What a urologist should know about pelvic neurophysiology testing

Pelvic neurophysiology testing (PNPT) plays an important role in the evaluation of urogenital dysfunction resulting from nerve injury. However, many Urologists are unaware of its existence let alone its utility in urological practice. Neurophysiology tests encompass tests which examine pelvic somatic innervation to evaluate neurological causes for voiding and sexual dysfunction. These include sphincter electromyography (EMG), pudendal somatosensory evoked potentials (pSEP), dermatomal somatosensory evoked potentials (dSEP), bulbocavernosus reflex study (BCR) and sympathetic skin response (SSR). In clinical practice, PNPT can be used to evaluate patients with chronic idiopathic non-obstructive urinary retention (NOUR), cauda equina syndrome (in particular when the MRI is normal), genital numbness, and pelvic floor pain.