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Anal emg and urodynamic testing

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Descarga gratuita de video nuevo sexo indio. Chicas que quieren sexo en Worcester. gratis sexo erotica dos anos 50. nuevo adolescente porno más caliente. mujeres desnudas solo en casa fotos xxx. Milf necesita sexo en Novigrad. tante de cine bugilsex x. video porno en línea observable. Anorectal manometry also called rectal manometry, ARM, or AM - Anorectal Anal emg and urodynamic testing is a test that evaluates bowel function in patients suffering from fecal incontinence or chronic constipation. The technique uses a small balloon in the rectum to distend the Anal emg and urodynamic testing and looks at: See Figure 1 showing a balloon. Anorectal manometry is a very important diagnostic tool used in the full and proper assessment of fecal incontinence and chronic constipation. The anal please click for source the rectal area contains specialized muscles that regulate the proper passage of bowel movements. Normally, when stool enters the rectum, the anal sphincter muscle tightens to prevent passage of stool at an undesirable time. If this muscle is weak or does not contract in a timely way, incontinence leakage of stool may occur. Sphincter muscles can be weakened for many reasons, and some are 1 tearing or partial tearing of the sphincter muscle, 2 spinal cord injuries, and 3 prior surgery complications. Normally, when a person pushes or bears down to have a bowel movement, the anal sphincter muscles relax. This will cause the pressures to decrease allowing evacuation of stool. If the sphincter muscles tighten when pushing, this could contribute to constipation. Anal manometry measures how strong the sphincter muscles are and whether they relax as they should during passing a stool. The patient then is asked to relax, squeeze and push Anal emg and urodynamic testing different times. Anal sphincter EMG confirms the proper muscle contractions during squeezing and muscle relaxation during pushing. In people who paradoxically contract the sphincter and pelvic floor muscles, the tracing of electrical activity increases, instead of decreasing, during bearing down to simulate a bowel movement defecation. College lesbo strapon banged during hazing Chanel preston loves herself some hot anal se.

imágenes de dibujos animados Anal emg and urodynamic testing dentista. Acta Belg Med Phys. Oct-Dec;13(4) Electromyography of the external anal sphincter muscle during urodynamic testing in children with. Baseline urodynamic testing (free uroflowmetry, filling cystometry, and EMG electrodes were placed at the time of rectal catheter insertion.

Sphincter EMG studies the bioelectric potentials generated in the distal striated.

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Urodynamic and EMG trace recordings displaying anal sphincter EMG: the. induced electrical activity of the nerve-muscle unit or to test nerve conductivity. EMG of the anal included EMG of the anal sphincter into the urodynamic. Key words: Urodynamic studies; Neurogenic bladder; Electromyography.

the Anal emg and urodynamic testing of CMG-anal EMG studies Anal emg and urodynamic testing normal persons when there is a rise in. Anorectal manometry is a very important diagnostic tool used in the full and proper assessment of fecal incontinence and chronic constipation. The anal and the rectal area contains specialized muscles that regulate the proper passage of bowel movements.

iranian sex Watch Xxx beautyfull girll video download Video Boobs sexey. Thus, patients with spinal cord injury, with neurologic disorders e. In this last group, there is evidence that involuntary muscle fiber activity preventing sphincter relaxation may have a hormonal etiology associated with polycystic ovarian disease Fowler, ; Fowler et al. Thus, there is limited role for EMG or kinesiologic studies in the routine urodynamic evaluation of incontinent or obstructed patients in whom neuropathy is not suggested by other clinical findings. However, if detrusor is relevant to sphincter urodynamically, it is very helpful to use standard urodynamics to evaluate synergia or dyssynergia, in coordination or discoordination. We think video-urodynamics should be used for more sophisticated cases. In patients who complained of symptoms of frequency or urge may actually suffer from sphincter overactivity or dysfunctional voiding, to which baclofen a GABA-ergic receptor agonist may be administered as a rational option and obtain good response in this case. It was quantitatively analyzed using the TL value, which was successfully applied in a series of assessment. We had conducted a randomized double-blind placebo-controlled crossover trial in 60 women with dysfunctional voiding and LUTD from January to January ; patients were randomly assigned either baclofen 10 mg three times daily, then matching placebo for 4 weeks, or matching placebo then baclofen 10 mg three times daily for 4 weeks, separated by a 2-week washout period. Female patient with dysfunctional voiding Fig. These encouraging results suggest that baclofen could be used to treat dysfunctional voiding in women Xu et al. A female patients aged 42 years old, who complained of urinary frequency for 3 years, was diagnosed as having dysfunctional voiding with a TL value of —0. In order to determine the prevalence of dysfunctional voiding in female SUI and its modification after tension-free vaginal tape TVT procedure, three hundred and sixty women with SUI were enrolled and underwent urodynamics from to Dysfunctional voiding was determined when non-neurogenic detrusor-sphincter dyssynergia occurred during voluntary voiding Fig 6 b. The distribution of other urodynamic variables was also evaluated. One hundred and fifty patients underwent the TVT procedure and forty of them were studied with urodynamics after anti-incontinence surgery of TVT during follow up. Overall, dysfunctional voiding was diagnosed in ninety-nine patients Fig 6 b , with a prevalence of The functional profile length in SUI women with dysfunctional voiding was significantly shorter than that in SUI women without dysfunctional voiding Fig 6 a 3. After the TVT procedure, the recovery of SUI between cases with and without dysfunctional voiding showed no significant difference. The rate of dysfunctional voiding state change after the surgery, namely from with to without dysfunctional voiding or from without to with dysfunctional voiding, significantly differed between the female patients with and without dysfunctional voiding The dysfunctional voiding improved after the surgery in SUI women with dysfunctional voiding. Dysfunctional voiding might represent a coexistent finding in women with SUI. The main difference of women with SUI and dysfunctional voiding, as compared with those without dysfunctional voiding, was a shortened functional profile length. Urodynamic studies on a female patient with stress urinary incontinence SUI without dysfunctional voiding as indicated by solid arrows DV a and another female patient with SUI and DV as indicated by dashed arrows b before the tension-free vaginal tape TVT procedure. If they complained of daily or nocturnal enuresis, the symptoms may be worse than before. This is a critical time point for them. Surgical intervention may be mandatory. Although the voiding reflex remains or detrusor is intact, the detrusor function has declined gradually since incontinence occurs. Between May and March , a total of patients underwent urodynamic examination Life-Tech Urovision Janus V in this institute. Among them, male patients old than 45 years with obstructive symptoms were analysed. Among them, there were 15 patients with lower compliance and intact detrusor, and 15 patients with lower compliance and detrusor underactivity enrolled into this trial. Their urodynamics and surgical outcome were compared between the two groups. Routine endoscopic surgeries were carried out for them and those with lower compliance and intact detrusor gained better recovery thereafter as compared with those with detrusor underactivity Xu et al. The main improvement was disappearance of enuresis and increased peak flow rates during follow-up. Male patients older than 45 years old complained of obstructive symptoms and nocturnal enuresis should routinely take comprehensive urodynamics. If they were diagnosed with decreased bladder compliance and intact detrusor, surgical intervention is a mandatory option. If they accept the surgical option, their prognosis is very well as compared with those with detrusor underactivity. Nephrogenic diabetes insipidus with dilatation of upper urinary tract and bladder is rarely reported. Urinary tract dilatation and bladder dysfunction, usually in the form of a large, atonic bladder, are commonly believed to be secondary to high urine output. Low bladder compliance means an abnormal volume and pressure relationship, and an incremental rise in bladder pressure during the bladder filling. It is well known that at the time bladder capacity decreases, intravesical pressure increases, and the risk of upper deterioration increases. Hypocompliance is usually thought to be the range from 1. Though the exact cause of hypocompliance is not known, it may be caused by changes in the elastic and viscoelastic properties of the bladder, changes in detrusor muscle tone, or combinations of the two Park, The lower bladder compliance patterns could be classified into three groups Cho et al. Group A gradual increase had the highest correlation with the presence of spinal cord injury. Group B terminal increase patients had a history of direct pelvic treatment such as radical prostatectomy and pelvic irradiation. Group C abrupt increase and plateau was positively correlated with the presence of detrusor overactivity and nocturnal enuresis. We found that children with polyuria, nocturnal enuresis and MRI-confirmed pituitary abnormality hypointensities on T1-weighted MRI and diabetes insipidus usually had hydroureteronephrosis, enlarged bladder capacity and lower bladder compliance at second-half storage phase. Their bladder compliance pattern belonged to terminal increase type as classified by Cho et al. Their detrusor and sphincter function had to be evaluated carefully as the first procedure. If the detrusor could contract and sphincter could relax during the voiding phase, the prognosis is good Fig. Che et al described 5 patients with nephrogenic diabetes insipidus whose first presentation was bilateral hydroureteronephrosis and chronic renal insufficiency Che et al, Between May and March , 5 boys came to our clinic with complaint of polydipsia and polyuria 4 , bilateral flank pain 2 , and fatigue 2. Ultrasonic scan found bilateral hydroureteronephrosis in all 5 patients and blood creatinine test showed renal insufficiency. Fluid deprivation test were performed and according to the results they were diagnosed as nephrogenic diabetes insipidus. All patients were catheterized for 7 to 18 days till blood creatinine level decreased as normal. Urodynamics showed that the mean values of the bladder capacity, detrusor pressure at the mid and end of filling, maximum flow rate Qmax , and PVR were ml, These results reminded us all these patients had a lower. A male patient aged 65 years old, who complained of poor-weak flow and urinary frequency for 5 years and nocturial enuresis for the last 5 months, was confirmed as having bladder outlet obstruction and lower bladder compliance as indicated by dashed arrow, however, his detrusor and sphincter function was still intact with detrusor-sphincter synergia as indicated by solid arrows a, b , and his symptoms at follow-up recovered 6 months after a successful TURP with a normal flow rate and compliance thereafter as indicated by solid arrow c, d. Given that the detrusor and sphincter function well as displayed on EMG, operation or desmopressin are rational option for patients with obstruction or diabetes insipidus. The patients had taken desmopressin acetate 0. And after a follow of 4 to 12 months, renal function remained normal and PVR was reduced. Nephrogenic diabetes insipidus should be considered in patients with dilatation of the urinary tract and polyuria. A lower compliance at second-half storage phase may contribute to the dilatation of urinary tract. Normal detrusor contractility with large PVR is a unique manifestation of this condition. A male patient aged 15 years old, complaining of pelvic pain and polyuria for more than 5 years, was found with hydroureteronephrosis and atrophy of the posterior lobe of the pituitary gland hypointensitites on T1-weighted MRI of the pituitary gland. His functional bladder capacity reached ml, and lower bladder compliance was terminal at a bladder volume of ml as indicated by dashed arrow, whereas his detrusor contracted and sphincter relaxed normally when he initiated a voiding reflex as indicated by solid arrows. Whether the operation succeeds or not depends upon exhibition of detrusor contraction and still remaining of detrusor and external sphincter dyssynergia. Theoretically, this type of neuro-anastomosis could not reverse dyssynergia. There were three kinds of neuro-anastomosis for patients with neurogenic LUTD due to spinal cord injury in China with intercostals nerve: They are: Creation of microsurgical anastomoses between T12 and S2 ventral roots a. Drawing showing creation of microsurgical anastomoses between S-1 and S-2 ventral roots b. Reproduced from Lin and Hou , Neurosurgery We have shown the detrusor contraction and sphincter overactivity in some patients suffered from spinal cord injury who received a successful procedure of artificial somatic-autonomic reflex pathway T10 anastomosed to S2 for bladder control in this institution. One of them with neurogenic detrusor underactivity and sphincter overactivity due to L1 fracture received operation of neuroanastomosis nine years ago. Her spontaneous voiding pattern recovered 1 year later and continued to be normal thereafter. Urodynamic follow-up data showed clearly detrusor contraction and some degree of external sphincter dyssynergia Fig Whereas in the papers of other authors, who used surface patch electrode, which was inferior to CNE for EMG documentation of urethral sphincter relaxation during voiding phase Mahajan et al. A female patient aged 46 years old, complained of paraplegia due to fracture of L1 for 9 yeas, urodynamic study before the procedure a , 5 years b and 9 years c after successful artificial somatic-autonomic reflex pathway procedure showed that detrusor was underactive before the operation as dashed arrows indicated , and after the procedure, detrusor became contractile and detrusor-sphincter dyssynergia still remained as solid arrows indicated. Voluntary voiding and bladder emptying was satisfactory with detrusor contraction and without abdominal straining. EMG, electromyogram; I. Vol, infused volume; Pabd, abdominal pressure; Pdet, detrusor pressure; Pves, vesical pressure; Q, flow rate; Qvol, uro volume. Such condition is characterized by a low sustained or wave-like contraction and is associated with poor flow or no flow at all. During conventional urodynamic measurements, adequate emptying of the bladder, without a detrusor contraction is possible in two ways. Firstly, in females who can have a very good relaxation of the pelvic floor; in this case, hardly any detrusor contraction is needed for complete voiding Fig. Secondly, in patients using abdominal straining without simultaneous sphincter relaxation to empty their bladder Fig. Of the 25 patients with a suspected acontractile detrusor based on the conventional urodynamic measurements data, 21 patients had multiple detrusor contractions during voiding attempts on ambulatory urodynamic measurements during normal daily life activities. Four patients even showed overactive detrusor contractions on their ambulatory urodynamic measurements. This implies that the symptoms of these patients must have been due to other factors such as pelvic muscular nonrelaxation, psychological reasons or obstruction. In order to display abdominal straining, the anal catheter must be fixed firmly so as to avoid its exodus from the anus. The female patient had better to change the position from supine to sitting. Sitting position was more normal than supine. Xu et al. Detrusor underactivity in women: She finished urination fluently even without detrusor contraction and her sphincter relaxation was complete as indicated by solid arrows a , another female aged 73 years old, complained of poor-weak flow and pain with voiding for 4 years b. She was found passing urine by using abdominal straining without simultaneous sphincter relaxation to empty their bladder b. In order to study the efficacy of low-frequency electrotherapy LFE for female patients with an early stage DUA due to neuromuscular deficiency, we have conducted a conservative treatment program to patients with DUA. Tokyo, Japan. Patients received two treatment sessions each lasting for 70 min daily for two weeks. Comprehensive urodynamic evaluations were performed in each patient prior to the LFE as the baseline and at 4 weeks following the procedure. The pattern of their detrusor contraction changed from low sustained contraction in 5 cases , or wave-like contraction 13 cases to normal parabola contraction. The dashed arrows indicate normal compliance and solid arrows indicate the state of the detrusor contractility and the sphincter relaxing ability during voiding phase. There exists discrepancy between symptomatic and urodynamic findings in patients with LUTD. So we should not let this prevent us from furthering our disease awareness via the use of physiological tests including urodynamics combined with sphincter EMG Agur et al. NICE, However, in a retrospective study of women with urinary incontinence, Agur W et al found that only 5. These strict criteria did not ensure that all women with potentially important urodynamic findings were evaluated accordingly. The symptomatic assessment had a sensitivity of only Agur et al. Furthermore, even the symptom location of the patients is usually very factitious and sometimes vague and so clinical investigation is necessary. Because excluding the large number subjects with straining and interrupted voiding patterns did not significantly alter EMG values, for improved generalizability we included these subjects in our qualitative EMG analyses. This graph demonstrates that EMG values were generally higher during flow than during fill. Black bars present median EMG values for all subjects in which all 10 time-points were annotated, gray bars present median EMG values for the 42 of these subjects with neither straining nor interrupted flow. Error bars: Similar analysis comparing uroflow start during flow and variables during fill yielded similar results data not presented. Overall, EMG was active more than half the time in most signals Subjectively, average EMG activity during flow was higher than fill in more than half of subjects. Specifically, EMG amplitude was higher during flow than fill in Of the subjects with interpretable EMG signals, 24 7. In Table IV , we compared rates of postoperative voiding dysfunction in subjects with different quantitative and qualitative EMG measures. This analysis of a large multi-institutional surgical trial on neurologically normal women with stress predominant urinary incontinence evaluated EMG signals during standardized preoperative urodynamics. EMG activity measured by perineal surface electrodes increased more during voiding than during bladder filling in more than half of patients. These findings were the opposite observation of what we expected, namely that the urethral sphincter should relax during the voiding phase. This failure to relax classically would indicate either occult neurologic disease or dysfunctional voiding, and these findings should warn of an increased risk of postoperative voiding dysfunction in these patients. However, these patients did not have neurological disease, nor did they have a high rate of postoperative voiding dysfunction. This large study using many urodynamic laboratories following a standardized urodynamic protocol questions the role of preoperative surface EMG monitoring in patients with stress predominant urinary incontinence. The primary objective of EMG during preoperative urodynamic testing in patients with incontinence is to predict those patients who have uncoordinated sphincter activity and may experience postoperative voiding dysfunction. Failure to relax the urethral sphincter with voiding indicates detrusor—sphincter dyssynergia, associated with supra sacral neurologic disease, or in the absence of neurologic disease suggests pelvic floor hyperactivity or dysfunctional voiding. It is unusual for patients without a history of neurologic disease or abnormal neurologic evaluation of the perineum and extremities to have uncoordinated voiding. Contemporary urodynamic testing of the incontinent female has used surface EMG monitoring. Skin patch electrodes are easy to use, more comfortable than needle electrodes, and allow the patient to move from a standing to sitting position. However, surface EMG electrode signals are often attenuated by intervening soft tissue, particularly if the muscle being studied is more than 10 mm from the skin surface as is the case between the skin near the anus and the urethral sphincter, and they record from wide areas of muscle territory. We did not standardize the surface EMG patches to any specific company or specify the exact placement of the EMG patches, but we do not think this non-standardization limits our results or conclusions because each patient served as their own baseline reference for comparative values obtained during the fill and flow. Skin patch EMG electrodes may not be sensitive and specific for urethral muscle and may reflect a sampling of various muscles in the perineum, pelvis, or buttocks. This phenomenon was described in a study of surface EMG to measure soleus and gastrocnemius muscle activity, in which a significant portion of the signal arose from adjacent or deeper muscles. The results of that study suggested that no surface EMG electrode could measure a single muscle if others are in reasonable proximity. A further analysis comparing voiding phase uroflow start and variables during the bladder filling phase yielded similar lack of relaxation. We suspect that surface perineal electrodes are recording activity from other muscle groups, or other artifacts, and not demonstrating the relaxation of the pelvic floor or urethral sphincter activity during voiding. We evaluated whether the change in position from standing to sitting could introduce artifact that increased EMG amplitudes compared to filling cystometry. EMG activity after patient movement from standing maximal cystometric capacity to sitting pressure flow baseline returned to approximately baseline suggesting that the position change was not the reason for the elevated EMG values seen during voiding. Whether the increased EMG activity with voiding reflected situational failure of patients to relax their pelvic floor or discomfort with the catheter or the testing is uncertain, but it would be test- or patient-specific, and still does not offer any prognostic on postoperative voiding dysfunction. EMG activity in this study did not predict the 7. The main strength of this study is the large number of quality EMG tracings from multiple institutions following a rigorous standardized urodynamic protocol. A weakness of this study is the large number of UDS that were not evaluated in this EMG analysis because these studies did not meet our predetermined quality and validity criteria for pressure measurements. Another weakness could be that we did not standardize the type of EMG surface electrodes or their placement. However, all subjects served as their own baseline reference for comparison in our analysis, so this should not have produced any bias. EMG activity measured by perineal surface patch electrodes did not measure the expected pelvic floor and urethral sphincter relaxation during voiding. It is not likely that over half of the patients in a multi-center surgical trial for SUI have either occult neurologic disease or pelvic floor dyssynergia. Our data question the role of preoperative EMG monitoring with surface perineal electrodes during urodynamic testing in neurologically normal patients with stress predominant urinary incontinence. Neurourol Urodyn. Author manuscript; available in PMC Jul Anna C. Kirby , 1 Charles W. Litman , 2 Mary P. Charles W. Heather J. Mary P. Kimberly J. Copyright notice. The publisher's final edited version of this article is available at Neurourol Urodyn. See other articles in PMC that cite the published article. Abstract Aims To describe perineal surface patch electromyography EMG activity during urodynamics UDS and compare activity between filling and voiding phases and to assess for a relationship between preoperative EMG activity and postoperative voiding symptoms. Methods women underwent standardized preoperative UDS that included perineal surface EMG prior to undergoing surgery for stress urinary incontinence. Conclusions Perineal surface patch EMG did not measure expected pelvic floor and urethral sphincter relaxation during voiding. Average resting pressure is recorded using the advanced diagnostic equipment. Above 40 mmHg is normal for resting pressure. Also, average squeeze pressure will be recorded. Greater than mmHg is normal for average squeeze pressure. Anal canal length is also typically measured. Normal anal canal length is 3 to 4 centimeters. Figure 2 below shows both the average and maximum pressure measurements and how they would typically appear on a complete anorectal manometry summary report. With the patient in a semi-recumbent position, the inserted rectal balloon will be slowly filled with water to assess and record the following rectal sensations: For a normal patient, the first sensation will normally be reported between 10 and 60 milliliters; the first urge to defecate should manifest at 10 to milliliters of filling; and the maximum tolerable rectal volume will range from to milliliters. The rectoanal inhibitory reflex is a response of the internal anal sphincter to rectal distention. The transient relaxation of the internal anal sphincter in response to rectal distention plays an important role in the continence mechanism. During the anorectal manometry test the patient will be placed in a semi-recumbent position and the rectoanal inhibitory reflex will be assessed as the water or air-filled catheter is inflated. A normal reflex should occur between 10 and 30 milliliters. The balloon expulsion test provides an assessment of the patient's ability to evacuate artificial stool during simulated defecation within the laboratory environment. For the balloon expulsion test, a small balloon as seen above in Figure 1 is inserted into the rectum and then inflated with approximately 50 ml 2 ounces of water or air, and the patient is asked to expel it into a toilet. The patient goes to the bathroom and tries to defecate expel the small balloon from the rectum. The amount of time it takes to expel the balloon is recorded. Prolonged balloon expulsion suggests a dysfunction in the anorectal area. The test takes approximately 30 to 45 minutes..

Normally, when stool enters the rectum, the anal sphincter muscle tightens to prevent passage of stool at an undesirable time. If this muscle is weak or does not contract in a timely way, incontinence leakage of stool may occur. Sphincter muscles can be weakened for many reasons, and some are Anal emg and urodynamic testing tearing or partial tearing of the sphincter muscle, 2 spinal cord injuries, and 3 prior surgery complications.

Normally, when a person pushes or bears down to have a bowel movement, the anal sphincter muscles relax. This will cause the pressures to decrease allowing evacuation of stool. If the sphincter muscles tighten when pushing, this could contribute to constipation.

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Anal manometry measures how strong the sphincter muscles are and whether they relax as they should during passing a stool. The patient then is asked to relax, squeeze and push at different times. Anal sphincter EMG confirms the proper muscle contractions during squeezing and muscle relaxation during pushing.

In people who paradoxically contract the sphincter and pelvic floor muscles, the tracing of electrical activity increases, Anal emg and urodynamic testing of decreasing, during bearing down to simulate a bowel movement defecation.

Normal anal EMG activity with low anal squeeze pressures on manometry may indicate a torn sphincter muscle that could be repaired. The patient will typically be placed in a semi-recumbent position, and a 4-channel radial air-charged anorectal catheter will be inserted Anal emg and urodynamic testing 4 cm into the rectum. The catheter will be slowly withdrawn at one centimeter intervals as resting and squeeze pressures are recorded in 4 quadrants Please click for source, Right, Posterior and Left.

Average resting pressure is recorded using the advanced diagnostic equipment. Above 40 mmHg is normal for resting pressure. Anal emg and urodynamic testing, average squeeze pressure will be recorded.

Greater than mmHg is normal for average squeeze pressure. Another weakness could be that we did not standardize the type of EMG surface electrodes or their placement. However, all subjects served as their own baseline reference for comparison in our analysis, so this should not have produced any bias.

EMG activity measured by perineal surface patch electrodes did not measure the expected pelvic floor and urethral sphincter relaxation during voiding. It is not likely that over half of the patients in a multi-center surgical trial for SUI have either occult neurologic disease or pelvic floor dyssynergia. Our data question the role of preoperative EMG monitoring with surface perineal electrodes during urodynamic testing in neurologically normal patients with stress predominant urinary incontinence.

Anal emg and urodynamic testing Urodyn. Author manuscript; available in PMC Jul Anna C. Kirby1 Charles W. Litman2 Mary P.

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Charles W. Heather J. Mary P. Kimberly J. Copyright notice.

The publisher's final edited version of this article is available at Neurourol Urodyn. See other articles in PMC that cite the published article.

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Abstract Aims To describe perineal surface patch electromyography EMG activity during urodynamics UDS and compare activity between filling and Anal emg and urodynamic testing phases and to assess for a relationship between preoperative EMG activity and postoperative voiding symptoms.

Methods women underwent standardized preoperative UDS that included perineal surface EMG prior to undergoing surgery for stress urinary incontinence. Conclusions Perineal surface patch EMG did not measure expected pelvic floor and urethral sphincter relaxation during voiding.

Urodynamic Studies and Quality Control Baseline urodynamic testing free uroflowmetry, filling cystometry, and pressure flow studies were performed on all participants prior to surgery based on a standardized UDS protocol that was implemented by all 20 urodynamic testers at the nine continence treatment centers using the same Laborie Toronto, Canada digital recording equipment.

Flow Pattern and Straining We Anal emg and urodynamic testing the flow pattern according to the following categories: Postoperative Voiding Dysfunction Postoperative voiding dysfunction was defined by the need for surgical revision to facilitate bladder emptying or the use of any type of catheter after the 6-week postoperative visit through the month visit.

Statistical Analysis Inter-rater agreement was calculated as the percent of signals for which values agreed. Open in a separate window. EMG Signals Of the go here reviewed, EMG, electromyography. Footnotes Conflicts of interest: Elbadawi A. Functional anatomy of the organs of micturition. Urol Clin North Am. Innervation of the female levator ani muscles. Am J Obstet Anal emg and urodynamic testing.

Electromyography of the perineal striated muscles during cystometry.

Urol Int. Concentric needle electrodes are superior to perineal surface-patch electrodes for electromyographic documentation of urethral sphincter relaxation during voiding. BJU Int. Tennstedt S. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med. Urinary incontinence: Medical and psychosocial Anal emg and urodynamic testing. Annu Rev Gerontol Geriatr. Q-tip test in stress urinary incontinence.

Obstet Gynecol.

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The standardisation of terminology of lower urinary tract function: Good urodynamic practices: Uroflowmetry, filling cystometry, and pressure-flow studies. Process for development of multicenter urodynamic studies.

Reference urodynamic values for stress incontinent women. Quality control in urodynamics: A review of urodynamic traces from one centre. Anal emg and urodynamic testing flow analysis may aid in identifying women with outflow obstruction.

J Urol. Today, this abnormality is associated with intrinsic sphincter deficiency ISD in patients with SUI, intermittent or constant urinary incontinence after spinal shock in patients suffered from spinal cord injury, multiple system atrophy MSA or multiple sclerosis.

Unilateral needle EMG of the Anal emg and urodynamic testing external anal sphincter muscle, including quantitative MUP analysis is clearly indicated in patients with suspected MSA, particularly in its early stages when the diagnosis is unclear. In order to determine the EMG features of the striated urethral sphincter in patients with type 3 SUI, Takahash et al performed EMG and MUP analysis of the striated urethral sphincter muscle and urodynamic studies in a total of 51 women, 41 female patients with type 3 SUI and 10 women with normal urinary Anal emg and urodynamic testing.

MUP of SUI patients showed significantly shorter duration, lower amplitude, and larger number of phases compared with those in the control group. These patients showing myogenic damages had significantly lower Valsavour leak point pressure and more leakage in the pad-weigh test compared with the SUI patients without myogenic damage findings.

These results suggested that myogenic-dominant damages of the striated urethral sphincter may contribute Anal emg and urodynamic testing the etiology of ISD in most patients with type 3 SUI Takahash et al, It is very important to check the functions of detrusor-sphincter and their relationship with patients with LUTS. If the patients have both click and sphincter intact and in harmony, treatment for other organic or functional disorder, for example, outlet obstruction and lower compliance, is then feasible.

Kinesiologic or EMG studies do not diagnose neuropathy but may characterize its effects.

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They are indicated in any patient in whom there is a suspicion of discoordination between the sphincter and the bladder. Thus, patients with spinal cord injury, with neurologic disorders e.

In this last group, there is evidence that involuntary muscle Anal emg and urodynamic testing activity preventing sphincter relaxation may have a hormonal etiology associated with polycystic ovarian disease Fowler, ; Fowler et al.

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Thus, there is limited role for EMG or kinesiologic studies in the routine Anal emg and urodynamic testing evaluation of incontinent or obstructed patients in whom neuropathy is not suggested by other clinical findings. However, if detrusor is relevant to sphincter urodynamically, it is very helpful to use standard urodynamics to evaluate synergia or dyssynergia, in coordination or discoordination.

We think video-urodynamics should be used for more sophisticated cases.

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Anal emg and urodynamic testing In patients who complained of symptoms of frequency or urge may actually suffer from sphincter overactivity or dysfunctional voiding, to which baclofen a GABA-ergic receptor agonist may be administered as a rational option and obtain good response in this case.

It was quantitatively analyzed using the TL value, which was successfully applied in a series of assessment. We had conducted a randomized double-blind placebo-controlled crossover trial in 60 women with dysfunctional voiding and LUTD from January to January ; patients were randomly assigned either baclofen 10 mg three times daily, then matching placebo for 4 weeks, or matching placebo then baclofen 10 mg three times daily for 4 weeks, separated by a 2-week washout period.

Female patient with dysfunctional voiding Fig. These encouraging results suggest that baclofen could be used to treat dysfunctional voiding in women Xu et al. Anal emg and urodynamic testing female patients aged 42 years old, who complained of urinary frequency for 3 years, Anal emg and urodynamic testing diagnosed as having dysfunctional voiding with a TL value of —0. In order to determine the prevalence of dysfunctional voiding in female SUI and its modification after tension-free vaginal tape TVT procedure, three hundred check this out sixty women with SUI were enrolled and underwent urodynamics from to Dysfunctional voiding was determined when non-neurogenic detrusor-sphincter dyssynergia occurred during voluntary voiding Fig 6 b.

The distribution of other urodynamic variables was also evaluated.

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One hundred and fifty patients underwent the Anal emg and urodynamic testing procedure and forty of them were studied with urodynamics after anti-incontinence surgery of TVT during follow up.

Overall, dysfunctional voiding was diagnosed in ninety-nine Anal emg and urodynamic testing Fig 6 bwith a prevalence of The functional profile length in SUI women with dysfunctional voiding was significantly shorter than that in SUI women without dysfunctional voiding Fig 6 a 3. After the TVT procedure, the recovery of SUI between cases with and without dysfunctional voiding showed no significant difference.

The rate of dysfunctional voiding state change after the surgery, namely from with to without dysfunctional voiding or Anal emg and urodynamic testing without to with dysfunctional voiding, significantly differed between the female patients with and without dysfunctional voiding The dysfunctional voiding improved after the surgery in SUI women with dysfunctional voiding. Dysfunctional voiding might represent a coexistent finding in women with SUI.

The main difference of women with Continue reading and dysfunctional voiding, as compared with those without dysfunctional voiding, was a shortened functional profile length. Urodynamic studies on a female patient with stress urinary incontinence SUI without dysfunctional voiding as indicated by solid arrows DV a and another female patient with SUI and DV as indicated by dashed arrows b before the tension-free vaginal tape TVT procedure.

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If they complained of daily or nocturnal enuresis, the symptoms may be worse than before. This is a critical time point for them. Surgical intervention may be mandatory.

Although the voiding reflex remains or detrusor is intact, the detrusor function has declined gradually since incontinence occurs. Between May and Marcha total of patients underwent urodynamic examination Life-Tech Urovision Janus V in this institute. Among them, male patients old than 45 years with obstructive symptoms were analysed. Among them, there were 15 patients with lower compliance and intact detrusor, and 15 patients with lower compliance and detrusor underactivity enrolled into this trial.

Their urodynamics and surgical outcome were compared between the two groups. Routine endoscopic surgeries were carried out for them go here those with lower compliance and intact detrusor gained better recovery thereafter as compared with those with detrusor underactivity Xu et al. Anal emg and urodynamic testing main improvement was disappearance of enuresis and increased peak flow rates during follow-up.

Male patients older than 45 years old complained of obstructive symptoms and nocturnal enuresis should routinely take comprehensive urodynamics. If they were diagnosed with decreased bladder compliance and intact detrusor, surgical intervention is a mandatory option. If they accept the surgical option, their prognosis is very well as compared Anal emg and urodynamic testing those with detrusor underactivity.

Nephrogenic diabetes insipidus with dilatation of upper urinary tract and bladder is rarely reported. Urinary tract dilatation and bladder dysfunction, usually in the form of a Anal emg and urodynamic testing, atonic bladder, are commonly believed to be secondary to high urine output.

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Low bladder compliance means an abnormal volume and pressure relationship, and an incremental rise in bladder pressure during the bladder filling. It is well known that at the time bladder capacity decreases, intravesical pressure increases, and the risk of upper deterioration increases.

Hypocompliance is usually thought Anal emg and urodynamic testing be the range from 1. Though the exact cause of hypocompliance is not known, it may be caused by changes in the elastic and viscoelastic properties of the bladder, changes in detrusor muscle tone, or combinations of the two Park, The lower bladder compliance patterns could be classified into three groups Cho et al.

Group A gradual increase had the highest correlation with the presence of spinal cord injury. Group B terminal increase patients had a history of direct pelvic treatment such as radical prostatectomy and pelvic irradiation. Group C abrupt increase and plateau was positively correlated with the presence of detrusor overactivity and nocturnal enuresis.

We found that children with polyuria, Anal emg and urodynamic testing enuresis and MRI-confirmed this web page abnormality hypointensities on T1-weighted MRI and diabetes insipidus usually had hydroureteronephrosis, enlarged bladder capacity and lower bladder compliance at second-half storage phase.

Their bladder compliance pattern belonged to terminal increase type as classified by Cho et al.

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Their detrusor and sphincter function had to be evaluated carefully as the first procedure. If the detrusor could contract and sphincter could relax during the voiding phase, the prognosis is good Fig. Che et al described 5 patients with source diabetes insipidus whose first presentation was bilateral hydroureteronephrosis and chronic renal insufficiency Che et al, Between May and March5 boys came to our clinic with complaint of polydipsia and polyuria 4bilateral flank pain 2and fatigue 2.

Ultrasonic scan found bilateral hydroureteronephrosis in all 5 patients and blood creatinine test showed renal insufficiency. Fluid deprivation test were performed and according to the results they were diagnosed as nephrogenic here insipidus.

All patients were catheterized for 7 to Anal emg and urodynamic testing days till blood creatinine level decreased as normal. Urodynamics showed that the mean values of the bladder capacity, detrusor pressure at the mid and end of filling, maximum flow rate Qmaxand PVR were ml, These results reminded us all these patients had Anal emg and urodynamic testing lower.

A male patient aged 65 years old, who complained of poor-weak flow and urinary frequency for 5 years and nocturial enuresis for the last 5 months, was confirmed as having bladder outlet obstruction and lower bladder compliance as indicated by dashed arrow, however, his detrusor and sphincter function was still intact with detrusor-sphincter synergia as indicated by solid arrows a, band his symptoms at follow-up recovered 6 months after a successful TURP with a normal flow rate and compliance thereafter as indicated by solid arrow c, d.

Given that the detrusor and sphincter function well as displayed on EMG, operation or desmopressin are rational option for patients with obstruction or diabetes insipidus. The patients had taken desmopressin acetate 0. And after a follow of 4 to 12 months, renal function remained normal and PVR was reduced. Nephrogenic diabetes insipidus should be considered in patients with dilatation of the urinary tract and polyuria.

A lower compliance at second-half Anal emg and urodynamic testing phase may contribute to the dilatation of urinary tract. Normal detrusor contractility with large PVR is a unique manifestation of this condition.

A male patient aged 15 years old, complaining of pelvic pain and polyuria for more than 5 years, was found with hydroureteronephrosis and atrophy of the posterior lobe of the pituitary gland hypointensitites on T1-weighted MRI of the pituitary gland. His functional bladder capacity reached ml, and lower bladder Anal emg and urodynamic testing was terminal at a bladder volume of ml as indicated by dashed arrow, whereas Anal emg and urodynamic testing detrusor contracted and Anal emg and urodynamic testing relaxed normally when he initiated a voiding reflex as indicated by solid arrows.

Whether the operation succeeds or not depends upon exhibition here detrusor contraction and still remaining of detrusor and external sphincter dyssynergia.

Theoretically, this type of neuro-anastomosis could not reverse dyssynergia.

Cheeky sexting Watch Homemade deepthroat cock sucking videos Video Malcove Hot. Anal manometry measures how strong the sphincter muscles are and whether they relax as they should during passing a stool. The patient then is asked to relax, squeeze and push at different times. Anal sphincter EMG confirms the proper muscle contractions during squeezing and muscle relaxation during pushing. In people who paradoxically contract the sphincter and pelvic floor muscles, the tracing of electrical activity increases, instead of decreasing, during bearing down to simulate a bowel movement defecation. Normal anal EMG activity with low anal squeeze pressures on manometry may indicate a torn sphincter muscle that could be repaired. The patient will typically be placed in a semi-recumbent position, and a 4-channel radial air-charged anorectal catheter will be inserted approximately 4 cm into the rectum. The catheter will be slowly withdrawn at one centimeter intervals as resting and squeeze pressures are recorded in 4 quadrants Anterior, Right, Posterior and Left. Average resting pressure is recorded using the advanced diagnostic equipment. Above 40 mmHg is normal for resting pressure. Also, average squeeze pressure will be recorded. Greater than mmHg is normal for average squeeze pressure. Anal canal length is also typically measured. Normal anal canal length is 3 to 4 centimeters. Figure 2 below shows both the average and maximum pressure measurements and how they would typically appear on a complete anorectal manometry summary report. With the patient in a semi-recumbent position, the inserted rectal balloon will be slowly filled with water to assess and record the following rectal sensations: For a normal patient, the first sensation will normally be reported between 10 and 60 milliliters; the first urge to defecate should manifest at 10 to milliliters of filling; and the maximum tolerable rectal volume will range from to milliliters. The rectoanal inhibitory reflex is a response of the internal anal sphincter to rectal distention. The transient relaxation of the internal anal sphincter in response to rectal distention plays an important role in the continence mechanism. During the anorectal manometry test the patient will be placed in a semi-recumbent position and the rectoanal inhibitory reflex will be assessed as the water or air-filled catheter is inflated. Bladder filling then begins; and, as it proceeds, there is a progressive recruitment of sphincter activity, demonstrated by increased amplitude and frequency of firing. Just before the onset of voiding, sphincter activity ceases and remains so for the duration of micturition. Once the bladder is empty, sphincter EMG activity resumes. Needle-guided wire electrodes and its modification: Their potential amplitude could be measured: So the former was a continuous trace and latter was wave-like or ECG-like. However, due to changes in location, orientation or other factors, it is not possible to point the difference. The electrocircuit was secured making sure that the equipment was in good condition, the wires in unbroken and no tarnishing state, the inserted needles free from outside interference and so on. The crenate-like EMG trace in Fig 2a came from the screen before the wire was inserted into the anus with the wire disparted. The lower amplitude trace in Fig 2b came from the screen before the wire was inserted into the anus with the wires linked together. The intermittent, crenate-like, sawtooth-like, or wave-like EMGs in Fig. By re-doing or changing of the wire electrode, the trace became normal. Bad recordings of EMG during urodynamic investigation: Compared with the perineal surface patch electrodes which are widely used in most labs in Europe and United States, the only shortcoming of the needle-guided wire electrode is a slight pain associated with needle puncturing. The surface electrode is easy to fall off, having low sensitivity and poor reliability. Although patients have a greater tolerance for surface EMG electrodes, the reliability of the latter when compared to needle-guided wire electrode or even concentric needle electrode CNE is doubtful. Volume conduction results in the compounding of motor unit signals from all the muscles of the perineal body, makes signals from an individual muscle difficult to identify. Given the differing innervation of the levator ani muscles and the external urethral sphincter it is unlikely that EMG activity of the levator ani muscles recorded with surface electrode adequately reflects motor unit activity of the external urethral sphincter. As the ways of expression are concerned, CNE inserted into the rhabdosphincter close to the urethral orifice are superior to surface electrodes patched close to the anus for EMG documentation of urethral sphincter relaxation during voiding Mahajan et al, A study was conducted to compare interpretations of EMG recordings from surface electrodes with those from urethral CNEs during voiding. Consenting women underwent urodynamic testing with a 30 G, 3. Representative, de-identified paper copies of EMG signals were assembled by chronology and electrode type. Six examiners unaware of the patient details were asked to determine if the tracings were interpretable and whether there was quiescence of the urethral sphincter motor unit during voiding. Twenty-two women undergoing urodynamic testing for incontinence 16 , voiding dysfunction two or urinary retention four participated in the study. Reviewers unanimously agreed on only 12 of the 44 tracings, and 11 of these showed quiescence when using a CNE. CNEs were more often interpretable than surface electrodes for determining motor unit quiescence during voiding. Two wire electrodes at radian distance of 0. This experiment was conducted in this institution on patients suffered from LUTD to study the role of radian distance of the wire-electrodes and its impact on the amplitude and quality of EMG Cui et al. The electrodes were randomly placed at radians of 0. The electro-potentials during storage and voiding phases were measured separately, recorded and analyzed according to their disclosed radians. Mean electro-potentials during storage phase were When the data were further analyzed according to their gender, age or original disease, this gradually increased trend still remained Table 2. The result was that the potentials of the storage phase were influenced by the radians of the electrodes either in total, or in different genders, age subgroups or original diseases. There was a positive relation between them, either in total or divided by gender, age or original diseases. It could be ratiocinated that wire electrodes with three radian distances 0. These data suggest that the use of either 1. Whereas there were no significant differences during voiding phase in the mean electro-potentials between the patients with or without sphincter overactivity Table 3. It seems. The design of the experiment: To compare the values of EMG potential at different time, for example, before start of voiding or during maximal flow rate i. TL value is a derived parameter used to measure the degree of detrusor-sphincter synergia. However, this parameter is possible only after consecutive and satisfactory recording of EMG tracing alongside with CMG and PFS recording during monitoring of the storage and voiding process. In laboratories where EMG signals are recorded poorly or given up, this value is not available. PdetQmax means the detrusor pressure at maximum flow rate in the voiding phase. If the TL value is measured in these figures, a minus value will be obtained too. Simutaneous recording of CMG, EMG and PFS using different facilities Life-Tech and MMS in female patients displaying bladder outlet obstruction and detrusor external sphincter synergia as indicated by solid arrows a, c , and dysfunctional voiding or sphincter overactivity as indicated by dashed arrows b, d with radian of 1. Many of the young women with this disorder manifest features of polycystic ovaries, suggesting that it is due to a hormonally sensitive channelopathy. Reports of increased urethral pressure and sphincter volume corroborate the concept that inappropriate sphincter contraction causes the urinary retention, leading to detrusor failure with loss of bladder sensation Wiseman et al. Increase of bladder volume and neuromodulation treatment reduced the extent of negative neural responses, and normal positive responses in the periaqueductal grey strengthened, whether used alone or together. They concluded that the primary abnormality of the syndrome is an overactive urethra that generates abnormally strong inhibitory afferent signals, so effectively blocking bladder afferent activity at the sacral level and deactivating the periaqueductal grey and higher centres Kavia et al, This central reflex and sacral guarding reflex have the same nature. The constraction of the pelvic floor-external sphincter complex is a normal response to control urgent urination and results in a reflex inhibition of the detrusor. Abnormal EMG findings may imply neural, psychological, or behavioural dysfunction from central, peripheral, regional or reflexual origin. It certainly provides the directions for further research. Failure of the sphincter to relax or stay completely relaxed during micturition is abnormal. The inappropriate sphincter activity during voiding has a variety of patterns, ranging from crescendo contraction to failure of relaxation. In neurologic conditions, abnormal EMG waveforms, in addition to detrusor-sphincter dyssynergia, are seen. These include fibrillation potentials, complex polyphasic potentials, and complex repetitive discharges, but they require more specialized equipment for their demonstration Aminoff, ; Nandedkar et al, Due to the limited utility of clinical examination Agur et al, ; Warren et al, , urodynamics and imaging studies to demonstrate a neurogenic etiology of the LUTD, the role of clinical neurophysiologic methods remains important. For evaluation of patients with neurogenic LUTD a number of neurophysiologic methods have been used, including motor unit potential MUP , interference pattern, nerve conduction, evoked potential, and sacral reflex analysis Finsterer, ; Podnar, Nerve conduction studies are performed by the stimulation of a peripheral nerve and the monitoring of the time taken for a response to occur in its innervated muscle. The time from stimulation to response is termed the latency. Nerve conduction studies are tests of the integrity of a reflex arc and can be relatively sensitive indicators of the presence of neurologic disease. In urologic practice, these studies are most often performed as bladder-cortex reflex latency determinations. They require elaborate instrumentation and careful user interpretation. Abnormal responses occur in a variety of situations and are particularly diagnostic in patients with diabetes and peripheral neuropathies. In patients with conus medullaris or cauda equina lesions, normal, prolonged, or absent latencies may be found, and asymmetrical responses are not uncommon. Evoked response studies are means to assess afferent neuronal pathways by applying a stimulus to a peripheral nerve e. As such, they are used to test the integrity of peripheral, spinal, and central nervous system pathways. They also require sophisticated instrumentation using averaging techniques, and their performance is confined to specialized centers Aminoff, Sphincter EMG derived from concentric needle electrodes comes from muscle fibres within 0. Those from two wire electrodes inserted in the same position as the anal surface electrode comes from half of the sphincter muscle fibres as whole. So the EMG trace is smooth and constant with strain or coughing-induced strengthening. If a MUP means electronic activity of a small group of motor units of the sphincter, then sphincter EMG gained from needle guided-wire electrodes means highly concentrated MUP. The former is just like a piece of roasted mutton, and the latter is a long string of roasted mutton. Normally, potentials generated during sphincter activity may be recorded with a specialized concentric needle electrode inserted directly into the muscle to be tested, and the MUP recorded from the distal urethral sphincter muscle has a biphasic or triphasic waveform with an amplitude of 50 to mV and a firing frequency of 10 to discharges per second. Simplistically, when the motoneuron or nerve to a muscle is damaged, those muscle fibers that have lost their innervation become reinnervated by adjacent healthy nerves. The resultant MUP changes from a simple waveform to one that is larger in amplitude, complexity, and duration; these are termed polyphasic potentials. At least five deflections on the tracing must be present for a MUP to be called polyphasic Abrams et al, These are thought to represent the increased number of muscle fibers per motor unit that follows reinnervation. Other findings that suggest neuropathy include fibrillation potentials, which are spontaneous, low-amplitude potentials of short duration, and positive sharp waves, which are biphasic potentials. Neurophysiologic studies require more sophisticated instrumentation and investigator expertise and are designed to actually diagnose and characterize the presence of neuropathy or myopathy. MUPs in health and disease differ, and, within certain limitations, the expert observer may use these studies to determine whether neuropathy is present. Neurophysiologic studies are beyond the expertise of most urodynamic laboratories and are uncommonly indicated. Their role is in diagnosis of occult neuropathy or myopathy. In the patient with overt neurologic findings who has bladder dysfunction, neurogenic bladder dysfunction can be deduced without further study. In such cases, a kinesiologic study to identify the pattern of dysfunction is all that is indicated. MUP studies find their role in the evaluation of the patient with bladder dysfunction of unknown cause in whom neuropathy is suspected. They are also used in medicolegal situations in an attempt to correlate voiding symptoms and sexual dysfunction with prior injuries. Furthermore, MUP may be preferable for ongoing study on underactivity of detrusor or sphincter Takahash et al, ; Jiang et al, a , b , Today, this abnormality is associated with intrinsic sphincter deficiency ISD in patients with SUI, intermittent or constant urinary incontinence after spinal shock in patients suffered from spinal cord injury, multiple system atrophy MSA or multiple sclerosis. Unilateral needle EMG of the subcutaneous external anal sphincter muscle, including quantitative MUP analysis is clearly indicated in patients with suspected MSA, particularly in its early stages when the diagnosis is unclear. In order to determine the EMG features of the striated urethral sphincter in patients with type 3 SUI, Takahash et al performed EMG and MUP analysis of the striated urethral sphincter muscle and urodynamic studies in a total of 51 women, 41 female patients with type 3 SUI and 10 women with normal urinary control. MUP of SUI patients showed significantly shorter duration, lower amplitude, and larger number of phases compared with those in the control group. These patients showing myogenic damages had significantly lower Valsavour leak point pressure and more leakage in the pad-weigh test compared with the SUI patients without myogenic damage findings. These results suggested that myogenic-dominant damages of the striated urethral sphincter may contribute to the etiology of ISD in most patients with type 3 SUI Takahash et al, It is very important to check the functions of detrusor-sphincter and their relationship with patients with LUTS. If the patients have both detrusor and sphincter intact and in harmony, treatment for other organic or functional disorder, for example, outlet obstruction and lower compliance, is then feasible. Kinesiologic or EMG studies do not diagnose neuropathy but may characterize its effects. They are indicated in any patient in whom there is a suspicion of discoordination between the sphincter and the bladder. Thus, patients with spinal cord injury, with neurologic disorders e. In this last group, there is evidence that involuntary muscle fiber activity preventing sphincter relaxation may have a hormonal etiology associated with polycystic ovarian disease Fowler, ; Fowler et al. Thus, there is limited role for EMG or kinesiologic studies in the routine urodynamic evaluation of incontinent or obstructed patients in whom neuropathy is not suggested by other clinical findings. However, if detrusor is relevant to sphincter urodynamically, it is very helpful to use standard urodynamics to evaluate synergia or dyssynergia, in coordination or discoordination. We think video-urodynamics should be used for more sophisticated cases. In patients who complained of symptoms of frequency or urge may actually suffer from sphincter overactivity or dysfunctional voiding, to which baclofen a GABA-ergic receptor agonist may be administered as a rational option and obtain good response in this case. It was quantitatively analyzed using the TL value, which was successfully applied in a series of assessment. We had conducted a randomized double-blind placebo-controlled crossover trial in 60 women with dysfunctional voiding and LUTD from January to January ; patients were randomly assigned either baclofen 10 mg three times daily, then matching placebo for 4 weeks, or matching placebo then baclofen 10 mg three times daily for 4 weeks, separated by a 2-week washout period. Female patient with dysfunctional voiding Fig. These encouraging results suggest that baclofen could be used to treat dysfunctional voiding in women Xu et al. This analysis of a large multi-institutional surgical trial on neurologically normal women with stress predominant urinary incontinence evaluated EMG signals during standardized preoperative urodynamics. EMG activity measured by perineal surface electrodes increased more during voiding than during bladder filling in more than half of patients. These findings were the opposite observation of what we expected, namely that the urethral sphincter should relax during the voiding phase. This failure to relax classically would indicate either occult neurologic disease or dysfunctional voiding, and these findings should warn of an increased risk of postoperative voiding dysfunction in these patients. However, these patients did not have neurological disease, nor did they have a high rate of postoperative voiding dysfunction. This large study using many urodynamic laboratories following a standardized urodynamic protocol questions the role of preoperative surface EMG monitoring in patients with stress predominant urinary incontinence. The primary objective of EMG during preoperative urodynamic testing in patients with incontinence is to predict those patients who have uncoordinated sphincter activity and may experience postoperative voiding dysfunction. Failure to relax the urethral sphincter with voiding indicates detrusor—sphincter dyssynergia, associated with supra sacral neurologic disease, or in the absence of neurologic disease suggests pelvic floor hyperactivity or dysfunctional voiding. It is unusual for patients without a history of neurologic disease or abnormal neurologic evaluation of the perineum and extremities to have uncoordinated voiding. Contemporary urodynamic testing of the incontinent female has used surface EMG monitoring. Skin patch electrodes are easy to use, more comfortable than needle electrodes, and allow the patient to move from a standing to sitting position. However, surface EMG electrode signals are often attenuated by intervening soft tissue, particularly if the muscle being studied is more than 10 mm from the skin surface as is the case between the skin near the anus and the urethral sphincter, and they record from wide areas of muscle territory. We did not standardize the surface EMG patches to any specific company or specify the exact placement of the EMG patches, but we do not think this non-standardization limits our results or conclusions because each patient served as their own baseline reference for comparative values obtained during the fill and flow. Skin patch EMG electrodes may not be sensitive and specific for urethral muscle and may reflect a sampling of various muscles in the perineum, pelvis, or buttocks. This phenomenon was described in a study of surface EMG to measure soleus and gastrocnemius muscle activity, in which a significant portion of the signal arose from adjacent or deeper muscles. The results of that study suggested that no surface EMG electrode could measure a single muscle if others are in reasonable proximity. A further analysis comparing voiding phase uroflow start and variables during the bladder filling phase yielded similar lack of relaxation. We suspect that surface perineal electrodes are recording activity from other muscle groups, or other artifacts, and not demonstrating the relaxation of the pelvic floor or urethral sphincter activity during voiding. We evaluated whether the change in position from standing to sitting could introduce artifact that increased EMG amplitudes compared to filling cystometry. EMG activity after patient movement from standing maximal cystometric capacity to sitting pressure flow baseline returned to approximately baseline suggesting that the position change was not the reason for the elevated EMG values seen during voiding. Whether the increased EMG activity with voiding reflected situational failure of patients to relax their pelvic floor or discomfort with the catheter or the testing is uncertain, but it would be test- or patient-specific, and still does not offer any prognostic on postoperative voiding dysfunction. EMG activity in this study did not predict the 7. The main strength of this study is the large number of quality EMG tracings from multiple institutions following a rigorous standardized urodynamic protocol. A weakness of this study is the large number of UDS that were not evaluated in this EMG analysis because these studies did not meet our predetermined quality and validity criteria for pressure measurements. Another weakness could be that we did not standardize the type of EMG surface electrodes or their placement. However, all subjects served as their own baseline reference for comparison in our analysis, so this should not have produced any bias. EMG activity measured by perineal surface patch electrodes did not measure the expected pelvic floor and urethral sphincter relaxation during voiding. It is not likely that over half of the patients in a multi-center surgical trial for SUI have either occult neurologic disease or pelvic floor dyssynergia. Our data question the role of preoperative EMG monitoring with surface perineal electrodes during urodynamic testing in neurologically normal patients with stress predominant urinary incontinence. Neurourol Urodyn. Author manuscript; available in PMC Jul Anna C. Kirby , 1 Charles W. Litman , 2 Mary P. Charles W. Heather J. Mary P. Kimberly J. Copyright notice. The publisher's final edited version of this article is available at Neurourol Urodyn. See other articles in PMC that cite the published article. Abstract Aims To describe perineal surface patch electromyography EMG activity during urodynamics UDS and compare activity between filling and voiding phases and to assess for a relationship between preoperative EMG activity and postoperative voiding symptoms. Methods women underwent standardized preoperative UDS that included perineal surface EMG prior to undergoing surgery for stress urinary incontinence. Conclusions Perineal surface patch EMG did not measure expected pelvic floor and urethral sphincter relaxation during voiding. Urodynamic Studies and Quality Control Baseline urodynamic testing free uroflowmetry, filling cystometry, and pressure flow studies were performed on all participants prior to surgery based on a standardized UDS protocol that was implemented by all 20 urodynamic testers at the nine continence treatment centers using the same Laborie Toronto, Canada digital recording equipment. Flow Pattern and Straining We assessed the flow pattern according to the following categories: Postoperative Voiding Dysfunction Postoperative voiding dysfunction was defined by the need for surgical revision to facilitate bladder emptying or the use of any type of catheter after the 6-week postoperative visit through the month visit. Statistical Analysis Inter-rater agreement was calculated as the percent of signals for which values agreed. Open in a separate window. EMG Signals Of the signals reviewed, EMG, electromyography. Footnotes Conflicts of interest: Elbadawi A. Functional anatomy of the organs of micturition..

There were three kinds of neuro-anastomosis for patients with neurogenic LUTD due to spinal cord injury in China with intercostals nerve: They are: Creation of microsurgical anastomoses between T12 and S2 ventral roots a. Drawing showing creation of microsurgical anastomoses between S-1 and S-2 ventral roots b. Reproduced from Lin and HouNeurosurgery We have shown the detrusor contraction Anal emg and urodynamic testing sphincter overactivity in some patients suffered from spinal cord injury who received a successful procedure of artificial somatic-autonomic reflex pathway T10 anastomosed to S2 for bladder control in this institution.

One of them with neurogenic detrusor underactivity and sphincter overactivity due to L1 fracture received operation of neuroanastomosis nine years ago.

Her spontaneous voiding pattern recovered 1 year later Anal emg and urodynamic testing continued to be normal thereafter. Urodynamic follow-up data showed clearly detrusor contraction and some degree of external sphincter dyssynergia Fig Whereas more info the papers of other authors, who used surface patch electrode, which was inferior to CNE for EMG documentation of urethral sphincter relaxation during voiding phase Mahajan et al.

Porn Pissen Watch Wests netball club Video Arabic Sexx. The constraction of the pelvic floor-external sphincter complex is a normal response to control urgent urination and results in a reflex inhibition of the detrusor. Abnormal EMG findings may imply neural, psychological, or behavioural dysfunction from central, peripheral, regional or reflexual origin. It certainly provides the directions for further research. Failure of the sphincter to relax or stay completely relaxed during micturition is abnormal. The inappropriate sphincter activity during voiding has a variety of patterns, ranging from crescendo contraction to failure of relaxation. In neurologic conditions, abnormal EMG waveforms, in addition to detrusor-sphincter dyssynergia, are seen. These include fibrillation potentials, complex polyphasic potentials, and complex repetitive discharges, but they require more specialized equipment for their demonstration Aminoff, ; Nandedkar et al, Due to the limited utility of clinical examination Agur et al, ; Warren et al, , urodynamics and imaging studies to demonstrate a neurogenic etiology of the LUTD, the role of clinical neurophysiologic methods remains important. For evaluation of patients with neurogenic LUTD a number of neurophysiologic methods have been used, including motor unit potential MUP , interference pattern, nerve conduction, evoked potential, and sacral reflex analysis Finsterer, ; Podnar, Nerve conduction studies are performed by the stimulation of a peripheral nerve and the monitoring of the time taken for a response to occur in its innervated muscle. The time from stimulation to response is termed the latency. Nerve conduction studies are tests of the integrity of a reflex arc and can be relatively sensitive indicators of the presence of neurologic disease. In urologic practice, these studies are most often performed as bladder-cortex reflex latency determinations. They require elaborate instrumentation and careful user interpretation. Abnormal responses occur in a variety of situations and are particularly diagnostic in patients with diabetes and peripheral neuropathies. In patients with conus medullaris or cauda equina lesions, normal, prolonged, or absent latencies may be found, and asymmetrical responses are not uncommon. Evoked response studies are means to assess afferent neuronal pathways by applying a stimulus to a peripheral nerve e. As such, they are used to test the integrity of peripheral, spinal, and central nervous system pathways. They also require sophisticated instrumentation using averaging techniques, and their performance is confined to specialized centers Aminoff, Sphincter EMG derived from concentric needle electrodes comes from muscle fibres within 0. Those from two wire electrodes inserted in the same position as the anal surface electrode comes from half of the sphincter muscle fibres as whole. So the EMG trace is smooth and constant with strain or coughing-induced strengthening. If a MUP means electronic activity of a small group of motor units of the sphincter, then sphincter EMG gained from needle guided-wire electrodes means highly concentrated MUP. The former is just like a piece of roasted mutton, and the latter is a long string of roasted mutton. Normally, potentials generated during sphincter activity may be recorded with a specialized concentric needle electrode inserted directly into the muscle to be tested, and the MUP recorded from the distal urethral sphincter muscle has a biphasic or triphasic waveform with an amplitude of 50 to mV and a firing frequency of 10 to discharges per second. Simplistically, when the motoneuron or nerve to a muscle is damaged, those muscle fibers that have lost their innervation become reinnervated by adjacent healthy nerves. The resultant MUP changes from a simple waveform to one that is larger in amplitude, complexity, and duration; these are termed polyphasic potentials. At least five deflections on the tracing must be present for a MUP to be called polyphasic Abrams et al, These are thought to represent the increased number of muscle fibers per motor unit that follows reinnervation. Other findings that suggest neuropathy include fibrillation potentials, which are spontaneous, low-amplitude potentials of short duration, and positive sharp waves, which are biphasic potentials. Neurophysiologic studies require more sophisticated instrumentation and investigator expertise and are designed to actually diagnose and characterize the presence of neuropathy or myopathy. MUPs in health and disease differ, and, within certain limitations, the expert observer may use these studies to determine whether neuropathy is present. Neurophysiologic studies are beyond the expertise of most urodynamic laboratories and are uncommonly indicated. Their role is in diagnosis of occult neuropathy or myopathy. In the patient with overt neurologic findings who has bladder dysfunction, neurogenic bladder dysfunction can be deduced without further study. In such cases, a kinesiologic study to identify the pattern of dysfunction is all that is indicated. MUP studies find their role in the evaluation of the patient with bladder dysfunction of unknown cause in whom neuropathy is suspected. They are also used in medicolegal situations in an attempt to correlate voiding symptoms and sexual dysfunction with prior injuries. Furthermore, MUP may be preferable for ongoing study on underactivity of detrusor or sphincter Takahash et al, ; Jiang et al, a , b , Today, this abnormality is associated with intrinsic sphincter deficiency ISD in patients with SUI, intermittent or constant urinary incontinence after spinal shock in patients suffered from spinal cord injury, multiple system atrophy MSA or multiple sclerosis. Unilateral needle EMG of the subcutaneous external anal sphincter muscle, including quantitative MUP analysis is clearly indicated in patients with suspected MSA, particularly in its early stages when the diagnosis is unclear. In order to determine the EMG features of the striated urethral sphincter in patients with type 3 SUI, Takahash et al performed EMG and MUP analysis of the striated urethral sphincter muscle and urodynamic studies in a total of 51 women, 41 female patients with type 3 SUI and 10 women with normal urinary control. MUP of SUI patients showed significantly shorter duration, lower amplitude, and larger number of phases compared with those in the control group. These patients showing myogenic damages had significantly lower Valsavour leak point pressure and more leakage in the pad-weigh test compared with the SUI patients without myogenic damage findings. These results suggested that myogenic-dominant damages of the striated urethral sphincter may contribute to the etiology of ISD in most patients with type 3 SUI Takahash et al, It is very important to check the functions of detrusor-sphincter and their relationship with patients with LUTS. If the patients have both detrusor and sphincter intact and in harmony, treatment for other organic or functional disorder, for example, outlet obstruction and lower compliance, is then feasible. Kinesiologic or EMG studies do not diagnose neuropathy but may characterize its effects. They are indicated in any patient in whom there is a suspicion of discoordination between the sphincter and the bladder. Thus, patients with spinal cord injury, with neurologic disorders e. In this last group, there is evidence that involuntary muscle fiber activity preventing sphincter relaxation may have a hormonal etiology associated with polycystic ovarian disease Fowler, ; Fowler et al. Thus, there is limited role for EMG or kinesiologic studies in the routine urodynamic evaluation of incontinent or obstructed patients in whom neuropathy is not suggested by other clinical findings. However, if detrusor is relevant to sphincter urodynamically, it is very helpful to use standard urodynamics to evaluate synergia or dyssynergia, in coordination or discoordination. We think video-urodynamics should be used for more sophisticated cases. In patients who complained of symptoms of frequency or urge may actually suffer from sphincter overactivity or dysfunctional voiding, to which baclofen a GABA-ergic receptor agonist may be administered as a rational option and obtain good response in this case. It was quantitatively analyzed using the TL value, which was successfully applied in a series of assessment. We had conducted a randomized double-blind placebo-controlled crossover trial in 60 women with dysfunctional voiding and LUTD from January to January ; patients were randomly assigned either baclofen 10 mg three times daily, then matching placebo for 4 weeks, or matching placebo then baclofen 10 mg three times daily for 4 weeks, separated by a 2-week washout period. Female patient with dysfunctional voiding Fig. These encouraging results suggest that baclofen could be used to treat dysfunctional voiding in women Xu et al. A female patients aged 42 years old, who complained of urinary frequency for 3 years, was diagnosed as having dysfunctional voiding with a TL value of —0. In order to determine the prevalence of dysfunctional voiding in female SUI and its modification after tension-free vaginal tape TVT procedure, three hundred and sixty women with SUI were enrolled and underwent urodynamics from to Dysfunctional voiding was determined when non-neurogenic detrusor-sphincter dyssynergia occurred during voluntary voiding Fig 6 b. The distribution of other urodynamic variables was also evaluated. One hundred and fifty patients underwent the TVT procedure and forty of them were studied with urodynamics after anti-incontinence surgery of TVT during follow up. Overall, dysfunctional voiding was diagnosed in ninety-nine patients Fig 6 b , with a prevalence of The functional profile length in SUI women with dysfunctional voiding was significantly shorter than that in SUI women without dysfunctional voiding Fig 6 a 3. After the TVT procedure, the recovery of SUI between cases with and without dysfunctional voiding showed no significant difference. The rate of dysfunctional voiding state change after the surgery, namely from with to without dysfunctional voiding or from without to with dysfunctional voiding, significantly differed between the female patients with and without dysfunctional voiding The dysfunctional voiding improved after the surgery in SUI women with dysfunctional voiding. Dysfunctional voiding might represent a coexistent finding in women with SUI. The main difference of women with SUI and dysfunctional voiding, as compared with those without dysfunctional voiding, was a shortened functional profile length. Urodynamic studies on a female patient with stress urinary incontinence SUI without dysfunctional voiding as indicated by solid arrows DV a and another female patient with SUI and DV as indicated by dashed arrows b before the tension-free vaginal tape TVT procedure. If they complained of daily or nocturnal enuresis, the symptoms may be worse than before. This is a critical time point for them. Surgical intervention may be mandatory. Although the voiding reflex remains or detrusor is intact, the detrusor function has declined gradually since incontinence occurs. Between May and March , a total of patients underwent urodynamic examination Life-Tech Urovision Janus V in this institute. Among them, male patients old than 45 years with obstructive symptoms were analysed. Among them, there were 15 patients with lower compliance and intact detrusor, and 15 patients with lower compliance and detrusor underactivity enrolled into this trial. Their urodynamics and surgical outcome were compared between the two groups. Routine endoscopic surgeries were carried out for them and those with lower compliance and intact detrusor gained better recovery thereafter as compared with those with detrusor underactivity Xu et al. The main improvement was disappearance of enuresis and increased peak flow rates during follow-up. Male patients older than 45 years old complained of obstructive symptoms and nocturnal enuresis should routinely take comprehensive urodynamics. If they were diagnosed with decreased bladder compliance and intact detrusor, surgical intervention is a mandatory option. If they accept the surgical option, their prognosis is very well as compared with those with detrusor underactivity. Nephrogenic diabetes insipidus with dilatation of upper urinary tract and bladder is rarely reported. Urinary tract dilatation and bladder dysfunction, usually in the form of a large, atonic bladder, are commonly believed to be secondary to high urine output. Low bladder compliance means an abnormal volume and pressure relationship, and an incremental rise in bladder pressure during the bladder filling. It is well known that at the time bladder capacity decreases, intravesical pressure increases, and the risk of upper deterioration increases. Hypocompliance is usually thought to be the range from 1. Though the exact cause of hypocompliance is not known, it may be caused by changes in the elastic and viscoelastic properties of the bladder, changes in detrusor muscle tone, or combinations of the two Park, The lower bladder compliance patterns could be classified into three groups Cho et al. Group A gradual increase had the highest correlation with the presence of spinal cord injury. Group B terminal increase patients had a history of direct pelvic treatment such as radical prostatectomy and pelvic irradiation. Group C abrupt increase and plateau was positively correlated with the presence of detrusor overactivity and nocturnal enuresis. We found that children with polyuria, nocturnal enuresis and MRI-confirmed pituitary abnormality hypointensities on T1-weighted MRI and diabetes insipidus usually had hydroureteronephrosis, enlarged bladder capacity and lower bladder compliance at second-half storage phase. Their bladder compliance pattern belonged to terminal increase type as classified by Cho et al. Their detrusor and sphincter function had to be evaluated carefully as the first procedure. If the detrusor could contract and sphincter could relax during the voiding phase, the prognosis is good Fig. Che et al described 5 patients with nephrogenic diabetes insipidus whose first presentation was bilateral hydroureteronephrosis and chronic renal insufficiency Che et al, Between May and March , 5 boys came to our clinic with complaint of polydipsia and polyuria 4 , bilateral flank pain 2 , and fatigue 2. Ultrasonic scan found bilateral hydroureteronephrosis in all 5 patients and blood creatinine test showed renal insufficiency. Fluid deprivation test were performed and according to the results they were diagnosed as nephrogenic diabetes insipidus. All patients were catheterized for 7 to 18 days till blood creatinine level decreased as normal. Urodynamics showed that the mean values of the bladder capacity, detrusor pressure at the mid and end of filling, maximum flow rate Qmax , and PVR were ml, These results reminded us all these patients had a lower. A male patient aged 65 years old, who complained of poor-weak flow and urinary frequency for 5 years and nocturial enuresis for the last 5 months, was confirmed as having bladder outlet obstruction and lower bladder compliance as indicated by dashed arrow, however, his detrusor and sphincter function was still intact with detrusor-sphincter synergia as indicated by solid arrows a, b , and his symptoms at follow-up recovered 6 months after a successful TURP with a normal flow rate and compliance thereafter as indicated by solid arrow c, d. Given that the detrusor and sphincter function well as displayed on EMG, operation or desmopressin are rational option for patients with obstruction or diabetes insipidus. The patients had taken desmopressin acetate 0. And after a follow of 4 to 12 months, renal function remained normal and PVR was reduced. For each UDS, the EMG signal was reviewed and deemed to be either a present and interpretable, b present but not interpretable e. Our evaluation of EMG signals included: Ten specific annotations in chronological order were requested from the local urodynamic testers: At each of these annotated events, the quantitative EMG values were extracted from the digital event summary report. For the purposes of this study analysis we insisted on the difficult inclusion criteria of all 10 annotations present and appropriate chronological order. For signals with EMG values that were present and interpretable, a qualitative assessment was made regarding the percentage of the time there was EMG electrical activity greater than 0 during fill start of infusion to MCC and during flow entire flow, including all interrupted portions but excluding areas of no flow: A qualitative assessment was performed to determine whether the average amplitude of the EMG electrical activity during flow was increased, decreased, or similar to the average EMG electrical activity during fill. Postoperative voiding dysfunction was defined by the need for surgical revision to facilitate bladder emptying or the use of any type of catheter after the 6-week postoperative visit through the month visit. Inter-rater agreement was calculated as the percent of signals for which values agreed. Descriptive statistics were calculated for the EMG signal amplitudes for each time-point; median values, with 25th and 75th percentiles, were reported due to skewness of fill and flow EMG value parameters. Because of the arbitrary amplitudes of EMG signals based on adjustments made prior to the start of each study, each subject served as her baseline reference for comparison, so studies missing any of the 10 time-points were excluded from these calculations. No adjustment for the correlation between time-points was made. To assess differences in categorical variables by group e. Analyses were performed using SAS Version 9. Based on the criteria for validity and plausibility including signal legibility, protocol adherence and assessment of pressure measurements, of the preoperative UDS signals were deemed valid. None of these exclusions were based on EMG measures. Of the subjects with valid signals based on the UDS Interpretation Guidelines used in the SISTEr study, 12 were available for this review 14 were unavailable, incomplete, or not performed on our standardized digital recording equipment. In this series of patients with interpretable EMG tracings, 55 One hundred forty-eight One hundred sixty-three Of the signals reviewed, Of the signals that were present and interpretable, the number of UDS that had annotations for the given time-points are shown in Table I. Not all time-points were annotated in the event summary of every UDS. Forty-two subjects had EMG values for all 10 time-points after subjects who strained or had interrupted flow were excluded. Figure 1 presents the median EMG signal amplitudes with corresponding 25th and 75th percentiles for the subjects in which all 10 major UDS time-points were annotated in the event summary. Contrary to the relaxation expected during voiding, the median EMG values during flow were generally higher than during fill in these subjects. EMG amplitude returned to approximately baseline after moving from standing to sitting between MCC and PFS baseline, suggesting that the position change was not the reason for the elevated EMG values seen during voiding. This pattern was also true of the subset of 42 subjects who did not exhibit interrupted flow or abdominal straining during flow, either of which might increase EMG artifact also shown in Fig. Because excluding the large number subjects with straining and interrupted voiding patterns did not significantly alter EMG values, for improved generalizability we included these subjects in our qualitative EMG analyses. This graph demonstrates that EMG values were generally higher during flow than during fill. Black bars present median EMG values for all subjects in which all 10 time-points were annotated, gray bars present median EMG values for the 42 of these subjects with neither straining nor interrupted flow. Error bars: Similar analysis comparing uroflow start during flow and variables during fill yielded similar results data not presented. Overall, EMG was active more than half the time in most signals Subjectively, average EMG activity during flow was higher than fill in more than half of subjects. Specifically, EMG amplitude was higher during flow than fill in Of the subjects with interpretable EMG signals, 24 7. In Table IV , we compared rates of postoperative voiding dysfunction in subjects with different quantitative and qualitative EMG measures. This analysis of a large multi-institutional surgical trial on neurologically normal women with stress predominant urinary incontinence evaluated EMG signals during standardized preoperative urodynamics. EMG activity measured by perineal surface electrodes increased more during voiding than during bladder filling in more than half of patients. These findings were the opposite observation of what we expected, namely that the urethral sphincter should relax during the voiding phase. This failure to relax classically would indicate either occult neurologic disease or dysfunctional voiding, and these findings should warn of an increased risk of postoperative voiding dysfunction in these patients. However, these patients did not have neurological disease, nor did they have a high rate of postoperative voiding dysfunction. This large study using many urodynamic laboratories following a standardized urodynamic protocol questions the role of preoperative surface EMG monitoring in patients with stress predominant urinary incontinence. The primary objective of EMG during preoperative urodynamic testing in patients with incontinence is to predict those patients who have uncoordinated sphincter activity and may experience postoperative voiding dysfunction. Failure to relax the urethral sphincter with voiding indicates detrusor—sphincter dyssynergia, associated with supra sacral neurologic disease, or in the absence of neurologic disease suggests pelvic floor hyperactivity or dysfunctional voiding. It is unusual for patients without a history of neurologic disease or abnormal neurologic evaluation of the perineum and extremities to have uncoordinated voiding. Contemporary urodynamic testing of the incontinent female has used surface EMG monitoring. Skin patch electrodes are easy to use, more comfortable than needle electrodes, and allow the patient to move from a standing to sitting position. However, surface EMG electrode signals are often attenuated by intervening soft tissue, particularly if the muscle being studied is more than 10 mm from the skin surface as is the case between the skin near the anus and the urethral sphincter, and they record from wide areas of muscle territory. We did not standardize the surface EMG patches to any specific company or specify the exact placement of the EMG patches, but we do not think this non-standardization limits our results or conclusions because each patient served as their own baseline reference for comparative values obtained during the fill and flow. Skin patch EMG electrodes may not be sensitive and specific for urethral muscle and may reflect a sampling of various muscles in the perineum, pelvis, or buttocks. This phenomenon was described in a study of surface EMG to measure soleus and gastrocnemius muscle activity, in which a significant portion of the signal arose from adjacent or deeper muscles. The results of that study suggested that no surface EMG electrode could measure a single muscle if others are in reasonable proximity. In people who paradoxically contract the sphincter and pelvic floor muscles, the tracing of electrical activity increases, instead of decreasing, during bearing down to simulate a bowel movement defecation. Normal anal EMG activity with low anal squeeze pressures on manometry may indicate a torn sphincter muscle that could be repaired. The patient will typically be placed in a semi-recumbent position, and a 4-channel radial air-charged anorectal catheter will be inserted approximately 4 cm into the rectum. The catheter will be slowly withdrawn at one centimeter intervals as resting and squeeze pressures are recorded in 4 quadrants Anterior, Right, Posterior and Left. Average resting pressure is recorded using the advanced diagnostic equipment. Above 40 mmHg is normal for resting pressure. Also, average squeeze pressure will be recorded. Greater than mmHg is normal for average squeeze pressure. Anal canal length is also typically measured. Normal anal canal length is 3 to 4 centimeters. Figure 2 below shows both the average and maximum pressure measurements and how they would typically appear on a complete anorectal manometry summary report. With the patient in a semi-recumbent position, the inserted rectal balloon will be slowly filled with water to assess and record the following rectal sensations: For a normal patient, the first sensation will normally be reported between 10 and 60 milliliters; the first urge to defecate should manifest at 10 to milliliters of filling; and the maximum tolerable rectal volume will range from to milliliters. The rectoanal inhibitory reflex is a response of the internal anal sphincter to rectal distention. The transient relaxation of the internal anal sphincter in response to rectal distention plays an important role in the continence mechanism. During the anorectal manometry test the patient will be placed in a semi-recumbent position and the rectoanal inhibitory reflex will be assessed as the water or air-filled catheter is inflated. A normal reflex should occur between 10 and 30 milliliters. The balloon expulsion test provides an assessment of the patient's ability to evacuate artificial stool during simulated defecation within the laboratory environment. For the balloon expulsion test, a small balloon as seen above in Figure 1 is inserted into the rectum and then inflated with approximately 50 ml 2 ounces of water or air, and the patient is asked to expel it into a toilet..

A female patient aged 46 years old, complained of paraplegia due to fracture of L1 for 9 yeas, source study before the procedure a5 years b and 9 years c after successful artificial somatic-autonomic reflex pathway procedure showed that detrusor was underactive before the operation as dashed arrows indicatedand after the procedure, detrusor became contractile and detrusor-sphincter dyssynergia still remained as solid arrows indicated.

Voluntary voiding and bladder emptying was satisfactory with detrusor contraction and without abdominal straining. EMG, electromyogram; I. Vol, infused volume; Pabd, abdominal pressure; Pdet, detrusor pressure; Pves, vesical pressure; Q, flow rate; Qvol, uro volume.

Such condition is characterized by a low sustained or wave-like contraction and is associated with poor flow or no flow at all. During conventional urodynamic measurements, adequate emptying of the bladder, without a detrusor contraction is possible in two ways. Firstly, in Anal emg and urodynamic testing who can have a very good relaxation of the pelvic floor; in this case, hardly any detrusor contraction is needed for complete Anal emg and urodynamic testing Fig. Secondly, in patients using abdominal straining without simultaneous Anal emg and urodynamic testing relaxation to empty their bladder Fig.

Of the 25 patients with a suspected acontractile detrusor based on the conventional urodynamic measurements data, 21 patients had multiple detrusor contractions during voiding attempts on ambulatory urodynamic measurements during normal daily life activities.

Four patients even showed overactive detrusor contractions on their ambulatory urodynamic measurements. This implies that the Anal emg and urodynamic testing of these patients must have been due to other factors such as pelvic muscular nonrelaxation, psychological reasons or obstruction. In order to display abdominal straining, the anal catheter must be fixed firmly so as to avoid its exodus from the anus.

The female patient had better to change the position from supine to sitting. Sitting position was more normal than supine.

Xu et al. Detrusor underactivity in women: She finished urination fluently even without detrusor contraction and her sphincter relaxation was complete as indicated by solid arrows aanother female aged 73 years old, complained of poor-weak flow and pain with voiding for 4 years b. She was found passing urine by using abdominal straining without simultaneous sphincter relaxation to empty their bladder b.

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In order to study the efficacy of low-frequency electrotherapy LFE Anal emg and urodynamic testing female patients with an early stage DUA due to neuromuscular deficiency, we have conducted a conservative treatment program to patients with DUA. Tokyo, Japan. Patients received two treatment sessions each lasting for 70 min daily for two weeks.

Comprehensive urodynamic evaluations were performed in each patient prior to the LFE as the baseline and Anal emg and urodynamic testing 4 weeks following the procedure. How likely is it to get pregnant from anal sex. To describe perineal surface patch electromyography EMG activity during urodynamics UDS and compare activity between filling and voiding phases and to assess for a relationship between preoperative EMG activity and postoperative voiding symptoms. Pressure-flow studies were evaluated for abdominal straining and interrupted flow.

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Quantitative EMG values were extracted from 10 predetermined time-points and compared between fill and void.

Postoperative voiding dysfunction was defined as surgical revision or catheterization more than 6 weeks after surgery.

Quantitative and qualitative EMG signals during flow were usually greater than during fill. The prevalence of postoperative voiding dysfunction in subjects with higher preoperative EMG activity during void was not significantly different. Results were similar Anal emg and urodynamic testing the 42 subjects who had neither abdominal straining during void nor interrupted flow. Perineal Anal emg and urodynamic testing patch EMG did not measure expected pelvic floor and urethral sphincter relaxation during voiding.

Preoperative EMG did not predict patients at risk for postoperative voiding dysfunction. Normal voiding is characterized by urethral relaxation that is coordinated with detrusor contraction.

As a substitute for direct recording from the urethral sphincter, perineal surface patch electrodes are commonly used, and at many centers the results of this qualitative measure have been considered interchangeable with the results from CNE recordings. The validity of perineal patch electrodes has been challenged by studies showing that the innervation of levator ani 2 and anal sphincter 3 differ from that of the urethral sphincter and that perineal surface patch electrodes do not accurately document urethral quieting.

The methods 5 and results 6 of a randomized trial comparing Burch colposuspension to rectus fascia suburethral sling for treatment Anal emg and urodynamic testing stress urinary incontinence have previously been published. As part of their baseline evaluation, subjects enrolled in that study underwent urodynamic testing including filling cystometry and Anal emg and urodynamic testing studies with concomitant recording of signals from perineal surface patch EMG.

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If surface EMG recordings accurately record urethral activity, then we would expect them to be quiescent during voiding in a group of neurologically normal stress incontinent women. The purpose of the current analysis was to describe the performance of EMG during pressure-flow studies, to compare EMG activity during fill and during void, and to compare preoperative EMG recordings with postoperative voiding dysfunction.

Details of the SISTEr study methods 5 and results 6 have been published previously and are briefly outlined here. Inclusion criteria for enrollment included: There were women who were randomized to the Burch colposuspension arm Burch and randomized to the pubovaginal sling arm sling. Data were collected by interview and clinical examination preoperatively and postoperatively at 6 weeks and at 3, 6, 12, 18, and Anal emg and urodynamic testing months. Baseline urodynamic testing free uroflowmetry, filling cystometry, and pressure flow studies were performed on all participants prior to surgery based on a standardized UDS protocol that was implemented by all 20 urodynamic testers at the nine continence treatment centers using the same Laborie Toronto, Canada digital recording equipment.

UDS studies Anal emg and urodynamic testing also performed postoperatively at Anal emg and urodynamic testing month visit. Standardized interpretation guidelines were used by on-site local physician reviewers.

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EMG signals were electronically processed, and the raw values were displayed on the Anal emg and urodynamic testing screen and recorded on the digital event summary report at the annotated discrete time-point. After standing filling cystometry, study participants sat to void for pressure flow studies PFS. Anal emg and urodynamic testing cystometrogram CMG data to be considered valid, they had to meet the following criteria: Initially, 50 arbitrarily selected urodynamic signals were jointly reviewed by the first and second author for EMG definition agreement.

Subsequently, a statistician HL randomly selected 22 new signals for independent review to evaluate inter-rater reliability; 17 of these signals contained EMG data. It was also determined a priori that, if acceptable reliability could be established, a single interpreter could perform the remainder of the data extraction.

The reviewers were blinded to all patient characteristics and outcome measures, including postoperative voiding dysfunction, when the urodynamic data were extracted. We assessed the flow pattern according to the following categories: We assessed for evidence of straining at any time during flow click at this page as p abd more than 10 cm H 2 O greater than p abd at PFS baseline and also specifically at Q max. For each UDS, the EMG Anal emg and urodynamic testing was reviewed and deemed to be either a present and interpretable, b present but not interpretable e.

Our evaluation of EMG signals included: Ten specific annotations in chronological order were requested from the local urodynamic testers: At each of these annotated click to see more, the quantitative EMG values were extracted from the digital event summary report.

For the purposes of this study analysis we insisted on the difficult inclusion criteria of all 10 annotations present and appropriate chronological order. For signals with EMG values that were present and interpretable, a qualitative Anal emg and urodynamic testing was made regarding the percentage of the time there was Anal emg and urodynamic testing electrical activity greater than 0 during fill start of infusion to MCC and during flow entire flow, including all interrupted portions but excluding areas of no flow: A qualitative assessment was performed to determine whether the average amplitude of the EMG electrical activity during flow was increased, decreased, or similar to the average EMG electrical activity during fill.

Postoperative voiding dysfunction was defined by the source for surgical revision to facilitate bladder emptying or the use of any type of catheter after the 6-week postoperative visit through the month visit.

Inter-rater agreement was calculated as the percent of signals for which values agreed. Descriptive statistics were calculated for the EMG signal amplitudes for each time-point; median values, with 25th and 75th percentiles, were reported due learn more here skewness of fill and flow EMG value parameters. Because of the arbitrary amplitudes of EMG signals based on adjustments made prior to the start of each study, each subject served as her baseline reference for comparison, so studies missing any of the 10 time-points were excluded from these calculations.

No adjustment for the correlation between time-points was made. To assess differences in categorical variables by group e. Analyses were performed using SAS Version 9. Based on the criteria for validity and plausibility including signal legibility, protocol adherence and assessment of pressure measurements, of the preoperative UDS signals were deemed valid. None of these exclusions were based on EMG measures.

Of the subjects with valid signals based on the UDS Interpretation Guidelines used in the SISTEr study, 12 were available for this review 14 were unavailable, incomplete, or not performed on our standardized digital recording equipment. In this series of patients with interpretable EMG tracings, 55 One hundred forty-eight One hundred sixty-three Of Anal emg and urodynamic testing signals reviewed, Of the signals that were present and interpretable, the number of UDS that had annotations for the given time-points are Anal emg and urodynamic testing in Table I.

Not all time-points were annotated in the event summary of every UDS. Forty-two subjects had EMG values for all 10 time-points after subjects who strained or had interrupted flow were excluded. Figure 1 presents the median EMG signal amplitudes with corresponding 25th and 75th percentiles for the subjects in which all 10 major UDS time-points were annotated in the event summary.

Contrary to the relaxation expected during voiding, the median EMG values during flow were generally higher than during fill in these subjects. EMG amplitude returned to approximately baseline after moving from source to sitting between MCC and PFS baseline, suggesting that the position change was not the reason for the elevated EMG values seen during voiding.

This pattern was also true of the subset of 42 subjects who did not exhibit interrupted flow or abdominal straining during flow, either of which might increase EMG artifact also shown in Fig.

Because excluding the large number subjects with straining and interrupted voiding patterns did not significantly alter EMG values, for improved generalizability we included these subjects in our qualitative EMG analyses. This graph demonstrates that EMG values were generally higher during flow than during Anal emg and urodynamic testing.

Black bars present median EMG values for all subjects in which all 10 time-points were annotated, gray bars present median EMG values for the 42 of these subjects with neither straining nor interrupted flow.

Error bars: Similar analysis comparing uroflow start during flow and variables during fill yielded similar results data not presented. Overall, EMG was active more than half the time in most signals Subjectively, average EMG activity during flow was higher than fill in more than half of subjects.

Specifically, EMG amplitude was higher during flow than fill in Of the subjects with Anal emg and urodynamic testing EMG signals, 24 7. In Table IVwe compared rates of postoperative voiding dysfunction in subjects with different quantitative and qualitative EMG measures. This Anal emg and urodynamic testing of a large multi-institutional surgical trial on neurologically normal women with stress predominant urinary incontinence evaluated EMG signals during standardized preoperative urodynamics.

EMG activity measured by perineal surface electrodes increased more during voiding than during bladder filling in more than half of patients.

These findings were the opposite observation of what we expected, namely that the urethral sphincter should relax during the voiding phase. This failure to relax classically would indicate either occult neurologic disease or dysfunctional voiding, and these findings should warn of an increased risk of postoperative voiding dysfunction in these patients.

However, these patients did not have neurological disease, nor did they have a high rate of postoperative voiding dysfunction. This large study using many urodynamic laboratories following a standardized urodynamic protocol questions the role of preoperative surface EMG monitoring in patients with stress predominant urinary incontinence.

The primary objective Anal emg and urodynamic testing EMG during preoperative urodynamic testing in patients with incontinence is to predict those patients who have uncoordinated sphincter activity and may experience postoperative voiding dysfunction.

Failure to relax the urethral sphincter with voiding indicates detrusor—sphincter dyssynergia, associated with supra sacral neurologic disease, or in the absence of neurologic disease suggests pelvic floor hyperactivity or dysfunctional voiding.

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It is unusual for patients without a history of neurologic disease or abnormal neurologic evaluation of the perineum and extremities to have uncoordinated voiding. Contemporary urodynamic testing of the incontinent female has used surface EMG monitoring. Skin patch electrodes are easy to use, more comfortable than needle electrodes, and allow the patient to move from a standing to sitting position.

However, surface EMG electrode signals are often attenuated by intervening soft tissue, particularly if the muscle being studied is more than 10 mm from the skin surface as is the case between the skin near the anus and the urethral sphincter, and Cum on college slut record from wide areas of muscle territory. We did not standardize the surface EMG patches to any specific company or specify the exact placement of the EMG patches, but we Anal emg and urodynamic testing not think this non-standardization limits our results or conclusions because each patient served as their own baseline Anal emg and urodynamic testing for comparative values obtained during the fill and flow.

Skin patch EMG electrodes may not be sensitive and specific for urethral muscle and may reflect a sampling of various muscles in the perineum, pelvis, or buttocks. This phenomenon was described in a study of surface EMG to measure soleus and gastrocnemius muscle activity, in which a significant portion of the signal arose from adjacent or deeper muscles.

The results of that study suggested that no surface EMG electrode could measure a single muscle if others are in reasonable proximity. A further analysis comparing voiding phase uroflow start and variables during the bladder filling phase yielded similar lack of relaxation. We suspect that surface perineal electrodes are recording activity from other muscle groups, or other artifacts, and not demonstrating the relaxation of the pelvic floor or urethral sphincter activity during voiding.

We evaluated whether the change in position from standing to sitting could introduce artifact that Anal emg and urodynamic testing EMG amplitudes compared to filling cystometry. EMG activity after patient movement from standing maximal cystometric capacity to sitting pressure flow baseline returned Anal emg and urodynamic testing approximately baseline suggesting that the position change was not the reason for the elevated EMG values seen during voiding.

Whether the increased EMG activity with voiding reflected situational failure of patients to relax their pelvic floor or discomfort with the catheter or the testing is uncertain, but it would be test- or Anal emg and urodynamic testing, and still does not offer any prognostic on postoperative voiding dysfunction.

EMG activity in this study did not predict the 7. The main strength of this study is the large number of quality EMG tracings from multiple institutions following a rigorous standardized urodynamic protocol. A weakness of this study is the large number of UDS that were not evaluated in this EMG analysis because these studies did source meet our predetermined quality and validity criteria for pressure measurements.

Another weakness could be that we did not standardize the type of EMG surface electrodes or their Anal emg and urodynamic testing.

However, all subjects served as their own baseline reference for comparison in our analysis, so this should not have produced any bias. EMG activity measured by perineal surface patch electrodes did not measure the expected pelvic floor and urethral sphincter relaxation during voiding. It is not likely that over half of the patients in a multi-center surgical trial for SUI have either occult neurologic disease or pelvic floor dyssynergia.

Our data question the role of preoperative EMG monitoring with surface perineal electrodes during urodynamic testing in neurologically normal patients with stress predominant urinary incontinence. Urodynamic testing is particularly valuable in assessing bladder function in.

Anal emg and urodynamic testing sphincter EMG has been used as a proxy for sphincter EMG in patients with. o For these individuals, EMG testing of the anal or urethral sphincter may Association (AUA) Guidelines on Urodynamic Testing recommend. KEYWORDS electromyography, EMG, urodynamic testing, anus. Pressure-flow studies were conducted with simultaneous input from both EMG electrodes. What is an anorectal/rectal manometry test? Normal anal EMG activity with low anal squeeze pressures on manometry may indicate a torn Anal emg and urodynamic testing muscle.

Simple urodynamic tests involve performing noninvasive uroflow studies, Voiding CMG (pressure-flow study).

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EMG. Static cystography. intravesical pressure, a rectal or vaginal catheter to record abdominal pressure, and. Sharkboy and lavagirl sex pics.

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