Estudio caso-control de electromiografía del piso pélvico en pacientes con síndrome doloroso pélvico crónico

Resultados La edad fue de 46,36 años (desviación estándar: ± 10,63) en el GC y de 45,58 años (± 12,96) en el GP. La regresión logística dio como la variable más importante el PAVGR (Wald = 5,4; p = 0,019) que representa el tono MPP en reposo, y fue de 0,079 μV (± 0,084) en el GC y de 0,49 μV (± 0,27) en el GP, siendo 0,41 μV mayor en el GP (p = 0,000). La media de la amplitud del trazo de EMS representa la actividad eléctrica del MPP en reposo, y fue de 0,044 μV (± 0,026) en el GC y de 0,65 μV (± 0,79) en el GP, siendo 0,60 μV mayor en el GP (p = 0,019). Conclusiones La variable más importante en la EMS es el PAVRG. La diferencia significativa del PAVRG demuestra un elevado tono de MPP en varones con SDPC, además tienen un piso pélvico inestable, demostrado por la mayor amplitud del trazo de EMS (p = 0,019). Estos datos sugieren que la EMS puede ser de gran utilidad diagnóstica en pacientes con SDPC, y abre la posibilidad de usar alternativas terapéuticas enfocadas a la inestabilidad e hipertonía de MPP, como la biorretroalimentación, la neuromodulación y el uso del botox. Abstract Background and objectives Instability of pelvic floor muscle (PFM) instability has been reported in patients suffering pelvic chronic pain syndrome (CPPS) type III or chronic prostatitis type III. The aim of this study is to compare the surface electromyography (SEMG) in CPPS versus healthy volunteers. Patients and method SEMG was performed with electrodes 3 cm from anal sphincter in 11 healthy volunteers (CG) and 12 men suffering CPPS (PG). The EMS was recorded with the Mca Verymed Myoexerciser machine. The PG inclusion criteria were CPPS with a minimum of 3 months pain with no pathological origin to explain it. Exclusion criteria were positive urine or sperm cultures, lithiasis, history of biopsy and/or surgery of prostate and bladder, radiation or bladder, or prostate cancer. Using an Excel Data Base, age, average resting SEMG microvolts (PAVGR), minimum, maximum and amplitude of curve, were also analysed using software SPSS 10.0. Results The mean age was 46.36 yrs (SD: ± 10.63) in the CG and 45.58 yrs (± 12.96) in the PG. The logistic regression results showed PAVGR was the most significant variable (Wald = 5.4; p = 0.019) which represents the resting tonus of the PFM, which was 0.079 μV (± 0.084) in CG and 0.49 μV (± 0.27) in PG, which was 0.41 μV higher in the PG (p = 0.000). The amplitude of SEMG, which represents the resting electric activity of the PFM, was also 0.044 μV (± 0.026) in the CG and 0.65 μV (± 0.79) in GP, 0.60 μV higher in the PG (p = 0.019). Conclusions The most important variable from the SEMG is PAVRG. The statistically significant difference of PAVRG shows an increased tonus of PFM in men with CPPS, also they have unstable PFM as shown by the higher amplitude of SEMG (p = 0.019). This data strongly suggest the great value of SEMG in diagnosis of CPPS, and it also opens the possibility of using alternative therapeutics focused on the PFM such as biofeedback, neuromodulation and botox. Palabras clave Síndrome doloroso pélvico crónico Prostatitis crónica Piso pélvico Electromiografía de superficie Botox Biorretroalimentación Key words Chronic pelvic pain syndrome Chronic prostatitis Pelvic floor Surface electromyography Botox Biofeedback Bibliografía 1. J. Chen H.F. Zhao Z.S. Xu The prostate has secretory dysfunction for category IIIA and IIIB prostatitis J Urol 170 2007 2166 2169 2. C.C. Yang J.C. Lee B.G. Kromm M.A. Ciol R.E. Berger Pain sensitization in male chronic pelvic pain syndrome: Why are symptoms so difficult to treat? J Urol 170 2003 823 827 3. C. Wallner C. Maas N. Dabhoiwala M. DeRuiter W. Lamers The innervation of the pelvic floor muscles: A reappraisal for the levator ani nerve Neurourol Urodyn 25 2006 537 538 4. J. DeLancey J. Gosling K. Creed J. Dixon V. Delmas D. Landon Gross anatomy and cell biology of the lower urinary tract P. Abrams L. Cardozo S. Khoury A. Wein Incontinence 2002 Health Publication Paris 17 82 5. P.W. Hodges R. Sapsford L.HM. Pengel Postural and respiratory functions of the pelvic floor muscles Neurourol Urodyn 26 2007 362 371 6. U. Yilmaz Y.W. Liu R.E. Berger C.C. Yang Autonomic nervous system changes in men with chronic pelvic pain syndrome J Urol 177 2007 2170 2174 7. Fowler CJ, Benson JT, Craggs MD, Vodisek DB, Yang CC, Podnar S. Clinical neurophysiology. En: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence. 2nd International Consultation on Incontinence. Paris July 1-3, 2001. p. 389-424. 8. D.C. Hetrick M.A. Ciol I. Rothman J.A. Turner M. Frest R.E. Berger Musculoskeletal dysfunction in men with chronic pelvic pain syndrome tipe III: A case-control Study J Urol 170 2003 828 831 9. D.H. Zerman N. Ishigooka R. Doggweiler R.A. Schmidt Neurourologic insights into the etiology of genitourinary pain in men J Urol 161 1999 903 908 10. D.C. Hetrick H. Glazer Y.W. Liu J.A. Turner M. Frest R.E. Berger Pelvic floor electromyography in men with chronic pelvic pain síndrome: a case-control study Neurourol Urodynam 25 2006 46 49 11. J.L. Hernández Arriaga Aspectos éticos de la investigación en seres humanos J.L. Hernández Arriaga Bioética general 2002 Ed. Manual Moderno México DF 133 162 12. M.D. Smith M.W. Coppieters P.W. Hodges Postural response of the pelvic floor and abdominal muscles in women with and without incontinence Neurourol Urodynam 26 2007 377 385 13. C. Pérez-Martínez D.I.B. Vargas P.H. Silva Toxina botulínica A: perspectivas presentes y futuras en urología Rev Mex Urol 66 2006 228 233