Sensory threshold for defecation and its correlation with pelvic organ prolapse:An exploration of related factors

Objectives This research aimed to investigate changes in defecation sensory threshold and related factors in patients with posterior vaginal wall prolapse.Methods A total of 214 patients with pelvic organ prolapse were recruited between October 2019 to January 2021.All patients underwent a defecation sensory threshold examination,physical examination,and pelvic floor ultrasound examination.Factors related to the defecation sensory threshold were analyzed.Results(1)Among the participants,57 patients(26.6%)had a defecation sensory threshold of more than 90ml.Patients with a threshold>90ml showed higher scores of defecation dysfunction in the Constipation Scoring System(CSS)score(p=0.003)and higher scores of constipation in the Colorectal-anal Distress Inventory 8(CRADI-8)score(p=0.002).(2)The defecation sensation threshold positively correlated with the Ap point(r=0.448,p<0.001),the Bp point(r=0.345,p=0.009),the area of the levator-ani hiatus measured by transvaginal ultrasound(r=0.403,p=0.002),and parity(r=0.355,p=0.007).Conclusions Patients diagnosed with pelvic organ prolapse commonly experience an increased threshold of defecation sensation.Elevated thresholds were associated with more frequent constipation symptoms.Additionally,the severity of posterior pelvic prolapse positively correlated with the defecation sensory threshold.

Penile sensory thresholds in subtypes of premature ejaculation： implications of comorbid erectile dysfunction

Penile hypersensitivity plays an important role in premature ejaculation （PE）, but differences in penile sensitivity among subtypes of PE are unknown. Therefore, we compared penile sensory thresholds in PE subtypes of lifelong and acquired PE, PE with and without erectile dysfunction （ED）, PE with an intravaginal ejaculation latency time 〈1 min and 〉1 min, and PE with and without orgasmic pleasure perceptual dysfunction. During August 2014 to January 2016, 136 patients with PE were included. Penile warm, cold, and vibratory thresholds were measured. Data of clinical characteristics, sexual life, Premature Ejaculation Diagnostic Tool （PEDT） score, and the 5-item version of the International Index of Erectile Function （IIEF-5） score were collected. Vibratory thresholds of the PE with ED group were higher in the right coronal sulcus （median amplitude： 4.92 vs 3.65 μm, P= 0.02） and the right penile shaft （median amplitude： 3.87 vs 3.30 μm, P = 0.03）, while differences in penile sensory thresholds between other subtypes were not significant. The median PEDT score was lower in the PE without ED group （12 vs 14, P 〈 0.001）. The IIEF-5 and PEDT scores were negatively correlated （r = -0.29, P 〈 0.001）. Patients with orgasmic pleasure perceptual dysfunction had a lower median IIEF-5 score （20 vs 21, P = 0.02）. Patients with PE and ED had lower penile sensitivity, and ED was associated with more severe symptoms and weaker orgasmic pleasure perception. In men with PE, management of comorbid ED is necessary. In case of side effects in erectile function, topical anesthetics should be cautiously used in men with PE and ED.

Autonomic and sensory nerve dysfunction in primary biliary cirrhosis

AIM:Cardiovascular autonomic and peripheral sensoryneuropathy is a known complication of chronic alcoholicand non-alcoholic liver diseases.We aimed to assess theprevalence and risk factors for peripheral sensory nerveand autonomic dysfunction using sensitive methods inpatients with primary biliary cirrhosis (PBC).METHODS:Twenty-four AMA M2 positive female patientswith clinical,biochemical and histological evidence of PBCand 20 age matched healthy female subjects were studied.Five standard cardiovascular reflex tests and 2d-h heartrate variability(HRV)analysis were performed to defineautonomic function.Peripheral sensory nerve function onmedian and peroneal nerves was characterized by currentperception threshold(CPT),measured by a neuroselectivediagnostic stimulator(Neurotron,Baltimore,MD).RESULTS:Fourteen of 24 patients(58%)had at least oneabnormal cardiovascular reflex test and thirteen(54%)had peripheral sensory neuropathy.Lower heart rateresponse to deep breathing(P=0.001),standing(P=0.03)and Valsalva manoeuvre(P=0.01),and more profounddecrease of blood pressure after standing(P=0.03)wasfound in PBC patients than in controls.As a novel findingwe proved that both time domain and frequency domainparameters of 24-h HRV were significantly reduced in PBCpatients compared to controls.Each patient had at leastone abnormal parameter of HRV.Lower CPT values indicatedhyperaesthesia as a characteristic feature at peronealnerve testing at three frequencies(2000 Hz:P=0.005;250 Hz:P=0.002;5 Hz:P=0.004)in PBC compared tocontrols.Correlation of autonomic dysfunction with theseverity and duration of the disease was observed.Lowertotal power of HRV correlated with lower CPT values atmedian nerve testing at 250 Hz(P=0.0001)and at 5 Hz(P=0.002),as well as with those at peroneal nerve testingat 2000 Hz(P=0.01).CONCLUSION:Autonomic and sensory nerve dysfunctionsare frequent in PBC.Twenty-four-hour HRV analysis is moresensitive than standard cardiovascular tests for detectingof both parasympathetic and sympathetic impairments.Ournovel data suggest that hyperaesthesia is a characteristicfeature of peripheral sensory neuropathy and mightcontribute to itching in PBC.Autonomic dysfunction is relatedto the duration and severity of PBC.

Observation on therapeutic efficacy of heat-sensitive moxibustion plus Western medicine for diabetic peripheral neuropathy

Objective:To observe the clinical efficacy of heat-sensitive moxibustion plus Western medicine in treating patients with diabetic peripheral neuropathy(DPN).Methods:A total of 70 patients with DPN were divided into an observation group and a control group by sealed envelope method combined with the random number table method,with 35 cases in each group.The control group was treated with routine medicine,and the observation group was treated with heat-sensitive moxibustion on the basis of the treatment in the control group.After 2 courses of treatment,the scores of Toronto clinical scoring system(TCSS)and vibration perception threshold(VPT)in both groups were observed,and the clinical efficacy was compared.Results:During treatment,3 cases dropped out in the control group and 4 cases in the observation group.After treatment,the total effective rate in the observation group was higher than that in the control group(P<0.05).The scores of TCSS and VPT in both groups decreased after treatment,and the intra-group comparison showed statistical significance(both P<0.05).The scores of TCSS and VPT in the observation group were lower than those in the control group,and the differences were statistically significant(both P<0.05).Conclusion:Heat-sensitive moxibustion plus Western medicine can improve the symptoms in patients with DPN,and has a better curative effect than the Western medicine alone.