Pudendal Nerve Terminal Motor Latency

Pudendal nerve terminal motor latency (PNTML) is a measurement of time, or latency, from stimulation of the pudendal nerve at the level of the ischial spine to the muscle response in the external anal sphincter.5,23 A disposable electrode is placed on the examiner's gloved index finger (Fig. 11.4) and inserted into the anal canal (Fig. 11.5). The stimulation is transrectally performed with the electrode located at the ischial spine while the response is recorded at the base of the examiner's finger. Recordings are made from both sides of the pelvis, as pudendal nerve damage may be asymmetric in some

Finger Electrodes
Figure 11.4. The St. Mark's pudendal electrode is placed on the examiner's gloved index finger. (From Tetzschner T, Sorensen M, Johnson L, Lose G, Christiansen J. Delivery and pudendal nerve function. Acta Obstet Gynecol Scand 1997;76:324-331, with permission from Blackwell Publishing.)
Mark Electrode Pudendal

Figure 11.5. The St. Mark's pudendal electrode is inserted into the anal canal and rectum. The stimulation is performed transrectally with the electrode located at the ischial spine (From Tetzschner T,Sorensen M,Johnson L, Lose G,Christiansen J.Delivery and pudendal nerve function. Acta Obstet Gynecol Scand 1997;76:324-331, with permission from Blackwell Publishing.)

Figure 11.5. The St. Mark's pudendal electrode is inserted into the anal canal and rectum. The stimulation is performed transrectally with the electrode located at the ischial spine (From Tetzschner T,Sorensen M,Johnson L, Lose G,Christiansen J.Delivery and pudendal nerve function. Acta Obstet Gynecol Scand 1997;76:324-331, with permission from Blackwell Publishing.)

sacral plexus and transcranial magnetic stimulation of the motor cortex may add some information regarding the level of neurologic injury. These techniques are not widely used in the assessment of the pelvic floor.

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