Concentric needle electrodes are superior to perineal surface-patch electrodes for electromyographic documentation of urethral sphincter relaxation during voiding


Sangeeta T. Mahajan, Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, University Hospitals of Cleveland, MAC 7015, 11100 Euclid Avenue, Cleveland OH44106, USA.



To compare interpretations of electromyographic (EMG) recordings from perineal surface patch electrodes (PSPEs) to those from urethral concentric needle electrodes (CNEs) during voiding.


Consenting women underwent urodynamic testing with a 30 G, 3.8 cm CNE at the 12 o’clock position in the striated urethral sphincter muscle, and with PSPEs placed at the 2 and 10 o’clock positions around the anus. Pressure-flow studies were conducted with simultaneous input from both EMG electrodes. Representative, de-identified paper copies of EMG signals were assembled by chronology and electrode type. Six examiners unaware of the patient details were asked to determine if the tracings were interpretable and whether there was quiescence of the urethral sphincter motor unit during voiding. The agreement between the interpretations of each tracing was assessed using McNemar and κ statistics.


Twenty-two women undergoing urodynamic testing for incontinence (16), voiding dysfunction (two) or urinary retention (four) participated in this study. CNE tracings were consistently more interpretable than PSPE tracings (mean 89% vs 67%). When tracings were interpretable, a significantly higher percentage of CNE EMG tracings (mean 79%) had urethral sphincter motor unit quiescence than PSPE EMG tracings (mean 28%). The κ values for agreement among the reviewers’ interpretations were highly variable and none were statistically significant. Reviewers unanimously agreed on only 12 of the 44 tracings, and 11 of these showed quiescence when using a CNE.


CNEs are more often interpretable than PSPEs for determining motor unit quiescence during voiding. CNE EMG appears to have greater clinical utility for central reading than PSPEs.