V12-06: Neuro-Urology in Daily Practice Part 2: Physical Exam
With the aging of our population and widening prevalence of diseases, there is an increasing number of patients with lower urinary tract symptoms and neurologic conditions. The general urologist often serves as a first line diagnostician for these patients. It is therefore vital for them to be able to perform a focused neuro-urologic history and physical exam. The objective of this video is to explain and demonstrate the key elements of a physical exam in patients with a suspected or established neurologic disease while seen in a general urology setting.
We present a framework of a basic physical exam in a neurologic patient which centers on sensitivity testing, reflex testing and a rectal examination. We will first highlight the key components of sensitivity testing, focusing on the sacral sensitivities and their respective dermatomes. Reflex testing will center on the bulbocavernosus reflex arc in a man and a woman, and the rectal examination will focus on the innervation of the anal sphincter.
The video begins with sensitivity testing in a patient with an incomplete spinal cord lesion, demonstrating how to perform light touch and painful stimuli using a cotton tipped swab in the office. This section also demonstrates how to perform sacral sensitivity testing using light touch and pinprick in patient who does not have a neurologic lesion, illustrating a normal exam, and then in a patient with a complete cervical lesion showing the absence of sensation. The following section demonstrates and explains the bulbocavernosus reflex on both a man and a woman, highlighting the steps necessary to perform this test in the office. The physical exam concludes with the rectal examination demonstrating the anal reflex in a man with a complete spinal cord lesion.
With increasing testing used for many urologic patients, the nuances of the physical exam are generally underestimated. There is an increasing number of patients with lower urinary tract symptoms and neurologic conditions in today's practice. A focused neurological physical exam is an important tool in the diagnosis and treatment of these complex patients.