Urodynamic Responses to Anal Stretch in Patients With Detrusor Sphincter Dyssynergia Yu-Hui Huang, MD, Sung-Lang Chen, MD, Su-Ju Tsai, MD, Liu-Ing Bih,

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Urodynamic Responses to Anal Stretch in Patients With Detrusor Sphincter Dyssynergia Yu-Hui Huang, MD, Sung-Lang Chen, MD, Su-Ju Tsai, MD, Liu-Ing Bih, MD, Henry L. Lew, MD, PhD Archives of Physical Medicine and Rehabilitation Volume 89, Issue 9, Pages 1748-1752 (September 2008) DOI: 10.1016/j.apmr.2007.12.051 Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 1 (A) The leaf size and (B) the opening width of the anal dilator (right) were similar to those of human fingers (left). Archives of Physical Medicine and Rehabilitation 2008 89, 1748-1752DOI: (10.1016/j.apmr.2007.12.051) Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 2 The change percentages of 3 video-urodynamic (VUD) parameters. The medians were (1) summated electromyographic activity (sEMG): 33% decrement for time 1 (t1) and 35% decrement for time 2 (t2); (2) urethral pressure (PUre): 8% decrement for time 1 and 9% decrement for time 2; and (3) detrusor pressure (PDet): 9% increment for time 1 and 1% decrement for time 2. *Significant change versus baseline value. Archives of Physical Medicine and Rehabilitation 2008 89, 1748-1752DOI: (10.1016/j.apmr.2007.12.051) Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 3 Urodynamic graphs of one of the SCI patients. The initial fluctuation of these 3 parameters was induced by placement of anal dilator (point X). We waited for 30 seconds until these parameters stabilized, and the values of the last 15 seconds were collected for baseline value (b). Then, the anus was stretched for an additional 30 seconds (from point Y to point Z). This duration of stretching was further divided into first half (t1) and second half (t2). Abbreviations: sEMG, summated electromyography; PDet, detrusor pressure; PUre, urethral pressure. Archives of Physical Medicine and Rehabilitation 2008 89, 1748-1752DOI: (10.1016/j.apmr.2007.12.051) Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 4 The change in percentages of summated electromyographic (sEMG) activity (during time 1) in patients for different AIS grades. The medians of change percentages were 52.4%, 40.5%, 0.3%, and 4% decrement in groups with AIS grades A, B, C, and D, respectively. *Significant change versus baseline (P<.05). Archives of Physical Medicine and Rehabilitation 2008 89, 1748-1752DOI: (10.1016/j.apmr.2007.12.051) Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions