Diagnostic value of bulbocavernosus reflex in nervous system diseases

doi:10.3877/cma.j.issn.1674-0785.2023.05.018

Abstract

Abstract:

Bulbocavernous reflex (BCR) has a long history of clinical application. It reflects the functional integrity of the whole sacral reflex arc consisting of the pudendal afferent nerve, S2-S4 spinal segments, and the pudendal efferent nerve, and is often an indirect reflection of the parasympathetic nerve function of the spinal cord. The BCR test is relatively simple and easy to carry out in the clinic. When combined with the pudendal nerve somatosensory evoked potentials, BCR has the value of localization diagnosis of nervous system diseases. BCR is helpful for the diagnosis and differentiation of neuroerectile dysfunction, diabetic pudendal neuropathy, spinal cord related diseases, and neurodegenerative diseases. In addition, BCR is the most valuable means for real-time monitoring of sphincter function and sexual function during surgery for spinal cord related diseases..

Key words: Bulbocavernous reflex, Reflex arc, Pudendal nerve somatosensory evoked potentials, Nervous system, Diagnosis

Tuanfeng Yang, Yanxiang Wang, Xianzeng Liu. Diagnostic value of bulbocavernosus reflex in nervous system diseases[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(05): 600-604.

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References 42

18	倪佩琦, 王汛, 牛晓婷, 等. 女性球海绵体肌反射及阴部神经躯体感觉诱发电位的正常值分析 [J]. 温州医学院学报, 2011, 41(1): 65-67.
19	张芸芸, 邵蓓, 葛东红, 等. 糖尿病性神经源性膀胱患者球海绵体肌反射及阴部神经体感诱发电位与超声尿动力学的相关性 [J]. 中华神经科杂志, 2014(6): 399-402.
20	Haldeman S, Bradley WE, Bhatia NN, et al. Pudendal evoked responses [J]. Arch Neurol, 1982, 39(5): 280-283.
21	Ertekin C, Akyürekli O, Gürses AN, et al. The value of somatosensory-evoked potentials and bulbocavernosus reflex in patients with impotence [J]. Acta Neurol Scand, 1985, 71(1): 48-53.
22	邵蓓, 王汛, 李澄棣, 等. 电生理检测在勃起功能障碍鉴别诊断中的价值 [J]. 温州医学院学报, 2004, 34(6): 420-422.
23	中华医学会男科学分会, 创伤性勃起功能障碍诊疗中国专家共识编写组. 创伤性勃起功能障碍诊疗中国专家共识 [J]. 中华男科学杂志, 2021, 27(6): 557-566.
24	Niu X, Wang X, Huang H, et al. Bulbocavernosus reflex test for diagnosis of pudendal nerve injury in female patients with diabetic neurogenic bladder [J]. Aging Dis, 2016, 7(6): 715-720.
25	Ditunno JF, Little JW, Tessler A, et al. Spinal shock revisited: a four-phase model [J]. Spinal Cord, 2004, 42(7): 383-395.
26	Greciet N, Mac-Thiong JM, Nguyen BH, et al. The functional impact of the absence of a bulbocavernosus reflex in the postoperative period after a motor-complete traumatic spinal cord injury [J]. Am J Phys Med Rehabil, 2020, 99(8): 712-718.
27	Zusman NL, Radoslovich SS, Smith SJ, et al. Physical examination is predictive of cauda equina syndrome: MRI to rule out diagnosis is unnecessary [J]. Global Spine J, 2022, 12(2): 209-214.
28	Sala F, Squintani G, Tramontano V, et al. Intraoperative neurophysiology in tethered cord surgery: techniques and results [J]. Childs Nerv Syst, 2013, 29(9): 1611-1624.
29	Morota N. Intraoperative neurophysiological monitoring of the bulbocavernosus reflex during surgery for conus spinal lipoma: what are the warning criteria? [J]. J Neurosurg Pediatr, 2019, 22: 1-9.
30	Pang D. Surgical management of complex spinal cord lipomas: how, why, and when to operate. A review [J]. J Neurosurg Pediatr, 2019, 23(5): 537-556.
31	Hwang H, Wang KC, Bang MS, et al. Optimal stimulation parameters for intraoperative bulbocavernosus reflex in infants [J]. J Neurosurg Pediatr, 2017, 20(5): 464-470.
32	Sugiyama K, Harada N, Kondo K, et al. Relationship between preoperative neuroradiological findings and intraoperative bulbocavernosus reflex amplitude in patients with intradural extramedullary tumors [J]. Neurol Med Chir (Tokyo), 2021, 61(8): 484-491.
33	Shinjo T, Hayashi H, Takatani T, et al. Intraoperative feasibility of bulbocavernosus reflex monitoring during untethering surgery in infants and children [J]. J Clin Monit Comput, 2019, 33(1): 155-163.
34	Cha S, Wang KC, Park K, et al. Predictive value of intraoperative bulbocavernosus reflex during untethering surgery for post-operative voiding function [J]. Clin Neurophysiol, 2018, 129(12): 2594-2601.
1	Bors E, French JD. Management of paroxysmal hypertension following injuries to cervical and upper thoracic segments of the spinal cord [J]. AMA Arch Surg, 1952, 64(6): 803-812.
2	Bors E, Blinn KA. Bulbocavernosus reflex [J]. J Urol, 1959, 82(1): 128-130.
3	Skinner SA, Vodušek DB. Intraoperative recording of the bulbocavernosus reflex [J]. J Clin Neurophysiol, 2014, 31(4):313-322.
4	Kirshblum S, Eren F. Anal reflex versus bulbocavernosus reflex in evaluation of patients with spinal cord injury [J]. Spinal Cord Ser Cases, 2020, 6(1): 2.
5	Rushworth G. Diagnostic value of the electromyographic study of reflex activity in man [J]. Electroencephalogr Clin Neurophysiol, 1967, 25: 65-73.
6	Blaivas JG, Zayed AA, Labib KB. The bulbocavernosus reflex in urology: a prospective study of 299 patients [J]. J Urol, 1981, 126(2): 197-199.
7	Ertekin C, Reel F. Bulbocavernosus reflex in normal men and in patients with neurogenic bladder and/or impotence [J]. J Neurol Sci, 1976, 28(1): 1-15.
8	Lee DG, Kwak SG, Chang MC. Prediction of the outcome of bladder dysfunction based on electrically induced reflex findings in patients with cauda equina syndrome: a retrospective study [J]. Medicine (Baltimore), 2017, 96(21): e7014.
9	李佩华, 吴常德, 马忠泰, 等. 电生理BCR、ICR、PEP检查对马尾综合征的诊断和预后的临床意义 [J]. 中华骨科杂志, 1999, 19(2): 99-102.
10	Shi J, Jia L, Yuan W, et al. Clinical classification of cauda equina syndrome for proper treatment [J]. Acta Orthop, 2010, 81(3): 391-395.
11	Deletis V, Vodusek DB. Intraoperative recording of the bulbocavernosus reflex [J]. Neurosurgery, 1997, 40(1): 88-93.
12	李慧晶, 牛晓婷, 王汛, 等. 球海绵体肌反射检测技术在帕金森病与多系统萎缩患者鉴别诊断中的应用 [J]. 中华神经科杂志, 2015, 48(3): 203-206.
13	Granata G, Padua L, Rossi F, et al. Electrophysiological study of the bulbocavernosus reflex: normative data [J]. Funct Neurol, 2013, 28(4): 293-295.
14	Schellino R, Boido M, Vercelli A. The dual nature of Onuf's nucleus: neuroanatomical features and peculiarities, in health and disease [J]. Front Neuroanat, 2020, 14: 572013.
15	Porst H, Tackmann W, van Ahlen H. Neurophysiological investigations in potent and impotent men. Assessment of bulbocavernosus reflex latencies and somatosensory evoked potentials [J]. Br J Urol, 1988, 61(5): 445-450.
16	王汛, 邵蓓, 倪佩琦, 等. 海绵体肌反射及阴茎背神经躯体感觉诱发电位的正常值分析[J]. 浙江医学, 2002, 24(8): 507-508.
17	陈小勇, 王雪峰, 张立元, 等. 366例志愿者勃起相关神经电生理检测的实验室参考值分析 [J]. 中国男科学杂志, 2013(5): 18-21.
35	Choi J, Kim JS, Hyun SJ, et al. Efficacy of intraoperative bulbocavernosus reflex monitoring for the prediction of postoperative voiding function in adult patients with lumbosacral spinal tumor [J]. J Clin Monit Comput, 2022, 36(2): 493-499.
36	Niu X, Cheng Y, Hu W, et al. Application of bulbocavernosus reflex combined with anal sphincter electromyography in the diagnosis of MSA and PD [J]. Int J Neurosci, 2022, 132(9): 851-856.
37	Wang ZY, Chen YH, Xu YY, et al. Altered bulbocavernosus reflex in patients with multiple system atrophy [J]. Neurol Res, 2016, 38(2): 138-143.
38	Huang HJ, Zhu XY, Wang X, et al. The bulbocavernosus reflex in the differential diagnosis of multiple system atrophy with predominant parkinsonism and parkinson's disease [J]. Front Neurol, 2018, 8: 697.
39	Sung JH, Mastri AR, Segal E. Pathology of Shy-Drager syndrome [J]. J Neuropathol Exp Neurol, 1979, 38(4): 353-368.
40	O'Sullivan SS, Holton JL, Massey LA, et al. Parkinson's disease with Onuf's nucleus involvement mimicking multiple system atrophy [J]. J Neurol Neurosurg Psychiatry, 2008, 79(2): 232-234.
41	唐北沙, 陈生弟, 中华医学会神经病学分会帕金森病及运动障碍学组, 等. 多系统萎缩诊断标准中国专家共识 [J]. 中华老年医学杂志, 2017, 36(10): 1055-1060.
42	Colosimo C, Inghilleri M, Chaudhuri KR. Parkinson's disease misdiagnosed as multiple system atrophy by sphincter electro-myography [J]. J Neurol, 2000, 247(7): 559-561.

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