Utility of pudendal nerve electrodiagnostics in cases of bladder-bowel dysfunction- A retrospective study from a tertiary care center in Pakistan

Background and Objective: Electrodiagnostic studies play a crucial role in identifying neurogenic and non-neurogenic causes of bladder and bowel dysfunction. Such data is scarce in Pakistan. The objective of this study was to evaluate utility of pudendal nerve assessment in bladder-bowel dysfunction. Methods:  A retrospective observational study was carried out at the neurophysiology lab in Aga Khan University Hospital. Patients referred for electromyography/nerve conduction studies (EMG/NCS) for pudendal nerve assessment from June 2013 to June 2023 were included. Clinical data, EMG/NCS results, and demographic information were analyzed using SPSS. Results:  Twenty patients (11 male and nine female) were included. Five patients experienced backache radiating to one or both lower extremities, along with urinary or fecal incontinence.  Three patients had urinary incontinence, and additional three presented with both urinary and fecal incontinence. Three patients reported perianal numbness. Four patients had fecal incontinence, while one patient each reported painful defecation and backache along with perianal numbness. Three patients were diagnosed with pudendal neuropathy, out of which one had a coexisting lumbosacral radiculopathy as well. Five patients had isolated lumbosacral radiculopathy. Twelve patients exhibited normal EMG/NCS results. Conclusion: This study highlights the diagnostic utility of EMG/NCS in diagnosing pudendal nerve injuries. Despite its widespread use worldwide, the utilization of these tests in Pakistan is hindered by factors such as limited awareness, inadequate training, and resource constraints.