Pérez-Martínez C, Vargas-Díaz IB

Language: Spanish
References: 20
Page: 225-228
PDF size: 161.20 Kb.

ABSTRACT

Objective: Instability in the pelvic floor musculature (PFM) in patients presenting with Type III Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) has been reported. The purpose of the present study is to report the results of Surface Electromyography (sEMG) using cutaneous patches in CP/CPPS patients when compared with healthy volunteers.
Materials and methods: Surface EMG using surface electrodes 3 cm from the anal sphincter was carried out in 14 healthy volunteers (control group, CG) and in 28 men presenting with CP/CPPS (problem group, PG). Surface EMG was registered by a Verimed Myoexerciser. PG inclusion criterion was chronic pelvic pain with a minimum 6-month progression in which no pathology was identified as the cause of symptoms. Patients presenting with positive urine and/or semen cultures, lithiasis, biopsy and/or prostate or bladder surgery, bladder or prostate cancer and radiation were all excluded from the study. Age, mean sEMG microvolts (µV) during rest (PAVRG) and trace minimum, maximum and amplitude were reported and analyzed using SPSS 10.0 statistical software.
Results: Mean age was 46.36 years in the CG and 44.04 years in the PG (P=0.768). Logistical regression identified PAVRG (P=0.000) as the most important variable. It represents the PFM tone during rest and was 0.0785 µV SD ± 0.0763 in the CG and 0.4243 µV SD ± 0.2387 in the PG. Mean sEMG trace amplitude represents PFM electrical activity during rest, and was 0.0714 µV SD ± 0.0588 in the CG and 0.4375 µV SD ± 0.5496 in the PG (P=0.018).
Conclusions: PAVRG is the most important sEMG variable. The significant difference between both groups for PAVRG shows an elevated PFM tone in CP/CPPS patients (P=0.000). This group also has an unstable pelvic floor, as shown by the greatest trace sEMG amplitude (P=0.018). These data suggest that sEMG with cutaneous patches can be of diagnostic use in CP/CPPS patients, and open the possibility of using alternative PFM therapies such as biofeedback, neuromodulation and botulinic toxin use.

REFERENCES

1. Chen J, Zhao HF, Xu ZS. The prostate has secretory dysfunction for category IIIA and IIIB prostatitis. J Urol 2007;177(6):2166-69.

2. Yang CC, Lee JC, Kromm BG, Ciol MA, Berger RE. Pain sensitization in male chronic pelvic pain syndrome: Why are symptoms so difficult to treat? J Urol 2003;170(3):826-7.

3. Wallner C, Maas C, Dabhoiwala N, DeRuiter M & Lamers W. The innervation of the pelvic floor muscles: A reappraisal for the elevator ani nerve. Neurourol Urodyn 2006;25:537-8.(Abs:23).

4. DeLancey J et al. Gross Anatomy and Cell Biology of the Lower Urinary Tract. En Abrams P, Cardozo L, Khoury S & Wein A. Incontinence, 2nd International Consultation on Incontinence, Paris July 1-3, 2002:17-82.

5. Hodges PW, Sapsford R, Pengel HM. Postural and Respiratory Functions of the Pelvic Floor Muscles. Neurourol Urodyn 2007;26(3):362-71.

6. Yilmaz U, Liu YW, Berger RE, Yang CC. Autonomic Nervous System Changes in Men with chronic pelvic pain syndrome. J Urol 2007;177(6):2170-74.

7. Fowler CJ, Benson JT, Craggs MD, Vodisek DB, Yang CC, Podnar S. Clinical Neurophysiology. En Abrams P, Cardozo L, Khoury S & Wein A. Incontinence. 2nd International Consultation on Incontinence, Paris July 1-3, 2002:389-424.

8. Hetrick DC, Ciol MA, Rothman I, Turner JA, Frest M, Berger RE. Musculoskeletal dysfunction in men with chronic pelvic pain syndrome type III: A case-control Study. J Urol 2003;170(3):828-31.

9. Zerman DH, Ishigooka N, Doggweiler R, Schmidt RA. Neurourological insights into the etiology of genitourinary pain in men. J Urol 1999;161(3):903-8.

10. Hetrick DC, Glazer H, Liu YW, Turner JA, Frest M, Berger RE. Pelvic Floor Electromyography in Men with Chronic Pelvic Pain Syndrome: A Case-Control Study. Neurourol Urodyn 2006;25(1):46-9.

11. Hernández A JL. Aspectos éticos de la investigación en seres humanos. En: Hernández Arriaga JL, Bioética General, Ed. Manual Moderno. Distrito, México. 2002:133-62.

12. Smith MD, Coppieters MW, Hodges PW. Postural Response of the Pelvic Floor and Abdominal Muscles in Women with and without Incontinence. Neurourol Urodyn 2007;26(3):377-85.

13. Martínez Pérez C, Vargas DIB, Silva PH. Toxina botulínica, perspectivas presentes y futuras en urología. Rev Mex Urol 2006;66(5):228-33.