Evaluation of different electrophysiological studies in the detection of urinary and sexual dysfunction in diabetic women

Abstract EN

Diabetes mellitus is the most common cause of urinary and sexual dysfunction.

Although diabetes mellitus can be diagnosed clearly and simply, diabetic neuropathy and diabetic cystopathy (DC) can progress insidiously over time without any symptoms, manifesting itself at a later stage, which increases the risk of secondary complications.

Therefore, early diagnosis in the asymptomatic stage of DC with a simple noninvasive method is of utmost importance.

Aim of the work To evaluate the different electrophysiological studies [including genital sympathetic skin response (SSR), somatosensory-evoked potential (SSEP) of the tibial nerve] in the early detection of urinary and sexual dysfunction in diabetic women.

Patients and methods This study was carried out on 30 diabetic women and 10 healthy women served as a control group.

All patients were divided into two groups (group I and group II) with respect to lower urinary tract symptoms and signs.

They were subjected to a full assessment of medical history, full neurological examination, and assessment by the female sexual function index questionnaire.

Urodynamic studies including: uroflowmetry and cystometry were carried out for all patients.

Electrophysiological studies were carried out for both patients and controls and included nerve conduction studies of both tibial and peroneal nerves, sensory nerve conduction studies of both sural nerves, SSEP of the tibial nerve and genital, hand, and foot SSR.

Results In group I: Abnormal findings of motor studies were recorded in 1/15 (6.6%) patients, prolonged genital SSR in one patient (6.6%) and absent in two patients 2/15 (13.3%).

Prolonged SSEP were recorded in 2/15 (13.3%) of patients.

As regards urodynamic study, abnormal findings were detected in 3 patients (20%).

In group II: Abnormal findings of motor studies were recorded in 8/15 (53.3%) patients, absent foot SSR in four patients (26.6%), absent genital SSR in seven (46.6%) patients.

Prolonged SSEP P40 were recorded in 6/15 (40%).

As regards urodynamic study, abnormal findings were detected in 12 patients (80%).

There was statistically significant difference between both groups as regards all electerophysiologic parameters except foot latency.

There was a statistically highly significant difference between urodynamic diagnosis and genital SSR and SSEP P40 of tibial nerve.

Conclusion Although urodynamic is essential for the actual diagnosis and the detection of variable pathophysiological changes, electrophysiological studies represent an easy, valid, and noninvasive objective method for the evaluation of DC and sexual dysfunction.oracic outlet syndrome (NTOS) with late surgical treatment after a trial of conservative management.

Patients and methods The study included 35 patients with NTOS (25 women and 10 men; aged 20–52 years) who were classified into two groups.

Patients in the first group (15 patients) were operated upon 6 months after medical and physical therapy; patients in the second group were operated upon within 3 months of onset.

All patients were operated upon using the supraclavicular surgical approach.

They were evaluated clinically and neurophysiologically and they answered the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire preoperatively and 6 months postoperatively for assessment of functional outcome.

Results Paresthesia and pain were seen to have improved significantly in group II compared with group I.

Muscle weakness was nonsignificantly less frequent in group II compared with group I.

Group II showed a significantly better sensory nerve action potential of the ulnar nerve and less denervation in electromyography compared with group I.

The postoperative DASH score improved in both groups but it was less statistically significant in group I compared with group II (Po0.05 in group I and Po0.001 in group II).

Conclusion We suggest that early surgical treatment for NTOS will improve functional disability, stop degeneration of nerves, and decrease the occurrence of muscle wasting and denervation of nerves compared with late surgery.