Lower urinary tract electrical sensory assessment: A systematic review and meta-analysis.

OBJECTIVE To summarize the current literature on lower urinary tract electrical sensory assessment (LUTESA), with regard to current perception thresholds (CPTs) and sensory evoked potentials (SEPs). The applied methods will be discussed in terms of technical aspects, confounding factors, and potential for lower urinary tract (LUT) diagnostics. METHODS The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Medline (PubMed), Embase and Scopus were searched upon October 13, 2020. Meta-analyses were performed and methodological qualities of the included studies were defined by assessing risk-of-bias (RoB) as well as confounding. RESULTS After screening 9925 articles, 80 studies (5 randomized controlled trials (RCTs) and 75 non-RCTs) were included, comprising a total of 3732 patients and 692 healthy subjects. 61 studies investigated exclusively CPTs and 19 studies reported on SEPs, with or without corresponding CPTs. The recording of LUTCPTs and -SEPs was shown to represent a safe and reliable assessment of LUT afferent nerve function in healthy subjects and patients. LUTESA demonstrated significant differences in LUT sensitivity between healthy subjects and neurological patients as well as after interventions such as pelvic surgery or drug treatments. Pooled analyses revealed that several stimulation parameters (e.g. stimulation frequency, location) as well as patient characteristics might affect the main outcome measures of LUTESA (CPTs, SEP latencies, peak-to-peak amplitudes, responder rate). RoB and confounding was high in most studies. CONCLUSIONS Preliminary data show that CPT and SEP recordings are valuable tools to more objectively assess LUT afferent nerve function. LUTESA complement already established diagnostics such as urodynamics, allowing for a more comprehensive patient workup. The high RoB and confounding rate was rather related to inconsistency and inaccuracy in reporting than the technique itself. LUTESA standardization and well-designed RCTs are crucial to implement LUTESA as a clinical assessment tool.