Inadequacy of the bethanechol test in the diagnosis of neurogenous vesicourethral dysfunction of inferior motor neuron type. Alternative urodynamic technics
Salinas, J.; Bustamante, S.; Laborda, E.; Cure, E.; Corral, J.
Archivos Espanoles de Urologia 40(7): 485-490
1987
ISSN/ISBN: 0004-0614 PMID: 3688993 Document Number: 299955
A urodynamic study was undertaken in 9 patients who had been referred for urinary retention. Patient work up included neurologic physical examination, cystomanometry, bethanecol test, EMG of the periurethral sphincter, videocystography and urethral profile. Cystomanometric evaluation revealed an acontractile bladder in all cases. The bethanecol test yielded 60% false-negatives and no false-positives. EMG revealed inferior motor lesion in all the cases studied with evident neurologic involvement. Videocystography revealed a decentralized autonomic innervation of the bladder neck in 60% of the patients with evident neurologic lesion. The maximum urethral pressure obtained in the urethral profile of a patient with evident neurologic involvement was markedly reduced. The results of the present study suggest that electromyographic evaluation of the periurethral sphincter is more reliable than the bethanecol test in the diagnosis of inferior motor neuron lesions. Furthermore, videocystography has proved useful in performing the foregoing evaluation.