Francois Giuliano1, David L Rowland. 1. AP-HP, Neuro-Uro-Andrology, Versailles Saint Quentin en Yvelines University, Versailles, France. francois.giuliano@uvsq.fr
Abstract
INTRODUCTION: Can neurophysiological testing in male patients with sexual dysfunction benefit the decision-making process? The answer remains unclear. AIM: To provide standard operating procedures for the neurophysiologic assessment of male sexual dysfunction. METHODS: Medical literature was reviewed and combined with expert opinion of the authors. RESULTS: Bulbocavernosus reflex latency time, pudendal somatosensory evoked potentials, and sympathetic skin responses have been considered as potential candidates for the diagnosis and assessment of erectile dysfunction (ED). Currently, there is no consensus on a standardized methodology for these neurophysiological investigations in the overall assessment of ED. These procedures are unable to assess the integrity of the efferent parasympathetic proerectile penile innervation; accordingly, none of these assessment procedures is recommended for ED patients. Corpus cavernosum electromyography (CC-EMG) can detect abnormalities in cavernous smooth muscle although these alterations can be attributed both to damage to autonomic penile innervation and to degenerative processes of the cavernous smooth muscle. CC-EMG is still considered experimental. Evidence does not support that men with premature ejaculation (PE) are consistently characterized by penile hypersensitivity; accordingly, penile threshold determination is not recommended to in the diagnosis of PE. Neurophysiological investigation of other components of the penile sensory pathways in PE patients has not provided any definitive contribution to the diagnosis. CONCLUSION: No neurophysiological assessment procedures yield additional information that consistently aids in the assessment of PE and ED.
INTRODUCTION: Can neurophysiological testing in male patients with sexual dysfunction benefit the decision-making process? The answer remains unclear. AIM: To provide standard operating procedures for the neurophysiologic assessment of male sexual dysfunction. METHODS: Medical literature was reviewed and combined with expert opinion of the authors. RESULTS: Bulbocavernosus reflex latency time, pudendal somatosensory evoked potentials, and sympathetic skin responses have been considered as potential candidates for the diagnosis and assessment of erectile dysfunction (ED). Currently, there is no consensus on a standardized methodology for these neurophysiological investigations in the overall assessment of ED. These procedures are unable to assess the integrity of the efferent parasympathetic proerectile penile innervation; accordingly, none of these assessment procedures is recommended for ED patients. Corpus cavernosum electromyography (CC-EMG) can detect abnormalities in cavernous smooth muscle although these alterations can be attributed both to damage to autonomic penile innervation and to degenerative processes of the cavernous smooth muscle. CC-EMG is still considered experimental. Evidence does not support that men with premature ejaculation (PE) are consistently characterized by penile hypersensitivity; accordingly, penile threshold determination is not recommended to in the diagnosis of PE. Neurophysiological investigation of other components of the penile sensory pathways in PE patients has not provided any definitive contribution to the diagnosis. CONCLUSION: No neurophysiological assessment procedures yield additional information that consistently aids in the assessment of PE and ED.
Authors: A Sansone; A Aversa; G Corona; A D Fisher; A M Isidori; S La Vignera; E Limoncin; M Maggi; M Merico; E A Jannini Journal: J Endocrinol Invest Date: 2020-10-30 Impact factor: 4.256