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Infertility Diagnosis and Treatment
Published in Sujoy K. Guba, Bioengineering in Reproductive Medicine, 2020
Bulbocavernosus reflex (BCR) latency measurement is a routine in impotence diagnostics. BCR latency includes the conduction time to and from the S2-S4 spinal segment and the delay within the segment. Stimulus is given with a pair of small surface electrodes applied longitudinally to the distal portion of the penis.58 Uniphasic constant voltage mode of excitation is commonly used with pulse duration of about 0.1 ms and repetition rate of 1 to 2 Hz. Stimulation voltage is progressively increased till a consistent response as judged from the bulbocavernosus electromyogram is obtained. This response is monitored by inserting a monopolar electrode into the bulbocavernosus muscle (Figure 4.20). The electrode is in the form of a hypodermic needle with a silver wire passing through the needle bore. The tip of the silver wire in the needle bevel is bare. The rest of the wire is insulated so that it is electrically isolated from the metal of the hypodermic needle. A wire connection from the silver wire goes to one terminal of a single ended electromyographic amplifier and the metal of the hypodermic needle is connected to the “ground” terminal of the amplifier. In the resting state the bulbocavernosus muscle is quiescent and electromyographic signals are virtually absent. Correct positioning of the needle electrode tip is checked by squeezing the glans penis. If the electrode is properly situated an electrical signal generated in the bulbocavernosus muscle is picked up.
Peripheral Autonomic Neuropathies
Published in David Robertson, Italo Biaggioni, Disorders of the Autonomic Nervous System, 2019
Ejaculation follows because of forceful contraction of the bulbocavernosus muscle (Whitelaw and Smithwick, 1951). If the vesical neck does not close during ejaculation, as it normally does, the seminal fluid is propelled back into the bladder by so called retrograde ejaculation. The sympathetic nervous system mediates the closure of both the bladder neck and the contraction of the seminal vesicles during emission, but in some diabetic patients the bladder neck does not contract while the autonomic innervation to the rest of the genital system remains apparently unimpaired. Diabetic patients with this disorder usually are aware of frothy material in the urine after intercourse. In such patients, there were signs of severe peripheral neuropathy and evidence of widespread autonomic nervous system involvement manifested by orthostatic hypotension, nocturnal diarrhoea and a large capacity hypotonic bladder with residual urine.
Neurostimulation
Published in Han C. Kuijpers, Colorectal Physiology: Fecal Incontinence, 2019
Maria Papachrysostomou, Adam N. Smith
Having applied stimulation to the pudendal nerve directly, to its roots and centrally transcutaneously to the spinal cord, it became apparent that a more physiological approach would have been through stimulation of a reflex involving both afferent, central, and efferent pathways. An already established reflex in urological practice is the bulbocavernosus one, which is elicited by applying electrical stimulation to the dorsal nerve of the glans penis or clitoris, evoking a reflex contraction of the bulbocavernosus muscle.22 This concept of reflex contraction of the striated muscle found its application in anorectal physiology: Varma and Smith23 adopted this idea, eliciting a reflex by stimulation of the dorsal nerve of the glans penis and clitoris and recording contraction of the EAS (Figure 1). The pudendo-anal reflex was further categorized in normal controls and in patients with FI.24 It has now become as conventional a method in the investigation of neurogenic FI25 as in urological patients.
Effectiveness of Physiotherapy Interventions in the Management Male Sexual Dysfunction: A Systematic Review
Published in International Journal of Sexual Health, 2023
Caleb Ademola Omuwa Gbiri, Joy Chukwumhua Akumabor
Dorey et al. (2004) had a similar conclusion to Van Kampen and Geraerts (2015). Participants in their studies had ED of various etiology. The best results were however achieved in the group of participants with ED due to venous-occlusive dysfunction. In the Van Kampen and Geraerts (2015) study, 15 out of 20 participants with ED caused by venous-occlusive dysfunction reported a return of penile erection to allow satisfactory sexual intercourse. A physiologic explanation for the improvement of erectile dysfunction is a decrease in the venous outflow. Contractions of the ischiocavernosus and bulbocavernosus muscles produce an increase in the intracavernous pressure and influence penile rigidity. The bulbocavernosus muscle compresses the deep dorsal vein of the penis to prevent the outflow of blood from an engorged penis.
Effect of udenafil administration on postmicturition dribbling in men: a prospective, multicenter, double-blind, placebo-controlled, randomized clinical study
Published in The Aging Male, 2020
Kyungtae Ko, Won Ki Lee, Sung Tae Cho, Young Gu Lee, Tae Young Shin, Min Soo Choo, Jun Hyun Han, Seong Ho Lee, Cheol Young Oh, Jin Seon Cho, Hyun Cheol Jeong, Dae Yul Yang
Studies on PMD have mostly been performed in the field of nursing care [9,10]. The major cause of PMD identified in these studies is weakening of the bulbocavernosus muscle in the pelvic floor. At the end of the micturition process, the bulbocavernosus muscle should contract and milk out the residual urine trapped in the bulbar urethra. However, weakening of this muscle causes residual urine to be retained, leading to PMD. Weakening of the bulbocavernosus muscle, similar to urinary incontinence in females, is thought to be caused by several factors, including constipation, being overweight, lack of physical exercise, chronic cough, neurological disorders, and damaged autonomic nerves due to pelvic surgeries [8,14]. PFMT has been widely used for PMD, because the exercise was the only method known to address these factors [10,11]. However, PFMT did not show immediate treatment effectiveness in males, and patients had difficulty learning the technique without appropriate supervision. Although squeezing or swiping the perineum after urination to remove residual urine is easy to perform, this by itself does not provide satisfactory results.
Female genito-pelvic reflexes: an overview
Published in Sexual and Relationship Therapy, 2019
Symen K. Spoelstra, Esther R. Nijhuis, Willibrord C. M. Weijmar Schultz, Janniko R. Georgiadis
The main somatic nerve of the perineum is the pudendal nerve, which has somatosensory and somatomotor tributaries, and which divides into three main branches (inferior rectal, perineal, dorsal penile/clitoral) at the level of the levator ani muscle. The muscles that embryonically derive from the cloacal sphincter (external anal and urethral sphincter, superficial transverse perineal muscle, bulbocavernosus muscle and ischiocavernosus muscle) are all innervated by pudendal nerve fibres originating in a specialized sacral motor neuronal pool called Onuf's nucleus (Iwata, Inoue, & Mannen, 1993; Onuf, 1899). As Onuf motoneurons innervate striated muscles but also are known to be relatively unaffected by somatic motoneuron diseases like amyotrophic lateral sclerosis (Mannen, Iwata, Toyokura, & Nagashima, 1977), they have been proposed to be of a mixed somatic/autonomic type (Kihira, Yoshida, Yoshimasu, Wakayama, & Yase, 1997). Interestingly, the pudendal nerve seems less involved in the innervation of the levator ani muscle. A separate nerve, the “levator ani nerve” (Wallner, Maas, Dabhoiwala, Lamers, & De Ruiter, 2010), arising from the ventral ramus of the third and fourth sacral nerves, is held to innervate the pelvic diaphragm. In at least 50% of cadavers studied, the pudendal nerve also contributed to innervation of the levator ani muscle, especially in regards to the medial portions (puborectal and pubococcygeal muscles) (Rock JA, 2003).