooth remotely. Multichannel urodynamics with air-charged transducers (T-Doc) was then performed in all patients who were normal anatomically.
Results: The median [interquartile range (IQR)] age and BMI were 34 (26.5) years and 23 (3.76) kg/m2 respectively. 5 (19.2%) patients were on clean intermittent catheterization 3-4 times a day out of which 4 (15.4%) patients could not void at all. All patients had normal urine culture and upper tract ultrasound imaging. Median (IQR) PVR was 125 (325) ml. The median (IQR) diurnal and nocturnal micturition episodes were 17 (9) and 3 (2) respectively. Cystoscopy revealed proximal-mid urethral scarring leading to stenosis in one patient. In all patients except the one with urethral stenosis on cystoscopy, sporadic accelerations-deceleration pattern of pelvic floor EMG was obtained on attempt to void during both the non-instrumented uroflow/EMG testing and urodynamics. During multichannel urodynamics, 5 (19.2%) patients could not void despite making an attempt and 4 (15.4%) patients had abdominal straining to void. There was urethral relaxation prior to void in 21 (80.8%) patients. Thus, 5 (19.2%) patients had both pelvic floor and external sphincter dyssynergia during void.
Conclusion: Non-instrumented uroflowmetry with surface EMG recording is a simple, non-invasive screening test that provides essential information about pelvic floor-external activity during voiding while simulating normal voiding conditions to the extent possible. This is critical in learned voiding dysfunction patients in whom privacy and voiding circumstances are essential determinants of their voiding patterns.
References: 1. Curr Urol Rep(2014) 15: 436.
- Curr Urol Rep (2012) 13: 356-62.
Disclosure:
Work supported by industry: no.