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

• DOI: 10.1016/j.clinph.2022.06.009
• Publication Date: 2022-06-24T04:15:21Z
• Authors: Hironobu Hayashi; Takeaki Shinjo; Tsunenori Takatani; Hideki Shigematsu; Keiko Uemura; Ayako Oi; Sachiko Kawasaki; Masahiko Kawaguchi
• Keywords: Bulbocavernosus reflex; External anal sphincter; breakpoint cluster region; Urethral sphincter

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.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.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.Our data indicate that tu-BCR monitoring improved the success rate of baseline recording and specificity during spine surgery in females.Tu-BCR monitoring was more reliable than c-BCR monitoring during spine surgery in females.