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DOI: 10.1055/s-0042-1743509
Alto porcentaje de ausencia de reflejo bulbocavernoso en pacientes neurológicamente sanos con disfunción vesical
High Percentage of Absence of Bulbocavernosus Reflex in Neurologically-Healthy Patients with Bladder Dysfunction
Resumen
Introducción y Objetivo El reflejo bulbocavernoso (RBCV) se ha observado ausente incluso en pacientes neurológicamente sanos. Los trastornos funcionales del piso pélvico deben incluir su evaluación.
Nuestro objetivo primario fue evaluar la prevalencia de ausencia de RBCV en pacientes sanos. El objetivo secundario fue observar la afectación del RBCV en presencia de otras comorbilidades cómo enfermedad neurológica y diabetes mellitus tipo 2.
Métodos Estudio descriptivo y retrospectivo, en el que se revisaron mil expedientes clínicos de pacientes sometidos a estudio urodinámico a quienes se les realizó exploración mecánica del RBCV como parte de una exploración rutinaria. Se realizó estadística descriptiva para las variables cuantitativas y cualitativas utilizando la prueba tde Student y la de chi cuadrado, respectivamente. Se consideraron estadísticamente significativos valores de p < 0,05.
Resultados La muestra tenía una media de edad de 59,84 años (desviación estándar [DE]: ± 14,13 años), y contenía 36,19% de mujeres y 21,13% de hombres sin enfermedad neurológica y RBCV ausente. Se observó mayor ausencia de RBCV en pacientes con presencia de enfermedad neurológica en comparación con pacientes neurológicamente sanos: 21,6% versus 10,6%, respectivamente (p < 0,0001); además, se observó una ausencia importante de RBCV en presencia de diabetes mellitus en comparación con pacientes no diabéticos: 30.8% versus 18.8%, respectivamente (p < 0,0001). No se observaron diferencias al comparar grupos con respecto a disfunción vesical.
Conclusión La ausencia de RBCV no es exclusiva de una enfermedad neurológica con repercusión de síntomas del tracto urinario inferior, y la proporción de pacientes neurológicamente sanos con ausencia de RBCV no es despreciable. No se encontró una diferencia significativa en los grupos con ausencia de RBCV con respecto a disfunción vesical.
Abstract
Introduction and Objective Absence of the bulbocavernosus reflex (BCVR) has been observed even in neurologically-healthy subjects. Functional disorders of the pelvic floor should include its assessment.
The primary objective of the present study was to evaluate the absence of BCVR in healthy subjects. The secondary objective was to evaluate the BCVR with regards to the presence of other comorbidities, such as neurogenic bladder and type-2 diabetes mellitus.
Methods A descriptive and retrospective study in which we reviewed the clinical files of one thousand subjects who underwent a urodynamic study and were submitted to a mechanical exploration of the BCVR as part of a routine evaluation. Descriptive statistics were performed for the quantitative and qualitative variables using the Student t and the Chi-squared tests accordingly. Values of p < 0.05 was considered statistically significant.
Results The sample had a mean age of 59.84 years (standard deviation [SD] ± 14.13 years), and it contained 36.19% of women and 21.13% of men without neurological disease and absent BCVR. A higher proportion of BCVR absence was observed in patients with neurological disease compared to their healthy counterparts: 21.6% and 10.6% respectively (p ≤ 0.0001); furthermore, an important absence of the BCVR was observed in patients with type-2 diabetes mellitus compared to non-diabetic patients: 30.8% and 18.8% respectively (p ≤ 0.0001). No statistically significant differences were observed in the group comparison regarding bladder dysfunction.
Conclusion The absence of the RBCV is not exclusive to a neurological disease with repercussions in terms of lower urinary tract symptoms, and the proportion of neurologically healthy subjects with absence of the BCVR is not negligible. No significant difference was found in groups with absence of the BCVR with regards to bladder dysfunction.
Palabras Clave
reflejo bulbocavernoso - reflejo bulboesponjoso - vejiga neurogénica - nervio pudendo - transtornos del piso pélvicoKeywords
bulbocavernosus reflex - bulbospongiosus reflex - neurogenic bladder - pudendal nerve - pelvic floor disordersPublication History
Received: 30 November 2020
Accepted: 20 January 2022
Article published online:
21 June 2022
© 2022. Sociedad Colombiana de Urología. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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Referencias
- 1 Kaiho Y, Namima T, Nakagawa H. et al. Bulbocavernosus reflex during the micturition cycle in normal male subjects. Int J Urol 2004; 11 (01) 33-37 DOI: 10.1111/j.1442-2042.2004.00738.x.
- 2 Previnaire JG. The importance of the bulbocavernosus reflex. Spinal Cord Ser Cases 2018; 4 (01) 2 DOI: 10.1038/s41394-017-0012-0.
- 3 Laudano MA, Chughtai B, Lee RK. et al. Use of the Bulbocavernosus Reflex System in assessing voiding dysfunction. World J Urol 2013; 31 (06) 1459-1462 DOI: 10.1007/s00345-013-1063-x.
- 4 Niu X, Shao B, Ni P. et al. Bulbocavernosus reflex and pudendal nerve somatosensory-evoked potentials responses in female patients with nerve system diseases. J Clin Neurophysiol 2010; 27 (03) 207-211 DOI: 10.1097/wnp.0b013e3181dd4fca.
- 5 Rosier PFWM, Schaefer W, Lose G. et al. International Continence Society Good Urodynamic Practices and Terms 2016: Urodynamics, uroflowmetry, cystometry, and pressure-flow study. Neurourol Urodyn 2017; Jun; 36 (05) 1243-1260
- 6 Sethi RK, Bauer SB, Dyro FM, Krarup C. Modulation of the bulbocavernosus reflex during voiding: loss of inhibition in upper motor neuron lesions. Muscle Nerve 1989; 12 (11) 892-897 DOI: 10.1002/mus.880121104.
- 7 Ertekin C, Reel F. Bulbocavernosus reflex in normal men and in patients with neurogenic bladder and/or impotence. J Neurol Sci 1976; 28 (01) 1-15 DOI: 10.1016/0022-510x(76)90044-7.
- 8 Steven McGee. Evidence-Based Physical Diagnosis. 4ª Edición.. Elsevier; 2018
- 9 Blaivas JG, Zayed AA, Labib KB. The bulbocavernosus reflex in urology: a prospective study of 299 patients. J Urol 1981; Aug; 126 (02) 197-199
- 10 Podnar S. Neurophysiologic studies of the penilo-cavernosus reflex: normative data. Neurourol Urodyn 2007; 26 (06) 864-869 DOI: 10.1002/nau.20411.
- 11 Niu X, Wang X, Huang H, Ni P, Lin Y, Shao B. Bulbocavernosus Reflex Test for Diagnosis of Pudendal Nerve Injury in Female Patients with Diabetic Neurogenic Bladder. Aging Dis 2016; 7 (06) 715-720 DOI: 10.14336/AD.2016.0309.
- 12 Kirshblum S, Eren F. Anal reflex versus bulbocavernosus reflex in evaluation of patients with spinal cord injury. Spinal Cord Ser Cases 2020; 6: 2 DOI: 10.1038/s41394-019-0251-3.
- 13 Amarenco G, Ismael SS, Bayle B, Kerdraon J. Dissociation between electrical and mechanical bulbocavernosus reflexes. Neurourol Urodyn 2003; 22 (07) 676-680 DOI: 10.1002/nau.10123.