RESUMEN
OBJECTIVE: The purpose of this systematic review was to characterize methodologies reported in the literature to elicit and record pudendal somatosensory evoked potentials (SEPs) in human adults. METHODS: We conducted an electronic literature search in MEDLINE, Embase, CENTRAL, and CINAHL for studies that elicited pudendal SEPs via electrical stimulation and recorded responses though electroencephalography. From included studies, we extracted methodological details of how the SEPs were evoked and recorded. RESULTS: 132 studies were included in our review. The majority of participants were male (n = 6742/8526, 79%). Almost all studies stimulated the dorsal nerve of penis/clitoris. Stimulus parameters varied, with most standardizing stimulus intensity to 2-4x perceptual threshold, pulse duration to 0.1-0.2 ms, and frequency to 3 Hz. The number of stimuli recorded varied by clinical population. CONCLUSIONS: Our results demonstrate the inconsistencies of pudendal SEP methodology in the literature, with the majority (77%) of publications not reporting enough detail to reasonably replicate their protocol. Most research to date has been conducted in males, highlighting the paucity of female pelvic neurophysiology research. SIGNIFICANCE: We propose a Pudendal SEP Reporting Checklist for adequate reporting of pudendal SEP protocols. Optimal sex- and patient-specific methodologies to investigate all branches of the pudendal nerve need to be established.
Asunto(s)
Potenciales Evocados Somatosensoriales , Nervio Pudendo , Humanos , Potenciales Evocados Somatosensoriales/fisiología , Nervio Pudendo/fisiología , Adulto , Masculino , Femenino , Electroencefalografía/métodos , Estimulación Eléctrica/métodos , Pene/fisiología , Pene/inervaciónRESUMEN
This study aimed to elucidate the macroscopic and microscopic distributions of the dorsal nerve of penis (DNP) that provides the greatest sensitivity over the glans penis. The glandes of 23 penises of formalin-embalmed cadavers were investigated to confirm the macroscopic and microscopic distributions of the DNP within the glans penis by whole-mount Sihler's staining and histological sectioning. Superficial regions of the mid-glans were reconstructed in three dimensions to define the microstructure of terminal branches of the DNP that project towards the skin surface. A mean of 6.7 bundles of the DNP consisting of several nerve fibres converged linearly towards the distal end of the penis, rather than diverging laterally as they travelled. Lateral branches of the DNP extended linearly to the distal end with ramifications, while dorsomedial branches of the DNP gave off nerve fibres to the dorsum of the mid-glans and the corona. The intrastromal ramifications of the DNP were more developed in the distal half of the glans penis than the proximal glans containing the corpus cavernosum. These ramifications gave rise to radial nerve fibres that project towards the skin surface to form a plexiform network of terminal branches in the dermis. Linear projections of the main branches of the DNP throughout the glans and fine networks of terminal branches in the dermis were distinctly visualized in the human penis.
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Pene/inervación , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: One of the methods to treat post radical prostatectomy stress urinary incontinence is the AdVance (American Medical Systems, Minnetonka, MN, USA) male sling procedure. During this procedure, the somatic innervation of the penis may be at risk for injury. Six AdVance procedures were performed in six donated bodies at the Anatomy and Embryology Department of the Leiden University Medical Centre. The pelves were dissected and the shortest distance between the sling and the dorsal nerve of the penis (DNP) was documented. AIM: The aim of this study was to describe the anatomical relation between the AdVance male sling and penile nerves based on the dissection of six adult male pelves. METHODS: The AdVance male sling procedure was conducted in six donated male bodies. After placement, the pelves were dissected and the shortest distance between sling and the DNP was documented. MAIN OUTCOME MEASURE: The main outcome measure was the distance between the AdVance male sling and the DNP. RESULTS: The mean distance of the sling to the DNP was 4.1 mm and was found situated directly next to the nerve (distance 0 mm) in 4 out of 12 (33%) hemipelves. The distance of the sling to the obturator neurovascular bundle was 30 mm or more in all six bodies. CONCLUSIONS: Damage to the DNP caused by the AdVance male sling procedure appears to be an extremely rare complication, which has not been described in current literature. The proximity of the AdVance to the DNP could, however, pose a risk that should be taken into consideration by physicians and patients when opting for surgery.
Asunto(s)
Pene/anatomía & histología , Complicaciones Posoperatorias/cirugía , Prostatectomía/efectos adversos , Nervio Pudendo/anatomía & histología , Cabestrillo Suburetral/efectos adversos , Adulto , Cadáver , Disfunción Eréctil/cirugía , Humanos , Masculino , Pene/inervación , Pene/cirugía , Riesgo , Incontinencia Urinaria de Esfuerzo/cirugíaRESUMEN
AIMS: The recently developed TOMAX-procedure restores unilateral genital sensation, improving sexual health in men with a low spinal lesion (LSL). It connects one dorsal nerve of the penis (DNP) to the intact ipsilateral ilioinguinal nerve. We proposed bilateral neurotization for full sensation of the glans but this entails cutting both DNPs, risking patients' erection/ejaculation ability. The objective was to select patients for a bilateral TOMAX-procedure by measuring remaining DNP function, and perform the first bilateral cases. METHODS: In 30 LSL patients with no penile- but normal groin sensation selected for a unilateral TOMAX-procedure the integrity of the sacral-reflex-arc and DNP function was tested pre-operatively using bilateral needle electromyography (EMG)-bulbocavernosus reflex (BCR) measurements, and an interview about reflex erections (RE) ability. RESULTS: In 13 spina bifida- and 17 spinal cord injury patients [median age 29.5 years (range 13-59 years), spinal lesion T12 (incomplete) to sacral], seven (23%) patients reported RE, four (57%) with intact BCR, and of nine (30%) patients with intact BCR, four reported RE (44%). CONCLUSIONS: Even patients with a LSL and no penile sensation can have signs of remaining DNP function, but cutting both DNPs to restore full glans sensation in a bilateral TOMAX-procedure might interfere with their RE/ejaculation. To avoid this risk, we propose a selecting-protocol for a unilateral- or bilateral procedure using RE and BCR measurements. Using this protocol, three patients were bilaterally operated with promising preliminary results. Full sensation of the glans could lead to further improvement in sexual function.
Asunto(s)
Enfermedades del Pene/cirugía , Pene/inervación , Nervio Pudendo/cirugía , Umbral Sensorial , Traumatismos de la Médula Espinal/complicaciones , Disrafia Espinal/complicaciones , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Adolescente , Adulto , Electromiografía , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Pene/diagnóstico , Enfermedades del Pene/etiología , Enfermedades del Pene/fisiopatología , Erección Peniana , Nervio Pudendo/fisiopatología , Calidad de Vida , Recuperación de la Función , Reflejo Anormal , Resultado del Tratamiento , Procedimientos Quirúrgicos Urológicos Masculinos/efectos adversos , Adulto JovenRESUMEN
OBJECTIVE: To explore the diagnostic value of the nerve conduction study in the dorsal nerve of penis before and after erection. METHOD: Nineteen subjects with a confirmed psychogenic impotence were studied for the superficial peroneal and sural sensory nerve conductions, bulbocavernous reflexes (BCR), tibial and pudendal somatosensory evoked potentials (SEP), and conduction studies of the dorsal nerve of penis. Sixteen subjects with normal findings had repeat studies after an injection of Prostaglandin E1. RESULTS: Erection helped to obtain a dorsal penile sensory potentials in 18.8% of the 16 subjects. The mean conduction velocity of the dorsal nerve of penis increased significantly from 33.8+/-9.3 m/sec to 48.4+/-12.8 m/sec. The mean sensory amplitude of the dorsal nerve of penis increased significantly from 1.7+/-1.0 microvolt to 2.8+/-1.4 microvolt. There was no significant difference in the BCR latency and the pudendal SEP (latency and amplitude) before and after erection. CONCLUSION: Erection helps to obtain the sensory potentials of the dorsal nerve of penis when it is technically difficult to obtain and increases the conduction velocity as well as amplitude of the dorsal nerve of penis. However it does not affect the BCR latency and pudendal SEP.