There are limited studies on the role of electromyography and its abnormalities in males undergoing urodynamics for evaluation of lower urinary tract symptoms. Indeed, electromyographic abnormalities are poorly standardized. The aim of this study was to assess the role of electromyography and its abnormalities in the evaluation of lower urinary tract symptoms in males.

Men undergoing urodynamics for evaluation of lower urinary tract symptoms (LUTS) from January 2021 to March 2022 are included in this study. This is an original retrospective cohort study. Preoperative evaluation included history, physical examination including focussed neurological examination, uroflowmetry (UFM), post-void residual urine (PVR), and International Prostate Symptom Score (IPSS). The primary objective was to determine the various urodynamic diagnosis of LUTS in patients with abnormal electromyography, and the secondary objective was to study the association of patients with abnormal EMG with preoperative factors. All urodynamic studies were analyzed and reviewed in a multidisciplinary team meetings to ensure accuracy of diagnosis. 
Data are expressed as mean +/- standard deviation, and P-values were obtained using a two-tailed unpaired student t-test for pairwise parametric data comparisons. The Fisher Exact test compares categorical data given as a number (Percentage). Statistical significance was defined as a P value of less than 0.05. The statistical analysis tool SPSS (Statistical Package for the Social Sciences) v25 was used.

The study included 110 male patients. Abnormal EMG was found in 49 (44%) patients. The patients were further divided based on neurogenic cause or non-neurogenic cause.  There were 15 (14%) patients with neurogenic abnormalities. Among neurogenic causes, three patients were found to have abnormal EMG. Type 1 Detrusor-sphincter dyssynergia (DSD) was found in two patients, and type 2 DSD was found in one patient. Among patients with non-neurogenic causes, 42 patients (38%) had abnormal EMG. These were further categorized into complete non-relaxation of the sphincter in 15 patients (13%), intermittently increasing in 17 patients (15%), Decrescendo pattern in three patients (2%), Crescendo pattern in two patients (2%), Crescendo-decrescendo pattern in one patient, Increased due to prolonged abdominal straining in seven patients (6%). The various urodynamic diagnosis in patients with abnormal EMG was Dysfunctional voiding combined with various other disorders like detrusor overactivity and detrusor underactivity. The seven patients having increased activity due to abdominal straining had a diagnosis of detrusor underactivity as these patients could not generate enough detrusor pressure.

EMG helped significantly change post urodynamics diagnosis in patients (p = 0.00). Figure 1 summarises the various urodynamic diagnosis obtained. Therefore, 38% of patients had their urodynamic diagnosis changed following EMG monitoring which could have been missed otherwise. The 6% of the patients having abnormal EMG due to abdominal straining can be easily identified by any expert urodynamic person.

For patients with LUTS or pelvic floor dysfunction, EMG is an essential criterion for diagnosing various urodynamic conditions. It might show the urethral sphincter's functional state. We should make every effort to obtain a high-quality EMG trace in order to establish an evidence-based diagnosis, rather than relying solely on the experience-based diagnosis.

Continence 2S2 (2022) 100251
DOI: 10.1016/j.cont.2022.100251