Vaginal pudendal nerve stimulation: a new technique for assessment of pudendal nerve terminal motor latency.

BACKGROUND: To evaluate vaginal stimulation of the pudendal nerve, a new method for investigation of pudendal nerve terminal motor latency (PNTML) and to assess the reproducibility of the method. METHODS: Thirteen healthy women and 11 female patients, median age 31 years (range 21-53 years), participated in the study. Ten patients had sustained an anal sphincter rupture and one had idiopathic anal incontinence. Pudendal nerve terminal motor latency was measured after vaginal stimulation of the pudendal nerve with motor response from the pelvic floor and rectal stimulation with motor response from the anal sphincter using the St. Marks pudendal electrode. The women were stimulated by two observers both vaginally and by the rectum. RESULTS: Vaginal PNTML for observer 1 was 2.06 msec (0.50 msec, 2 s.d.) and 2.04 msec (0.55 msec, 2 s.d.) for observer 2, while rectal PNTML was 1.99 msec (0.56 msec, 2 s.d.) and 1.97 msec (0.54 msec, 2 s.d.) respectively. The difference between vaginal and rectal PNTML was 0.065 msec for observer 1 (p = 0.106) and 0.070 msec for observer 2 (p < 0.05). Degree of agreement between vaginal and rectal PNTML was 80%-116% for observer 1 and 84%-12% for observer 2 (100% represent total agreement between measurements). Interobserver reproducibility for vaginal PNTML was 90%-109% and 86%-113% for rectal PNTML. CONCLUSION: In clinical practice vaginal PNTML may replace rectal PNTML in women. Reproducibility is in the same range as for rectal PNTML.

Assessment of lower urinary tract symptoms in women by a self-administered questionnaire: test-retest reliability.

A self-administered questionnaire assessing female lower urinary tract symptoms and their impact on quality of life is described and validated, on 56 females in six participating departments. The patients answered two identical questionnaires on separate occasions before treatment. Test-retest reliability of the questionnaire, correlation between the symptoms and their troublesomeness, and the reproducibility of this correlation were assessed. The percentage of mistakes in answers to each of the questions varied from 1.8% to 49.1%, mainly owing to missing answers in the item groups: appliances, sexual function and social activities. Test-retest showed a repeat frequency of 50.0%-91.0% for symptoms and 44.6%-82.1% for trouble. A highly significant positive correlation was found between symptoms and trouble, which was most pronounced for questions concerning pain and incontinence. This correlation was consistent within time. The primary validation of this questionnaire is good. Its relevance as a basis for medical priority and clinical decision making remains to be investigated.

Dynamic anal manometry in the assessment of patients with obstructed defecation.

Patients with obstructed defecation show no consistent abnormalities when assessed by standard anorectal physiologic methods. With a recently developed technique for dynamic anal manometry, we studied 13 female patients with obstructed defecation and 20 healthy volunteers. Seven parameters of anal function were measured. There were no differences between the median values for the two groups. Seven patients (54 percent; 95 percent confidence limits, 25-81 percent) had anal compliance below the normal range, either during opening or closing of the sphincter at rest (five patients), during squeeze (one patient), or both (one patient). Opening and closing pressures of the sphincter at rest, maximal closing pressure during squeeze, and anal hysteresis were normal. Standard anal manometry did not show any differences between patients and controls. Rectal compliance was lower in patients with obstructed defecation, median difference 5 ml/cm H2O (95 percent confidence limits, 1-9 ml/cm H2O). In conclusion, the more detailed method of dynamic anal manometry shows that some patients with obstructed defecation have a less compliant anal sphincter and a less compliant rectum, but in many patients no abnormal findings can be made.

Rectal compliance in the assessment of patients with fecal incontinence.

Rectal compliance (dV/dP) was studied in 31 patients with fecal incontinence, 8 patients with constipation, and 16 control subjects. Patients with fecal incontinence experienced a constant defecation urge at a lower rectal volume and also had a lower maximal tolerable volume and a lower rectal compliance than control subjects (median 126 vs. 155 ml, 170 vs. 220 ml, and 9 vs. 15 ml/mm Hg, respectively; P less than 0.05). Constipated patients had a higher constant defecation urge volume and maximal tolerable volume than controls (median, 266 ml and 300 ml; P less than 0.05). There was no differences in the parameters between patients with idiopathic fecal incontinence and patients with incontinence of traumatic origin, indicating that a poorly compliant rectum in patients with fecal incontinence may be secondary to anal incontinence due to the lack of normal reservoir function.