Transurethral electrical stimulation for intraoperative bulbocavernosus reflex monitoring during spine surgery in females

Clin Neurophysiol. 2022 Sep:141:9-14. doi: 10.1016/j.clinph.2022.06.009. Epub 2022 Jun 24.

Abstract

Objective: Intraoperative bulbocavernosus reflex (BCR) monitoring is more difficult in females than in males. This study was designed to compare the feasibility of transurethral electrical stimulation BCR (tu-BCR) monitoring with that of conventional BCR (c-BCR) monitoring during spine surgery in females.

Methods: Twenty-four females were included. For stimulation in c-BCR monitoring, a pair of surface electrodes was placed on the genitals (cathode/anode: clitoris/adjacent labium). For stimulation in tu-BCR monitoring, a urethral catheter attached to a pair of electrodes was inserted into the urethra. BCRs were recorded from the external anal sphincter after a single train of four stimulation pulses.

Results: There was no postoperative urinary tract injury associated with urethral catheter insertion for tu-BCR. Tu-BCR monitoring had a significantly higher success rate of baseline recording than c-BCR monitoring (87.5% vs 66.7%, respectively, p = 0.028). The specificities of tu-BCR and c-BCR monitoring were 100% and 87.2%, respectively. The sensitivity was not calculated because no patients had postoperative urinary or bowel dysfunction.

Conclusions: Our data indicate that tu-BCR monitoring improved the success rate of baseline recording and specificity during spine surgery in females.

Significance: Tu-BCR monitoring was more reliable than c-BCR monitoring during spine surgery in females.

Keywords: Bulbocavernosus reflex; Female; Intraoperative monitoring; Transurethral stimulation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Electric Stimulation
  • Female
  • Humans
  • Male
  • Monitoring, Intraoperative*
  • Penis*
  • Reflex / physiology
  • Urethra / surgery