The role of bulbocavernosus reflex in the diagnosis of neuropathy in patients with pelvic organ prolapse and pelvic pain syndrome


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Resumo

Aim. To investigate the clinical value of testing bulbocavernosus reflex (BCR) and the M-response during pudendal nerve stimulation electroneuromyography (ENMG) in patients with pelvic organ prolapse and neurogenic pain syndrome. Materials and methods. The study included 56patients with pelvic organ prolapse and chronic neurogenic pelvic pain managed from 2019 to 2020. The mean age of patients was 50.1 ± 11.6 years. The patients had pelvic organ prolapse in the form of rectocele [25/56 (44.6%)] and rectocele combined with internal rectal intussusception [31/56(55.4%)]. All patients underwent comprehensive examination, including physical examination, colonoscopy (to exclude organic pathology), defecography (to diagnose rectocele and internal rectal intussusception), neurophysiological study (stimulation ENMG) to measure the M-response and BCR. The statistical analysis was performed using Stata 14.2 (StataCorp). Results. Among patients with pelvic organ prolapse and neurogenic pelvic pain, 66.1% had abnormal M-response latency. Changes in BCR parameters were observed in 33.9% of patients with pelvic organ prolapse and neurogenic pelvic pain with normal M-response. In a clinical context, this observation can be interpreted as a sign of pudendal neuropathy. BCR latency was evoked in all patients and was abnormal in 92.9% of them. In 7.1% of cases of normal BCR latency, M-response latency was changed. Conclusion. Assessment of pelvic floor muscles innervation requires testing for both M-response and BCR, which allows identification of pudendal neuropathy in all patients with pelvic organ prolapse and neurogenic pelvic pain.

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Sobre autores

O. Fomenko

Ryzhikh National Medical Research Centre for Coloproctology, Ministry of Health of Russia

Email: oksana671@yandex.ru
MD, PhD, Associate Professor, Head of the Laboratory of Clinical Pathophysiology 123423, Russia, Moscow, Salama Adilya str., 2

G. Poryadin

Pirogov Russian National Research Medical University, Ministry of Health of Russia

Corresponding Member of the RAS, MD, PhD, Professor of the Department of Pathophysiology and Clinical Pathophysiology, Honorary Professor 117997, Russia, Moscow, Ostrovityanov str., 1

M. Martynov

Pirogov Russian National Research Medical University, Ministry of Health of Russia

Corresponding Member of the RAS, MD, PhD, Professor of the Department of Neurology, Neurosurgery and Medical Genetics 117997, Russia, Moscow, Ostrovityanov str., 1

V. Kashnikov

Ryzhikh National Medical Research Centre for Coloproctology, Ministry of Health of Russia

MD, PhD, Deputy Director for scientific and medical work 123423, Russia, Moscow, Salama Adilya str., 2

A. Shkoda

L.A.Vorokhobov City Hospital No 67, Moscow Health Department

MD, PhD, Professor, Head 123423, Russia, Moscow, Salama Adilya str., 2/44

V. Kozlov

Ryzhikh National Medical Research Centre for Coloproctology, Ministry of Health of Russia

Associate Professor, PhD in economics, Researcher 123423, Russia, Moscow, Salama Adilya str., 2

S. Belousova

Ryzhikh National Medical Research Centre for Coloproctology, Ministry of Health of Russia

MD, Senior Researcher of the Laboratory of Clinical Pathophysiology 1475-2599. 123423, Russia, Moscow, Salama Adilya str., 2

A. Rumyantsev

L.A. Vorokhobov City Clinical Hospital No 67, Moscow Health Department

traumatologist-orthopedist 123423, Russia, Moscow, Salama Adilya str., 2/44

S. Achkasov

Ryzhikh National Medical Research Centre for Coloproctology, Ministry of Health of Russia

MD, PhD, Professor, Head of the Department of Oncology and Colon Surgery 123423, Russia, Moscow, Salama Adilya str., 2

Bibliografia

  1. Пушкарь Д.Ю., Раснер П.И., Гвоздев М.Ю. Пролапс гениталий. РМЖ. 2013; 34: 11
  2. https://my.clevelandclinic.org/health/diseases/14737-neuropathy
  3. Antolak S.J., Antolak C.M. Chronic pelvic pain: neurogenic or non-neurogenic? Warm detection threshold testing supports a diagnosis of pudendal neuropathy. Pain Physician. 2018; 21(2): E125-35.
  4. Извозчиков С.Б. Механизмы формирования и диагностика туннельных пудендонейропатий. Журнал неврологии и психиатрии им. С.С. Корсакова. 2019; 119(11): 98-102.
  5. Коган М.И., Белоусов И.И., Шорников П.В. Нейрофизиологическая оценка пациентов с хроническим простатитом (синдром хронической тазовой боли III Б). Урология. 2012; 4: 37-43
  6. Зайцев А.В., Шаров М.Н., Пушкарь Д.Ю., Ходырева Л.А., Дударева А.А. Хроническая тазовая боль. Методические рекомендации. М.: Издательский дом «АБВ-пресс»; 2016
  7. Antolak S.J., Hough D.M., Spinner R.J. Anatomical basis of chronic pelvic pain syndrome: the ischial spine and pudendal nerve entrapment. Med. Hypotheses. 2002; 59: 349-53. https://dx.doi.org/10.1016/s0306-9877(02)00218-9.
  8. Insola A., Granata G., Padua L. Alcock canal syndrome due to obturator internus muscle fibrosis. Muscle Nerve. 2010; 42(3): 431-2. https://dx.doi.org/10.1002/ mus.21735.
  9. Possover M. Laparoscopic management of endopelvic etiologies of pudendal pain in 134 consecutive patients. J. Urol. 2009; 181(4): 1732-6. https:// dx.doi.org/10.1016/j.juro.2008.11.096.
  10. Itza Santos F., Salinas J., Zarza D., Gomez Sancha F., Allona Almagro A. Update in pudendal nerve entrapment syndrome: an approach anatomic-surgical, diagnostic and therapeutic. Actas Urol. Esp. 2010; 34(6): 500-9. https:// dx.doi.org/10.1016/s2173-5786(10)70121-9.
  11. Ramsden C.E., McDaniel M.C., Harmon R.L., Renney K.M., Faure A. Pudendal nerve entrapment as source of intractable perineal pain. Am. J. Phys. Med. Rehabil. 2003. 82(6): 479-84. https://dx.doi.org/10.1097/00002060-200306000-00013.
  12. Durante J.A., Macintyre I.G. Pudendal nerve entrapment in an Ironman athlete: a case report. J. Can. Chiropr. Assoc. 2010; 54(4): 276-81.
  13. Filler A.G. Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: imaging, injections, and minimal access surgery. Neurosurg. Focus. 2009; 26(2): E9. https:/dx./doi.org/10.3171/FOC.2009.26.2.E9.
  14. Гусев Е.И., Коновалов А.Н., Скворцова В.И., Гехт А.Б., ред. Неврология. Национальное руководство. М.: ГЭОТАР-Медиа; 2018.
  15. Stav K., Dwyer P.L., Roberts L. Pudenda l neuralgia. Fact or fiction? Obstet. Gynecol. Surv. 2009; 64(3): 190-9. https://dx.doi.org/10.1097/ogx.0b013e318193324e.
  16. Labat J.J., Riant T., Robert R., Amarenco G., Lefaucheur J.P, Rigaud J. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol. Urodyn. 2008; 27(4): 306-10. https://dx.doi.org/10.1002/nau.20505.
  17. Аполихина И.А., Миркин Я.Б., Эйзенах И.А., Малинина О.Ю., Бедретдинова Д.А. Тазовые дисфункции и болевые синдромы в практике уролога. Экспериментальная и клиническая урология. 2012; 2: 84-90.
  18. Contreras Ortiz O., Bertotti A.C., Rodriguez Nunez J.D. Pudendal reflexes in women with pelvic floor disorders. Zentralbl Gynakol. 1994; 116(10): 561-5.
  19. Contreras Ortiz O., Bertotti A.C., Rodriguez Nunez J.D. Deep pudendal reflex. Medicina (B Aires). 1994; 54(5, Pt 1): 407-10.
  20. Contreras Ortiz O., Bertotti A.C., Rodriguez Nunez J.D. Female pelvic floor reflex responses. Int. Urogynecol. J. 1994; 5: 278-82. https:/dx./doi.org/10.1007/ BF00376240.
  21. Contreras Ortiz O., Coya Nunez F. Dynamic assessment of pelvic floor function in women using the intravaginal device test. Int. Urogynecol. J. Pelvic Floor Dysfunct. 1996; 7(6): 317-20. https://dx.doi.org/10.1007/BF01901106.
  22. Benson D.R., Keenan T.L. Evalution and treatment of trauma to the vertebral column. Ints. Course Lect. 1990; 39: 578.
  23. Шилкин В.В., Филимонов В.И. Анатомия по Пирогову (Атлас анатомии человека). т. 1. Верхняя конечность. Нижняя конечность. М.: ГЭОТАР-Медиа; 2011. 548с.
  24. Niu X., Shao B., Ni P., Wang X., Chen X., Zhu B. et al. Bulbocavernosus reflex and pudendal nerve somatosensory-evoked potentials responses in female patients with nerve system diseases. J. Clin. Neurophysiol. 2010; 27(3): 207-11. https:// dx.doi.org/10.1097/WNP.0b013e3181dd4fca.
  25. Фоменко О.Ю., Ачкасов С.И., Краснопольский В.И., Мартынов М.Ю., Порядин Г.В., Попов А.А., Салмаси Ж.М., Белоусова С.В., Алешин Д.В., Козлов В.А., Федоров А.А., Некрасов М.А., Ефремова Е.С. Роль комплексного нейрофизиологического исследования в диагностике нейропатии полового нерва у пациенток с пролапсом тазовых органов и болевым синдромом. Акушерство и гинекология. 2020; 6: 72-9.
  26. Шелыгин Ю.А., Фоменко О.Ю., Николаев С.Г., Ачкасов С.И., Белоусова С.В., Мудров А.А., Алешин Д.В. Патент на изобретение «Способ определения нейрофизиологического состояния мышц тазового дна». Заявка № 2019129221/(057510) от 17.09.2019. https://yandex.ru/patents/ doc/RU2708052C1_20191203 Ссылка активна на 27.07.2020
  27. Jorge J.M., Wexner S.D., Ehrenpreis E.D., Nogueras J.J., Jagelman D.G. Does perineal descent correlate with pudendal neuropathy? Dis. Colon Rectum. 1993; 36(5): 475-83. https://dx.doi.org/10.1007/BF02050014.
  28. Olsen A.L., Ross M., Stansfield R.B., Kreiter C. Pelvic floor nerve conduction studies: establishing clinically relevant normative data. Am. J. Obstet. Gynecol. 2003; 189(4): 1114-9. https:/dx./doi.org/10.1067/S0002-9378(03)00551-9.
  29. Fall M., Baranowski A.P., Elneil S., Engeler D., Hughes J., Messelink E.J., Oberpenn F., de C. Williams A.C. Синдром хронической тазовой боли. Перевод Алымов Ю.В. Научное редактирование Коган М.И. Европейская ассоциация урологов; 2011.
  30. Tan G., Jensen M.P., Thornby J.I., Shanti B.F. Validation of the brief pain inventory for chronic nonmalignant pain. J. Pain. 2004; 5(2): 133-7.
  31. Шелыгин Ю.А., Бирюков О.М., Титов А.Ю., Фоменко О.Ю., Мудров А.А. Существуют ли предикторы результатов хирургического лечения ректоцеле? Колопроктология. 2015; 1: 64-9.
  32. Jorge J.M., Wexner S.D. Etiology and management of fecal incontinence. Dis. Colon Rectum. 1993; 36(1): 77-97. https:/dx.doi.org/10.1007/BF02050307

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