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Webb K, de Rijk MM, Gajewski JB, Kanai AJ, Perrouin-Verbe MA, van Koeveringe G, Wyndaele JJ, Drake MJ. Developing new ways to assess neural control of pelvic organ function in spinal conditions: ICI-RS 2023. Neurourol Urodyn 2024; 43:1431-1438. [PMID: 38048095 DOI: 10.1002/nau.25347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Several central nervous system (CNS) centers affect muscle groups of the lower urinary tract (LUT) and anorectal tract (ART) via autonomic and somatic pathways, working in different modes (storage or expulsion). Hence spinal cord dysfunction can affect the LUT and ART by several possible mechanisms. METHODS This review reports the discussions of a workshop at the 2023 meeting of the International Consultation on Incontinence Research Society, which reviewed uncertainties and research priorities of spinal dysfunction. RESULTS Discussion focussed on the levator ani nerve, mechanisms underpinning sensory function and sensation, functional imaging, dyssynergia, and experimental models. The following key research questions were identified. (1) Clinically, how can we evaluate the levator ani muscle to support assessment and identify prognosis for effective treatment selection? (2) How can we reliably measure levator ani tone? (3) How can we evaluate sensory information and sensation for the LUT and the ART? (4) What is the role of functional CNS imaging in development of scientific insights and clinical evaluation? (5) What is the relationship of detrusor sphincter dyssynergia to renal failure? CONCLUSIONS Spinal cord dysfunction can fundamentally disrupt LUT and ART function, with considerable clinical impact. The evaluation needs to reflect the full scope of potential problems, and new clinical and diagnostic approaches are needed, for prognosis and treatment. The preclinical science evaluating spinal cord function in both LUT and ART storage and elimination remains a major priority, even though it is a challenging experimental context. Without this underpinning evidence, development of new clinical evidence may be held back.
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Affiliation(s)
- Katie Webb
- Physiotherapy Department, Imperial College Healthcare Trust, St Mary's Hospital, London, UK
| | - Mathijs M de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jerzy B Gajewski
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anthony J Kanai
- Departments of Medicine-Renal-Electrolyte Division, and Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Gommert van Koeveringe
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Marcus J Drake
- Department of Surgery and Cancer, Imperial College, London, UK
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Kuo HC. Lower urinary tract dysfunction in the central nervous system neurogenic bladder and the real-life treatment outcome of botulinum toxin A. Tzu Chi Med J 2024; 36:260-270. [PMID: 38993829 PMCID: PMC11236072 DOI: 10.4103/tcmj.tcmj_29_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 07/13/2024] Open
Abstract
Neurogenic lower urinary tract dysfunction (NLUTD) is common in patients with central nervous system (CNS) lesions. Cases of cerebrovascular accidents (CVA), Parkinson's disease, dementia, and other intracranial lesions develop poor bladder control with or without urinary difficulty due to loss of cortical perception of bladder filling sensation and poor coordination of urethral sphincter relaxation during reflex micturition. Patients with CNS lesions usually have overactive bladder (OAB) symptoms, including urgency, frequency, incontinence, voiding symptoms of dysuria, large postvoid residual volume, and retention. In elderly patients with severe CNS disease the OAB symptoms are usually difficult to adequately relieve by medical treatment, and thus, their quality of life is greatly. Botulinum toxin A (BoNT-A) is currently licensed and has been applied in patients with idiopathic and neurogenic OAB due to spinal cord injury or multiple sclerosis. However, the application of BoNT-A in the treatment of urinary incontinence due to NLUTD in chronic CNS lesions has not been well-documented. Although cohort studies and case series support BoNT-A treatment for neurogenic OAB, chronic urine retention after intravesical BoNT-A injection for OAB and exacerbated urinary incontinence after urethral BoNT-A injection for voiding dysfunction have greatly limited its application among patients with NLUTD due to CNS lesions. This article reviews the pathophysiology and clinical characteristics of NLUTD in patients with CNS lesions and the clinical effects and adverse events of BoNT-A injection for patients with NLUTD. A flowchart was created to outline the patient selection and treatment strategy for neurogenic OAB.
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Affiliation(s)
- Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Mochizuki T, Manita S, Shimura H, Kira S, Sawada N, Bito H, Sakimura K, Augustine GJ, Mitsui T, Takeda M, Kitamura K. Optogenetic stimulation of neurons in the anterior cingulate cortex induces changes in intravesical bladder pressure and the micturition reflex. Sci Rep 2024; 14:6367. [PMID: 38493201 PMCID: PMC10944464 DOI: 10.1038/s41598-024-56806-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
Lower urinary tract (LUT) function is controlled by the central nervous system, including higher-order cognitive brain regions. The anterior cingulate cortex (ACC) is one of these regions, but the role of its activity in LUT function remains poorly understood. In the present study, we conducted optogenetic experiments to manipulate neural activity in mouse ACC while monitoring bladder pressure to elucidate how the activity of ACC regulates LUT function. Selective optogenetic stimulation of excitatory neurons in ACC induced a sharp increase in bladder pressure, whereas activation of inhibitory neurons in ACC prolonged the interval between bladder contractions. Pharmacological manipulation of ACC also altered bladder contractions, consistent with those observed in optogenetic experiments. Optogenetic mapping of the cortical area responsible for eliciting the increase in bladder pressure revealed that stimulation to ACC showed more potent effects than the neighboring motor cortical areas. These results suggest that ACC plays a crucial role in initiating the bladder pressure change and the micturition reflex. Thus, the balance between excitation and inhibition in ACC may regulate the reflex bidirectionally.
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Affiliation(s)
- Takanori Mochizuki
- Department of Urology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Satoshi Manita
- Department of Neurophysiology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroshi Shimura
- Department of Urology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Satoru Kira
- Department of Urology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Norifumi Sawada
- Department of Urology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Haruhiko Bito
- Department of Neurochemistry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenji Sakimura
- Department of Cellular Neurobiology, Brain Research Institute, Niigata University, Niigata, Japan
| | | | - Takahiko Mitsui
- Department of Urology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Masayuki Takeda
- Department of Urology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Kazuo Kitamura
- Department of Neurophysiology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan.
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4
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Tonani LL, Bortolini MAT, Santos RGM, Fukujima MM, Castro RA. Correlation between ischemic stroke topography and female urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2023; 291:206-211. [PMID: 37922773 DOI: 10.1016/j.ejogrb.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/28/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
AIM To investigate the association between ischemic stroke topography and the onset of urinary incontinence (UI); to evaluate predictors of post-stroke UI in women. METHOD We prospectively followed up a cohort of women with ischemic stroke confirmed by clinical and computed tomography (CT) or magnetic resonance imaging (MRI) scans findings. Participants were subjected to interview, clinical evaluation, and urodynamic study if needed at 6 months post-stroke and divided in continent and incontinent groups. Non-parametric tests compared the baseline characteristics among the groups and determined association between post-stroke UI and the brain sites of injury. Logistic regression analysis determined predictors of post-stroke UI. Significance level at 5 % was set. RESULTS 162 S-women were included: 128 (79 %) continent and 34 (21 %) incontinent. Frontal lobe lesions were higher in the incontinent group (82.9 % versus 51.2 %, p = 0.001); lesions in the parietal lobe and the left cerebral hemisphere were higher in the continent group (40.9 % versus 20 %, p = 0.023; and 61.4 % versus 40 %, p = 0.024, respectively). Frontal lobe injury [RR 3.68 (CI 1.2-11.2)], body mass index (BMI) [RR1.16 (CI 1.062-1.266)] and number of vaginal deliveries [RR 1.358 (CI 1.163-1.585)] are risk factors for post-stroke UI. Left parietal lobe injury is less likely to occur in continent women after 6 months [RR 0.168 (CI 0.029-0.981; p = 0.048)]. CONCLUSION There is a correlation between the topography of the ischemic stroke and the onset of UI. Frontal lobe lesion, BMI and number of vaginal deliveries are predictors of post-stroke UI.
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Affiliation(s)
- Leonardo L Tonani
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maria A T Bortolini
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Renata G M Santos
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcia M Fukujima
- Division of Neurologic Emergency, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rodrigo A Castro
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
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Li X, Fang R, Liao L, Li X. Real-time changes in brain activity during tibial nerve stimulation for overactive bladder: Evidence from functional near-infrared spectroscopy hype scanning. Front Neurosci 2023; 17:1115433. [PMID: 37090808 PMCID: PMC10113489 DOI: 10.3389/fnins.2023.1115433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/17/2023] [Indexed: 04/07/2023] Open
Abstract
Purpose To use functional near-infrared spectroscopy (fNIRS) to identify changes in brain activity during tibial nerve stimulation (TNS) in patients with overactive bladder (OAB) responsive to therapy. Methods Eighteen patients with refractory idiopathic OAB patients were recruited consecutively for this pilot study. At baseline, all patients completed 3 days voiding diary, Quality-of-Life score, Perception-of-Bladder-Condition, and Overactive-Bladder-Symptom score. Then 4 region-of-interest (ROI) fNIRS scans with 3 blocks were conducted for each patient. The block design was used: 60 s each for the task and rest periods and 3 to 5 repetitions of each period. A total of 360 s of data were collected. During the task period, patients used transcutaneous tibial nerve stimulation (TTNS) of 20-Hz frequency and a 0.2-millisecond pulse width and 30-milliamp stimulatory current to complete the experiment. The initial scan was obtained with a sham stimulation with an empty bladder, and a second was obtained with a verum stimulation with an empty bladder. Patients were given water till strong desire to void, and the third fNIRS scan with a verum stimulation was performed. The patients then needed to urinate since they could not tolerate the SDV condition for a long time. After a period of rest, the patients then were given water until they exhibited SDV state. The fourth scan with sham fNIRS scan in the SDV state was performed. NIRS_KIT software was used to analyze prefrontal activity, corrected by false discovery rate (FDR, p < 0.05). Statistical analyses were performed using GraphPad Prism software; p < 0.05 was considered significant. Results TTNS treatment was successful in 16 OAB patients and unsuccessful in 2. The 3 days voiding diary, Quality-of-Life score, Perception-of-Bladder-Condition, and Overactive-Bladder-Symptom score were significantly improved after TNS in the successfully treated group but not in the unsuccessfully treated group. The dorsolateral prefrontal cortex (DLPFC) (BA 9, Chapters 25 and 26) and the frontopolar area (FA) (BA 10, Chapters 35, 45, and 46) were significantly activated during TNS treatment with an empty bladder rather than with an SDV. Compared with the successfully treated group, the unsuccessfully treated group did not achieve statistical significance with an empty bladder and an SDV state. Conclusion fNIRS confirms that TNS influences brain activity in patients with OAB who respond to therapy. That may be the central mechanism of action of TNS.
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Affiliation(s)
- Xunhua Li
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
| | - Rui Fang
- Department of Occupational Therapy, China Rehabilitation Research Center, Beijing, China
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
- China Rehabilitation Science Institute, Beijing, China
| | - Xing Li
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
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Zhao P, Zhang G, Shen Y, Wang Y, Shi L, Wang Z, Wei C, Zhai W, Sun L. Urinary dysfunction in patients with vascular cognitive impairment. Front Aging Neurosci 2023; 14:1017449. [PMID: 36742205 PMCID: PMC9889668 DOI: 10.3389/fnagi.2022.1017449] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
Vascular cognitive impairment (VCI) is caused by vascular pathologies, with the spectrum of cognitive disorders ranging from subjective cognitive dysfunction to dementia. Particularly among older adults, cognitive impairment is often complicated with urinary dysfunction (UD); some patients may present with UD before cognitive impairment owing to stroke or even when there are white matter hyperintensities on imaging studies. Patients with cognitive impairment often have both language and movement dysfunction, and thus, UD in patients with VCI can often be underdiagnosed and remain untreated. UD has an impact on the quality of life of patients and caregivers, often leading to poor outcomes. Medical history is an important aspect and should be taken from both patients and their caregivers. Clinical assessment including urinalysis, voiding diary, scales on UD and cognitive impairment, post-void residual volume measurement, uroflowmetry, and (video-) urodynamics should be performed according to indication. Although studies on UD with VCI are few, most of them show that an overactive bladder (OAB) is the most common UD type, and urinary incontinence is the most common symptom. Normal urine storage and micturition in a specific environment are complex processes that require a sophisticated neural network. Although there are many studies on the brain-urinary circuit, the specific circuit involving VCI and UD remains unclear. Currently, there is no disease-modifying pharmacological treatment for cognitive impairment, and anti-acetylcholine drugs, which are commonly used to treat OAB, may cause cognitive impairment, leading to a vicious circle. Therefore, it is important to understand the complex interaction between UD and VCI and formulate individualized treatment plans. This review provides an overview of research advances in clinical features, imaging and pathological characteristics, and treatment options of UD in patients with VCI to increase subject awareness, facilitate research, and improve diagnosis and treatment rates.
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7
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Franco I. Anatomy, physiology, and evaluation: Bowel, bladder, and sexual disorders. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:403-423. [PMID: 37620081 DOI: 10.1016/b978-0-323-98817-9.00009-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Our present understanding of bowel and bladder control has changed dramatically with the introduction of functional imagining technologies such as PET, SPECT, fMRI scanning, and near-infrared spectroscopy of the brain. Urologists tend to see control of urination and defecation as processes that occurred at or below the level of the pons for the most part. In this chapter, we examine the control of storing and emptying of urine and stool from what will be a more neurocentric perspective, integrating the frontal lobes into the process and moving beyond the pons on which most of the literature has focused in the past. Utilizing this approach gives us a better understanding of why there is an overlapping of neuropsychiatric problems in many patients with voiding dysfunction.
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Affiliation(s)
- Israel Franco
- Yale School of Medicine, Yale-New Haven Children's Bladder and Continence Program, Yale New Haven Children's Hospital, New Haven, CT, United States.
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8
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Intrathecal Baclofen for Spasticity: Is There an Effect on Bladder Function? Report of Three Cases and Review of the Literature. Biomedicines 2022; 10:biomedicines10123266. [PMID: 36552022 PMCID: PMC9775073 DOI: 10.3390/biomedicines10123266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION traumatic brain injury (TBI) is very often associated with spasticity. Medical interventions may include medications such as baclofen, a Gamma-Aminobutyric Acid (GABA) -receptor agonist of poor lipid solubility. Intrathecal baclofen (ITB) administration is a contemporary treatment option which minimizes adverse effects in contrast with the oral form of the drug. Regarding low urinary tract dysfunction, TBI, as a suprapontine lesion, results in neurogenic detrusor overactivity. Frequency, urgency and urge incontinence are the predominant signs and symptoms of this condition. Our study aims to report the potential changes in bladder function in patients with spasticity, due to TBI, after the implantation of the baclofen pump and the control of spasticity. MATERIAL AND METHODS We report three cases of TBI whose spasticity responded well to ITB. We evaluated our medical reports regarding bladder function retrospectively, before and after baclofen pump implantation. We compared the data of bladder diaries and urodynamic parameters. RESULTS Bladder function was improved in all patients. Regarding bladder diaries; the number of incontinence and micturition episodes was decreased and the volume per void was slightly increased. Regarding urodynamic parameters; bladder capacity and reflex volume increased, Pdetmax decreased, PVR was the same and DLPP was slightly decreased. CONCLUSIONS Although the baclofen pump is implanted to treat spasticity, detrusor activity may be also affected. Therefore, patients' urologic profiles should also be reevaluated after ITB. Further prospective studies are required to investigate the effect of ITB on bladder function in the clinical field and also at the basic science level.
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9
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Influence of cerebral infarction on both bladder and urethral activities and changes after tramadol administration in rats. Neurourol Urodyn 2022; 41:1679-1691. [DOI: 10.1002/nau.25043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/18/2022] [Accepted: 08/24/2022] [Indexed: 11/07/2022]
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10
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Pang D, Gao Y, Liao L. Functional brain imaging and central control of the bladder in health and disease. Front Physiol 2022; 13:914963. [PMID: 36035497 PMCID: PMC9411744 DOI: 10.3389/fphys.2022.914963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022] Open
Abstract
Central control of the bladder is a complex process. With the development of functional imaging technology and analysis methods, research on brain-bladder control has become more in-depth. Here, we review previous functional imaging studies and combine our latest findings to discuss brain regions related to bladder control, interactions between these regions, and brain networks, as well as changes in brain function in diseases such as urgency urinary incontinence, idiopathic overactive bladder, interstitial cystitis/bladder pain syndrome, urologic chronic pain syndrome, neurogenic overactive bladder, and nocturnal enuresis. Implicated brain regions include the pons, periaqueductal grey, thalamus, insula, prefrontal cortex, cingulate cortex, supplementary motor area, cerebellum, hypothalamus, basal ganglia, amygdala, and hippocampus. Because the brain is a complex information transmission and processing system, these regions do not work in isolation but through functional connections to form a number of subnetworks to achieve bladder control. In summarizing previous studies, we found changes in the brain functional connectivity networks related to bladder control in healthy subjects and patients involving the attentional network, central executive network or frontoparietal network, salience network, interoceptive network, default mode network, sensorimotor network, visual network, basal ganglia network, subcortical network, cerebella, and brainstem. We extend the working model proposed by Griffiths et al. from the brain network level, providing insights for current and future bladder-control research.
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Affiliation(s)
- Dongqing Pang
- China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- Department of Urology, China Rehabilitation Research Center, Beijing, China
- Department of Urology, Capital Medical University, Beijing, China
| | - Yi Gao
- China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- Department of Urology, China Rehabilitation Research Center, Beijing, China
- Department of Urology, Capital Medical University, Beijing, China
| | - Limin Liao
- China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- Department of Urology, China Rehabilitation Research Center, Beijing, China
- Department of Urology, Capital Medical University, Beijing, China
- *Correspondence: Limin Liao,
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Mahon E, Eiras-Diaz A, Mason S, Stabile F, Uriarte A. Case Report: Ventriculoperitoneal Shunting and Radiation Therapy Treatment in a Cat With a Suspected Choroid Plexus Tumor and Hypertensive Hydrocephalus. Front Vet Sci 2022; 9:828083. [PMID: 35400094 PMCID: PMC8989464 DOI: 10.3389/fvets.2022.828083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
A 14-year-old male neutered domestic short-hair cat was presented for a history of behavioral changes and episodes of urinary retention. Neurological examination was consistent with a multifocal intracranial neuroanatomical localization, with suspected right sided lateralisation and suspected raised intracranial pressure (ICP). Brain magnetic resonance imaging (MRI) revealed an intraventricular multilobulated well-defined T2W-hyperintense and T1W-isointense, markedly contrast enhancing mass lesion within the dorsal aspect of the III ventricle extending into the left lateral ventricle, causing hypertensive obstructive hydrocephalus. A ventriculoperitoneal shunt (VPS) was placed within the left lateral ventricle, followed by a radiation therapy (RT) course of 45 Gy total dose in 18 daily fractions. Six-months post-RT, computed tomography revealed mild reduction in mass size and resolution of the hydrocephalus. The patient was neurologically normal with no medical treatment. Raised ICP causes severe clinical signs, can lead to brain ischaemia and herniation, and significantly increases anesthetic risk during RT. Placement of a VPS in cats with hypertensive obstructive hydrocephalus may allow improvement of neurological signs due to raised ICP, and therefore making the patient a more stable candidate for anesthesia and radiation therapy.
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Affiliation(s)
- Elizabeth Mahon
- Department of Neurology and Neurosurgery, Southfields Veterinary Specialists, Essex, United Kingdom
| | - Aldara Eiras-Diaz
- Department of Internal Medicine, Southfields Veterinary Specialists, Essex, United Kingdom
| | - Sarah Mason
- Department of Oncology/Radiation Therapy, Southfields Veterinary Specialists, Essex, United Kingdom
| | - Fabio Stabile
- Department of Neurology and Neurosurgery, Southfields Veterinary Specialists, Essex, United Kingdom
| | - Ane Uriarte
- Department of Neurology and Neurosurgery, Southfields Veterinary Specialists, Essex, United Kingdom
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12
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Change in the central control of the bladder function of rats with focal cerebral infarction induced by photochemically-induced thrombosis. PLoS One 2021; 16:e0255200. [PMID: 34752461 PMCID: PMC8577768 DOI: 10.1371/journal.pone.0255200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/15/2021] [Indexed: 11/19/2022] Open
Abstract
The photochemically-induced thrombosis (photothrombosis) method can create focal cerebral infarcts anywhere in the relatively superficial layers of the cerebrum; it is easy to implement and minimally invasive. Taking advantage of this versatility, we aimed to establish a new rat model of urinary frequency with focal cerebral infarction, which was characterized by its simplicity, nonlethal nature, and high reproducibility. The prefrontal cortex and the anterior cingulate cortex, which are involved in lower urinary tract control, were targeted for focal cerebral infarction, and urinary parameters were measured by cystometrogram. Cystometric analysis indicated that micturition intervals significantly shortened in photothrombosis-treated rats compared with those in the sham operative group on Days 1 and 7 (P < 0.01), but prolonged after 14 days, with no difference between the two groups. Immunopathological evaluation showed an accumulation of activated microglia, followed by an increase in reactive astrocytes at the peri-infarct zone after photothrombotic stroke. Throughout this study, all postphotothrombosis rats showed cerebral infarction in the prefrontal cortex and anterior cingulate cortex; there were no cases of rats with fatal cerebral infarction. This model corresponded to the clinical presentation, in that the micturition status changed after stroke. In conclusion, this novel model combining nonlethality and high reproducibility may be a suitable model of urinary frequency after focal cerebral infarction.
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13
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Zhao L, Liao L, Gao Y. Brain functional connectivity during storage based on resting state functional magnetic resonance imaging with synchronous urodynamic testing in healthy volunteers. Brain Imaging Behav 2021; 15:1676-1684. [PMID: 32725470 DOI: 10.1007/s11682-020-00362-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aim of the study was to elucidate the correlation between spatially distinct brain areas with a full bladder from the perspective of functional connectivity using resting-state functional magnetic resonance imaging (rs-fMRI) with simultaneous urodynamic testing in healthy volunteers. The brain regions with full and empty bladders were reported via rs-fMRI using a 3 T magnetic resonance system. Then, we identified brain regions that are activated during bladder filling by calculating the amplitude of low-frequency fluctuation (ALFF) values using brain imaging software (DPABI and SPM8) and empirically derived six regions of interest (ROI) from analysis of activation were used as seeds for resting-state functional connectivity (rs-FC) analysis with the rest of the brain to examine differences in the two conditions. Statistical analysis was performed with a paired t-test and statistical significance was defined as a P < 0.01. Twenty-two healthy volunteers (11 men and 11 women) 35-64 years of age were enrolled. The rs-fMRI scans of 22 healthy volunteers were analyzed. After motion correction, two subjects were excluded. Meaningful data were obtained on 20 of these subjects. Compared with an empty bladder, functional connection enhancement was noted mainly in the right inferior orbitofrontal cortex and bilateral calcarine gyrus, the left lingual gyrus, left fusiform gyrus, left superior occipital gyrus, right insula, right inferior temporal gyrus, superior parietal lobe, left insula, right lingual gyrus, right fusiform gyrus, left parahippocampal gyrus, right inferior temporal gyrus, superior parietal lobe, left calcarine gyrus, bilateral lingual gyrus, prefrontal cortex, including the middle frontal gyrus and superior frontal gyrus, the right middle temporal gyrus, bilateral posterior cingulate cortex, and right precuneus. The decrease in functional connection was mainly located in the right inferior orbitofrontal cortex, prefrontal cortex, including the superior frontal gyrus, orbitofrontal cortex, and anterior cingulate cortex, the left inferior orbitofrontal cortex, right insula, middle occipital gyrus, angular gyrus, inferior frontal gyrus, right insula, middle temporal gyrus, inferior parietal lobe, middle occipital gyrus, supplementary motor area, superior frontal gyrus, left insula, bilateral posterior cingulate cortex, bilateral precuneus, middle occipital gyrus, and right middle temporal lobe. There were significant changes in the functional connectivity of the brain between full and empty bladders in healthy volunteers, which suggests that the central neural processes involved in storage needs brain areas with integrated control. These findings are strong evidence for physicians to consider brain responses in urine storage and offer the provision of some normative data.
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Affiliation(s)
- Lingna Zhao
- Department of Urology of Beijing Boai Hospital at China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, No 10. Jiaomen Beilu, Fengtai District, Beijing, 100068, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing Institute for Brain Disorders, Beijing, 100068, China
| | - Limin Liao
- Department of Urology of Beijing Boai Hospital at China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, No 10. Jiaomen Beilu, Fengtai District, Beijing, 100068, China.
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing Institute for Brain Disorders, Beijing, 100068, China.
| | - Yi Gao
- Department of Urology of Beijing Boai Hospital at China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, No 10. Jiaomen Beilu, Fengtai District, Beijing, 100068, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing Institute for Brain Disorders, Beijing, 100068, China
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Responses of functional brain networks to bladder control in healthy adults: a study using regional homogeneity combined with independent component analysis methods. Int Urol Nephrol 2021; 53:883-891. [PMID: 33523398 DOI: 10.1007/s11255-020-02742-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/02/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE A functional magnetic resonance imaging (fMRI) study was performed during urodynamic examination in healthy adults to determine the responses of functional brain networks to bladder control during urine storage. METHODS The brain imaging was performed in empty and full bladder states during urodynamic examination. First, we used independent component analysis (ICA) to obtain several resting state network masks, then the brain regions with significantly different regional homogeneity (ReHo) values between the two states were determined using a paired t test (p < 0.05; Gaussian random field correction [GRF]: voxel p < 0.01 and cluster p < 0.05) and presented in their corresponding resting state network (RSN) masks. RESULTS Data sets obtained from the remaining 20 subjects were analyzed after motion correction. Nine RSNs were identified by group-ICA, including the salience network (SN), default mode network (DMN), central executive network (CEN), dorsal attention network (dAN), auditory network (AN), sensorimotor network (SMN), language network (LN), visual network (VN), and cerebellum network (CN). The ReHo values were significantly increased (p < 0.05, GRF corrected) within the SN, DMN, and CEN in the full bladder state compared with the empty bladder state. CONCLUSION Significant changes within the three functional brain networks were demonstrated when the bladder was full, suggesting that SN provides bladder sensation and DMN may provide self-reference, self-reflection, and decision-making about whether to void after assessment of the external environment, while CEN may provide support related to episodic memory, which provides new insight into the processing of bladder control and could serve as a premise to further explore the pathologic process underlying bladder dysfunction.
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Abstract
AbstractLower urinary tract dysfunction is a common sequel of neurological disease resulting in symptoms that significantly impacts quality of life. The site of the neurological lesion and its nature influence the pattern of dysfunction. The risk for developing upper urinary tract damage and renal failure is considerably lower in patients with slowly progressive nontraumatic neurological disorders, compared with those with spinal cord injury or spina bifida. This acknowledged difference in morbidity is considered when developing appropriate management algorithms. The preliminary evaluation consists of history taking, and a bladder diary and may be supplemented by tests such as uroflowmetry, post-void residual measurement, renal ultrasound, (video-)urodynamics, neurophysiology, and urethrocystoscopy, depending on the clinical indications. Incomplete bladder emptying is most often managed by intermittent catheterization, and storage dysfunction is managed by antimuscarinic medications. Intra-detrusor injections of onabotulinumtoxinA have revolutionized the management of neurogenic detrusor overactivity. Neuromodulation offers promise for managing both storage and voiding dysfunction. In select patients, reconstructive urological surgery may become necessary. An individualized, patient-tailored approach is required for the management of lower urinary tract dysfunction in this special population.
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Affiliation(s)
- Jalesh N. Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, United Kingdom
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16
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Tish MM, Geerling JC. The Brain and the Bladder: Forebrain Control of Urinary (In)Continence. Front Physiol 2020; 11:658. [PMID: 32719609 PMCID: PMC7349519 DOI: 10.3389/fphys.2020.00658] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/25/2020] [Indexed: 12/11/2022] Open
Abstract
Neural circuits extending from the cerebral cortex to the bladder maintain urinary continence and allow voiding when it is socially appropriate. Injuries to certain brain regions produce a specific disruption known as urge incontinence. This neurologic symptom is distinguished by bladder spasticity, with sudden urges to void and frequent inability to maintain continence. The precise localization of neural circuit disruptions responsible for urge incontinence remains poorly defined, partly because the brain regions, cell types, and circuit connections that normally maintain continence are unknown. Here, we review what is known about the micturition reflex circuit and about forebrain control of continence from experimental animal studies and human lesion data. Based on this information, we hypothesize that urge incontinence results from damage to a descending pathway that normally maintains urinary continence. This pathway begins with excitatory neurons in the prefrontal cortex and relays subcortically, through inhibitory neurons that may help suppress reflex micturition during sleep and until it is safe and socially appropriate to void. Identifying the specific cell types and circuit connections that constitute the continence-promoting pathway, from the forebrain to the brainstem, will help us better understand why some brain lesions and neurodegenerative diseases disrupt continence. This information is needed to pave the way toward better treatments for neurologic patients suffering from urge incontinence.
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Affiliation(s)
- Margaret M Tish
- Department of Neurology, University of Iowa, Iowa City, IA, United States
| | - Joel C Geerling
- Department of Neurology, University of Iowa, Iowa City, IA, United States
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17
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Tateno F, Sakakibara R, Aiba Y, Takahashi O, Shimizu A, Sugiyama M, Ogata T, Takada N. Bladder Autonomic Dysfunction after a Parietal Stroke. J Stroke Cerebrovasc Dis 2020; 29:104620. [PMID: 32033903 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 12/09/2019] [Accepted: 12/22/2019] [Indexed: 01/22/2023] Open
Abstract
We describe a case of a 57-year-old man who, immediately after a right parietal ischemic stroke, showed urodynamically determined bladder sensory decrement during filling and an underactive detrusor during voiding, both of which were ameliorated during the course of his treatment. The lower urinary tract symptom (LUTS) occurs in stroke in up to 60% of patients, when it involves the frontal and insular cortices. In addition, LUTS does occur in parietal stroke as seen in our patient, presumably by sensory deafferentiation within the brain that is relevant to the central regulation of the micturition reflex.
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Affiliation(s)
- Fuyuki Tateno
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Ryuji Sakakibara
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan.
| | - Yosuke Aiba
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Osamu Takahashi
- Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, Japan
| | - Ayami Shimizu
- Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, Japan
| | - Megumi Sugiyama
- Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, Japan
| | - Tsuyoshi Ogata
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Nobuo Takada
- Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, Japan
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18
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Jeanson G, Lebreton F. [Neuroanatomical correlates between stroke lesions and urinary disorders: A narrative review]. Prog Urol 2018; 29:226-234. [PMID: 30527571 DOI: 10.1016/j.purol.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 10/15/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
CONTEXT Stroke generates diverse urinary disorders, frequent but often under-diagnosed and thus untreated. Even though advances in the comprehension of the physiological voiding control and involved brain areas, the precise correspondence between lesion sites and observed urinary symptoms is not clearly established. OBJECTIVE This review aimed to update on this neuroanatomical correlates. DOCUMENTARY SOURCES The search focused on articles written in French or English, on PubMed, studying human beings or animals, published between the 1st of January 2000 and the 31st of August 2018 using the following keywords (stroke or hemiplegia) and (urinary incontinence or low urinary tract symptom or retention or overactive bladder or dysuria) and (anatomy or location or localization or area or lesion). STUDIES SELECTION The main author selected the most pertinent articles on abstracts and then on full text. RESULTS Twelve studies were included in our review. We could not fully confirm the neuroanatomical correlates based on the animal model. Frontoparietal lesions in urinary incontinence, role of the insula in the urinary retention, and systematic but different urinary symptoms in the brain stem lesions are the main findings. LIMITS Few studies were included, with varying methodologies and types of population. CONCLUSION A few cerebral areas damaged by stroke seem to be linked to certain urinary troubles, but new studies with a higher methodological quality are required to confirm this result.
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Affiliation(s)
- G Jeanson
- Service de MPR Neurologie, CHU Grenoble-Alpes, 38700 La Tronche, France.
| | - F Lebreton
- Service de neuro-urologie, hôpital Tenon, AP-HP, Paris 75020, France.
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19
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20
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Electrochemical detection of NGF using a reduced graphene oxide- titanium nitride nanocomposite. Sci Rep 2018; 8:6929. [PMID: 29720604 PMCID: PMC5931993 DOI: 10.1038/s41598-018-25196-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 04/16/2018] [Indexed: 11/25/2022] Open
Abstract
There is a correlation between the severity of neurological impairment in patients that have suffered a cerebrovascular accident and the nerve growth factor (NGF) level. This study addressed the fabrication of a titanium nitride (TiN) and reduced graphene oxide (RGO)-based composite with remarkable electrocatalytic activity towards NGF oxidation in a phosphate buffer solution (PB, 0.1 M). The proposed electrochemical sensor was linearly related to the NGF concentration in the range of 10 nM-5 μM with a detection limit of 2.6 nM.
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21
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Kaushik V, Smith ST, Mikobi E, Raji MA. Acetylcholinesterase Inhibitors: Beneficial Effects on Comorbidities in Patients With Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2018; 33:73-85. [PMID: 28974110 PMCID: PMC10852526 DOI: 10.1177/1533317517734352] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Elderly patients with Alzheimer's disease (AD) and other dementias are at high risk of polypharmacy and excessive polypharmacy for common coexisting medical conditions. Polypharmacy increases the risk of drug-drug and drug-disease interactions in these patients who may not be able to communicate early symptoms of adverse drug events. Three acetylcholinesterase inhibitors (ACHEIs) have been approved for AD: donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne). They are also used off-label for other causes of dementia such as Lewy body and vascular dementia. We here report evidence from the literature that ACHEI treatment, prescribed for cognitive impairment, can reduce the load of medications in patients with AD by also addressing cardiovascular, gastrointestinal, and other comorbidities. Using one drug to address multiple symptoms can reduce costs and improve medication compliance.
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Affiliation(s)
- Vinod Kaushik
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA
| | - Sarah Toombs Smith
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA
| | - Emmanuel Mikobi
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Mukaila A. Raji
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA
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22
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Mechanisms of action for α1-adrenoceptor blockers in storage symptoms with new insights into the micturition reflex. Life Sci 2017; 191:90-96. [DOI: 10.1016/j.lfs.2017.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/07/2017] [Accepted: 10/11/2017] [Indexed: 01/22/2023]
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23
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Panfili Z, Metcalf M, Griebling TL. Contemporary Evaluation and Treatment of Poststroke Lower Urinary Tract Dysfunction. Urol Clin North Am 2017; 44:403-414. [PMID: 28716321 DOI: 10.1016/j.ucl.2017.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Stroke is an extremely common clinical entity, and poststroke incontinence is a major cause of morbidity for stroke survivors. Although patients can experience a wide variety of lower urinary tract symptoms, detrusor overactivity is among the most common clinical findings following stroke. All forms of lower urinary tract symptoms can negatively impact physical and psychosocial function for affected patients and their caregivers and loved ones. Careful evaluation is critical for successful management. Treatment is tailored to the goals and needs of each individual patient. Improvements in continence status can help to enhance overall and health-related quality of life.
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Affiliation(s)
- Zachary Panfili
- Department of Urology, The University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS, USA
| | - Meredith Metcalf
- Department of Urology, The University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS, USA
| | - Tomas L Griebling
- Department of Urology, The University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS, USA; The Landon Center on Aging, The University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS, USA.
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24
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Balducci F, De Risio L, Shea A, Canal S, Stabile F, Bernardini M. Neurogenic urinary retention in cats following severe cluster seizures. J Feline Med Surg 2017; 19:246-250. [PMID: 26337374 PMCID: PMC10816561 DOI: 10.1177/1098612x15602739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Case series summary Four cats that presented with severe cluster seizures developed neurogenic urinary retention in the postictal phase. None of the cats had previous seizures. Micturition was reported as normal in all cats for 3 or more years before seizure onset. All cats required a continuous rate infusion of propofol to control the seizure activity. In all cats manual bladder expression was performed every 8 h until recovery of normal micturition. One cat was started on phenoxybenzamine to reduce internal urethral sphincter tone. All cats recovered normal micturition within 4 weeks of the last cluster of seizures. Relevance and novel information Transient neurogenic urinary retention has not previously been reported in cats or dogs following severe cluster seizures. Urinary retention should be considered a potential postictal deficit, requiring prompt recognition and treatment to avoid urinary tract infection and detrusor muscle atony.
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Affiliation(s)
- Federica Balducci
- Neurology Unit, Portoni Rossi Veterinary Hospital, Zola Predosa, Bologna, Italy
| | - Luisa De Risio
- Neurology/Neurosurgery Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
| | - Anita Shea
- Neurology/Neurosurgery Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
| | - Sara Canal
- Neurology Unit, Portoni Rossi Veterinary Hospital, Zola Predosa, Bologna, Italy
- Department of Animal Medicine, Production and Health, Clinical Section, University of Padua, Legnaro, Padua, Italy
| | - Fabio Stabile
- Neurology/Neurosurgery Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
| | - Marco Bernardini
- Neurology Unit, Portoni Rossi Veterinary Hospital, Zola Predosa, Bologna, Italy
- Department of Animal Medicine, Production and Health, Clinical Section, University of Padua, Legnaro, Padua, Italy
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25
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Liang CC, Lee TH, Chang SD. Effect of umbilical cord blood stem cells transplantation on bladder dysfunction induced by cerebral ischemia in rats. Taiwan J Obstet Gynecol 2016; 55:672-679. [DOI: 10.1016/j.tjog.2015.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 12/16/2022] Open
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27
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Tudor KI, Sakakibara R, Panicker JN. Neurogenic lower urinary tract dysfunction: evaluation and management. J Neurol 2016; 263:2555-2564. [DOI: 10.1007/s00415-016-8212-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 06/18/2016] [Indexed: 12/20/2022]
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28
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Li LF, Ka-Kit Leung G, Lui WM. Sacral Nerve Stimulation for Neurogenic Bladder. World Neurosurg 2016; 90:236-243. [DOI: 10.1016/j.wneu.2016.02.108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 01/23/2023]
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29
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Smith PP, Kuchel GA, Griffiths D. Functional Brain Imaging and the Neural Basis for Voiding Dysfunction in Older Adults. Clin Geriatr Med 2015; 31:549-65. [DOI: 10.1016/j.cger.2015.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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30
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Autonomic symptoms in hypertensive patients with post-acute minor ischemic stroke. Clin Neurol Neurosurg 2015; 139:188-91. [PMID: 26513431 DOI: 10.1016/j.clineuro.2015.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/09/2015] [Accepted: 10/07/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Most studies regarding autonomic dysfunction in ischemic stroke are limited to heart rate and blood pressure changes during the acute phase. However, there are few data on quantitative assessment of autonomic symptoms. We sought to assess autonomic symptoms in hypertensive ischemic stroke patients. METHODS In 100 hypertensive patients (45 with symptomatic ischemic stroke (6 months after stroke onset) and 55 without stroke), we assessed autonomic symptoms using the Scale for Outcomes in Parkinson disease-Autonomic (SCOPA-AUT). RESULTS The age (mean ± standard deviation) for the stroke group was 66 ± 12 and 63 ± 15 for the without stroke group (P=0.8). Orthostatic hypotension occurred in 3.6% of the stroke group and 4.4% in the group without stroke. The total SCOPA-AUT score was higher in the stroke group compared with the group without stroke (P=0.001). Domain scores for gastrointestinal (P=0.001), urinary (P=0.005) and cardiovascular (P=0.001) were higher in the stroke group. No differences were found when comparing the total SCOPA-AUT scores for stroke subtypes (P=0.168) and for lateralization (P=0.6). SCOPA AUT scores were correlated with depression scores (P=0.001) but not with stroke severity (P=0.2). CONCLUSION Autonomic symptoms, especially, gastrointestinal, urinary and cardiovascular function, were significantly increased in hypertensive patients with minor ischemic stroke. Symptoms were associated with depression but not with the characteristic of the stroke.
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31
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Panicker JN, Fowler CJ, Kessler TM. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol 2015; 14:720-32. [PMID: 26067125 DOI: 10.1016/s1474-4422(15)00070-8] [Citation(s) in RCA: 262] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 12/21/2022]
Abstract
Lower urinary tract (LUT) dysfunction is a common sequela of neurological disease, resulting in symptoms that have a pronounced effect on quality of life. The site and nature of the neurological lesion affect the pattern of dysfunction. The risk of developing upper urinary tract damage and renal failure is much lower in patients with slowly progressive non-traumatic neurological disorders than in those with spinal cord injury or spina bifida; this difference in morbidity is taken into account in the development of appropriate management algorithms. Clinical assessment might include tests such as uroflowmetry, post-void residual volume measurement, renal ultrasound, (video-)urodynamics, neurophysiology, and urethrocystoscopy, depending on the indication. Incomplete bladder emptying is most often managed by intermittent catheterisation, and storage dysfunction by antimuscarinic drugs. Intradetrusor injections of onabotulinumtoxinA have transformed the management of neurogenic detrusor overactivity. Neuromodulation offers promise for managing both storage and voiding dysfunction. An individualised, patient-tailored approach is required for the management of LUT dysfunction associated with neurological disorders.
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Affiliation(s)
- Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK.
| | - Clare J Fowler
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
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32
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de Groat WC, Yoshimura N. Anatomy and physiology of the lower urinary tract. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:61-108. [PMID: 26003239 DOI: 10.1016/b978-0-444-63247-0.00005-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain, spinal cord, and peripheral autonomic ganglia that coordinates the activity of smooth and striated muscles of the bladder and urethral outlet. Neural control of micturition is organized as a hierarchic system in which spinal storage mechanisms are in turn regulated by circuitry in the rostral brainstem that initiates reflex voiding. Input from the forebrain triggers voluntary voiding by modulating the brainstem circuitry. Many neural circuits controlling the lower urinary tract exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. The major component of the micturition switching circuit is a spinobulbospinal parasympathetic reflex pathway that has essential connections in the periaqueductal gray and pontine micturition center. A computer model of this circuit that mimics the switching functions of the bladder and urethra at the onset of micturition is described. Micturition occurs involuntarily during the early postnatal period, after which it is regulated voluntarily. Diseases or injuries of the nervous system in adults cause re-emergence of involuntary micturition, leading to urinary incontinence. The mechanisms underlying these pathologic changes are discussed.
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Affiliation(s)
- William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Naoki Yoshimura
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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33
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Jarrahi B, Mantini D, Balsters JH, Michels L, Kessler TM, Mehnert U, Kollias SS. Differential functional brain network connectivity during visceral interoception as revealed by independent component analysis of fMRI TIME-series. Hum Brain Mapp 2015; 36:4438-68. [PMID: 26249369 DOI: 10.1002/hbm.22929] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 07/20/2015] [Accepted: 07/27/2015] [Indexed: 12/15/2022] Open
Abstract
Influential theories of brain-viscera interactions propose a central role for interoception in basic motivational and affective feeling states. Recent neuroimaging studies have underlined the insula, anterior cingulate, and ventral prefrontal cortices as the neural correlates of interoception. However, the relationships between these distributed brain regions remain unclear. In this study, we used spatial independent component analysis (ICA) and functional network connectivity (FNC) approaches to investigate time course correlations across the brain regions during visceral interoception. Functional magnetic resonance imaging (fMRI) was performed in thirteen healthy females who underwent viscerosensory stimulation of bladder as a representative internal organ at different prefill levels, i.e., no prefill, low prefill (100 ml saline), and high prefill (individually adapted to the sensations of persistent strong desire to void), and with different infusion temperatures, i.e., body warm (∼37°C) or ice cold (4-8°C) saline solution. During Increased distention pressure on the viscera, the insula, striatum, anterior cingulate, ventromedial prefrontal cortex, amygdalo-hippocampus, thalamus, brainstem, and cerebellar components showed increased activation. A second group of components encompassing the insula and anterior cingulate, dorsolateral prefrontal and posterior parietal cortices and temporal-parietal junction showed increased activity with innocuous temperature stimulation of bladder mucosa. Significant differences in the FNC were found between the insula and amygdalo-hippocampus, the insula and ventromedial prefrontal cortex, and the ventromedial prefrontal cortex and temporal-parietal junction as the distention pressure on the viscera increased. These results provide new insight into the supraspinal processing of visceral interoception originating from an internal organ.
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Affiliation(s)
- Behnaz Jarrahi
- Clinic for Neuroradiology, University Hospital, Zurich, Switzerland.,Department of Information Technology and Electrical Engineering, Institute for Biomedical Engineering, Federal Institute of Technology (ETH), Zurich, Switzerland.,Neuro-Urology Spinal Cord Injury Center and Research, Balgrist University Hospital, Zurich, Switzerland.,Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), California.,Neuroscience Center Zurich, University and ETH, Zurich, Switzerland
| | - Dante Mantini
- Neuroscience Center Zurich, University and ETH, Zurich, Switzerland.,Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.,Department of Health Sciences and Technology, Neural Control of Movement Laboratory, ETH Zurich, Switzerland
| | - Joshua Henk Balsters
- Department of Health Sciences and Technology, Neural Control of Movement Laboratory, ETH Zurich, Switzerland
| | - Lars Michels
- Clinic for Neuroradiology, University Hospital, Zurich, Switzerland.,Center for MR-Research, University Children's Hospital, Zurich, Switzerland
| | - Thomas M Kessler
- Neuro-Urology Spinal Cord Injury Center and Research, Balgrist University Hospital, Zurich, Switzerland
| | - Ulrich Mehnert
- Neuro-Urology Spinal Cord Injury Center and Research, Balgrist University Hospital, Zurich, Switzerland
| | - Spyros S Kollias
- Clinic for Neuroradiology, University Hospital, Zurich, Switzerland.,Neuroscience Center Zurich, University and ETH, Zurich, Switzerland
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34
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Dumoulin C, Korner-Bitensky N, Tannenbaum C. Urinary Incontinence After Stroke: Does Rehabilitation Make a Difference? A Systematic Review of the Effectiveness of Behavioral Therapy. Top Stroke Rehabil 2015; 12:66-76. [PMID: 16110429 DOI: 10.1310/enmx-ruv5-15wl-vna2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study uses a comprehensive review of the literature to assess the scientific evidence for the effectiveness of behavioral therapies to treat urinary incontinence (UI) post stroke. Evidence for the different behavioral therapies was critically appraised to achieve a level of evidence based on Foley's classification of levels of evidence. Only four randomized clinical trials (RCTs), one cohort study, and recommendations from three clinical practice guidelines were found. There is limited evidence that bladder retraining with urge suppression in combination with pelvic floor exercises results in reduction of UI in male individuals with stroke. Further research is urgently needed to elucidate clinical recommendations about the efficacy of behavioral approaches.
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Affiliation(s)
- Chantale Dumoulin
- School of Physical and Occupational Therapy, McGill University, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
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Ogama N, Yoshida M, Nakai T, Niida S, Toba K, Sakurai T. Frontal white matter hyperintensity predicts lower urinary tract dysfunction in older adults with amnestic mild cognitive impairment and Alzheimer's disease. Geriatr Gerontol Int 2015; 16:167-74. [DOI: 10.1111/ggi.12447] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2014] [Indexed: 02/04/2023]
Affiliation(s)
- Noriko Ogama
- Center for Comprehensive Care and Research on Memory Disorders; National Center for Geriatrics and Gerontology; Obu Japan
- Biobank; National Center for Geriatrics and Gerontology; Obu Japan
| | - Masaki Yoshida
- Department of Urology; National Center for Geriatrics and Gerontology; Obu Japan
| | - Toshiharu Nakai
- NeuroImaging and Informatics; National Center for Geriatrics and Gerontology; Obu Japan
| | - Shumpei Niida
- Biobank; National Center for Geriatrics and Gerontology; Obu Japan
| | - Kenji Toba
- Center for Comprehensive Care and Research on Memory Disorders; National Center for Geriatrics and Gerontology; Obu Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders; National Center for Geriatrics and Gerontology; Obu Japan
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Sakakibara R. Lower urinary tract dysfunction in patients with brain lesions. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:269-87. [PMID: 26003249 DOI: 10.1016/b978-0-444-63247-0.00015-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Stroke and brain tumor are well-known brain diseases. The incidence of lower urinary tract dysfunction (LUTD) in these patients ranges from 14% to 53%, mostly overactive bladder (OAB), and is higher when the frontal cortex is involved. This presumably reflects damage at the prefrontal cortex, cingulate cortex, and other areas that regulate (mainly inhibit) the micturition reflex. White-matter disease (WMD) is a chronic, bilateral form of cerebrovascular disease, leading to a high prevalence of OAB (up to 90%). Since WMD is particularly common in the elderly, WMD may be one of the anatomic substrates for elderly OAB. Traumatic brain injury and normal-pressure hydrocephalus are rather diffuse brain diseases, which cause OAB with a prevalence rate of 60-95%. Recent neuroimaging studies have shown a relationship between LUTD and the frontal cortex in these diseases. Data on other brain diseases, particularly affecting deep brain structures, are limited. Small infarctions, tumors, or inflammatory diseases affecting the basal ganglia, hypothalamus, and cerebellum lead to mainly OAB. In contrast, similar diseases affecting the brainstem lead to either OAB or urinary retention. The latter reflects damage at the periaqueductal gray and the pontine micturition center that directly relay and modulate the micturition reflex. Urinary incontinence (UI) in brain disease can be divided into two types: neurogenic UI (due to OAB) and functional UI (immobility and loss of initiative/cognition). These two types of UI may occur together, but management differs significantly. Management of neurogenic UI includes anticholinergic drugs that do not penetrate the blood-brain barrier easily. Management of functional UI includes behavioral therapy (timed/prompted voiding with physical assistance and bladder/pelvic floor training) and drugs to treat gait as well as cognition that facilitate continence. These treatments will maximize the quality of life in patients with brain diseases.
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Affiliation(s)
- Ryuji Sakakibara
- Department of Neurology, Sakura Medical Center, Toho University, Sakura, Japan.
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Clinical guidelines for the diagnosis and management of neurogenic lower urinary tract dysfunction. Tzu Chi Med J 2014. [DOI: 10.1016/j.tcmj.2014.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Michels L, Blok BFM, Gregorini F, Kurz M, Schurch B, Kessler TM, Kollias S, Mehnert U. Supraspinal Control of Urine Storage and Micturition in Men--An fMRI Study. Cereb Cortex 2014; 25:3369-80. [PMID: 24969474 PMCID: PMC4585491 DOI: 10.1093/cercor/bhu140] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Despite the crucial role of the brain in the control of the human lower urinary tract, little is known about the supraspinal mechanisms regulating micturition. To investigate the central regulatory mechanisms activated during micturition initiation and actual micturition, we used an alternating sequence of micturition imitation/imagination, micturition initiation, and actual micturition in 22 healthy males undergoing functional magnetic resonance imaging. Subjects able to micturate (voiders) showed the most prominent supraspinal activity during the final phase of micturition initiation whereas actual micturition was associated with significantly less such activity. Initiation of micturition in voiders induced significant activity in the brainstem (periaqueductal gray, pons), insula, thalamus, prefrontal cortex, parietal operculum and cingulate cortex with significant functional connectivity between the forebrain and parietal operculum. Subjects unable to micturate (nonvoiders) showed less robust activation during initiation of micturition, with activity in the forebrain and brainstem particularly lacking. Our findings suggest that micturition is controlled by a specific supraspinal network which is essential for the voluntary initiation of micturition. Once this network triggers the bulbospinal micturition reflex via brainstem centers, micturition continues automatically without further supraspinal input. Unsuccessful micturition is characterized by a failure to activate the periaqueductal gray and pons during initiation.
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Affiliation(s)
- Lars Michels
- Institute of Neuroradiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands
| | - Flavia Gregorini
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zurich, Balgrist University Hospital, 8008 Zurich, Switzerland
| | - Michael Kurz
- Department of Urology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Brigitte Schurch
- Neuro-Urology, Department of Clinical Neurosciences, University Hospital Centre (CHUV), University of Lausanne, 1011 Lausanne, Switzerland
| | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zurich, Balgrist University Hospital, 8008 Zurich, Switzerland
| | - Spyros Kollias
- Institute of Neuroradiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Ulrich Mehnert
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zurich, Balgrist University Hospital, 8008 Zurich, Switzerland
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Mehdi Z, Birns J, Bhalla A. Post-stroke urinary incontinence. Int J Clin Pract 2013; 67:1128-37. [PMID: 23834208 DOI: 10.1111/ijcp.12183] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 04/04/2013] [Indexed: 01/23/2023] Open
Abstract
AIM To provide a comprehensive review of the current evidence on post-stroke urinary incontinence. METHOD An electronic database search was performed to identify relevant studies and review articles related to Urinary Incontinence (UI) in the stroke population between the years 1966 and 2012. FINDINGS Urinary incontinence following stroke is a common problem affecting more than one-third of acute stroke patients and persisting in up to a quarter at 1 year. It is well established that this condition is a strong marker of stroke severity and is associated with poorer functional outcomes and increased institutionalisation and mortality rates compared with those who remain continent. Despite evidence linking better outcomes to those patients who regain continence, the results of national audits have demonstrated that the management of UI following stroke is suboptimal, with less than two-thirds of stroke units having a documented plan to promote continence. CONCLUSION Current evidence supports a thorough assessment to categorise the type and severity of post-stroke urinary incontinence. An individually tailored, structured management strategy to promote continence should be employed. This has been associated with better stroke outcomes and should be the aim of all stroke health professionals.
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Affiliation(s)
- Z Mehdi
- Department of Ageing and Health, St Thomas' Hospital, London, UK
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Sakakibara R, Panicker J, Fowler CJ, Tateno F, Kishi M, Tsuyusaki Y, Yamanishi T, Uchiyama T, Yamamoto T, Yano M. Is overactive bladder a brain disease? The pathophysiological role of cerebral white matter in the elderly. Int J Urol 2013; 21:33-8. [PMID: 24118122 DOI: 10.1111/iju.12288] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 08/26/2013] [Indexed: 12/30/2022]
Abstract
Small-vessel disease of the brain affecting the deep white matter characteristically manifests with neurological syndromes, such as vascular dementia and vascular parkinsonism. There is, however, compelling evidence to suggest that white matter disease can cause overactive bladder and incontinence, and in some patients these might be the initial manifestation. As white matter disease increases significantly with age, and preferentially affects the prefrontal deep white matter, white matter disease becomes an anatomical substrate in the brain etiology of overactive bladder. Treatment entails the management of small-vessel disease risk factors and anticholinergic drugs that do not easily penetrate the blood-brain barrier, to improve bladder control. In short, when caring for elderly overactive-bladder patients, we should look at both the brain and the bladder.
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Affiliation(s)
- Ryuji Sakakibara
- Neurology Division, Department of Internal Medicine, Toho University, Sakura, Japan
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SAKAKIBARA R, ITO T, YAMAMOTO T, UCHIYAMA T, YAMANISHI T, KISHI M, TSUYUSAKI Y, TATENO F, KATSURAGAWA S, KUROKI N. Depression, Anxiety and the Bladder. Low Urin Tract Symptoms 2013; 5:109-20. [DOI: 10.1111/luts.12018] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 02/20/2013] [Accepted: 02/20/2013] [Indexed: 12/21/2022]
Affiliation(s)
- Ryuji SAKAKIBARA
- Division of Neurology, Department of Internal Medicine, Sakura Medical Center; Toho University; Sakura Japan
| | - Takashi ITO
- Division of Neurology; Chiba University; Chiba Japan
| | | | | | | | - Masahiko KISHI
- Division of Neurology, Department of Internal Medicine, Sakura Medical Center; Toho University; Sakura Japan
| | - Yohei TSUYUSAKI
- Division of Neurology, Department of Internal Medicine, Sakura Medical Center; Toho University; Sakura Japan
| | - Fuyuki TATENO
- Division of Neurology, Department of Internal Medicine, Sakura Medical Center; Toho University; Sakura Japan
| | | | - Nobuo KUROKI
- Mental Health Clinic, Sakura Medical Center; Toho University; Sakura Japan
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Kuei CH, Liao CH, Kuo HC. Urodynamic characteristics of voiding dysfunction in patients with a cerebrovascular accident. UROLOGICAL SCIENCE 2013. [DOI: 10.1016/j.urols.2013.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Itoh Y, Yamada S, Konoeda F, Koizumi K, Nagata H, Oya M, Suzuki N. Burden of overactive bladder symptom on quality of life in stroke patients. Neurourol Urodyn 2012; 32:428-34. [DOI: 10.1002/nau.22336] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 09/24/2012] [Indexed: 11/11/2022]
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Li WJ, Oh SJ. Management of lower urinary tract dysfunction in patients with neurological disorders. Korean J Urol 2012; 53:583-92. [PMID: 23060994 PMCID: PMC3459999 DOI: 10.4111/kju.2012.53.9.583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 07/18/2012] [Indexed: 01/29/2023] Open
Abstract
The proper performance of the lower urinary tract is dependent on an intact neural innervation of the individual structures involved. Therefore, any congenital neurological anomalies, diseases, or lesions of the central, peripheral, or autonomic nervous systems can result in lower urinary tract symptoms. Lower urinary tract dysfunction (LUTD) secondary to neurological disorders can significantly reduce quality of life (QoL) and may also give rise to serious complications and psychological and social sequelae. The goals of management of LUTD in patients with neurological disorders are to prevent serious complications and to improve the patient's QoL. Understanding the physiology and pathophysiology of micturition is critical to selecting appropriate treatment options. This article provides an overview of the clinical characteristics, diagnosis, and management of LUTD in patients with certain central and peripheral neuropathies and common lesions.
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Affiliation(s)
- Wen Ji Li
- Department of Urology, Seoul National University Hospital, Neuroscience Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea. ; Department of Urology and Andrology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Keller JJ, Liu SP, Lin HC. Traumatic brain injury increases the risk of female urinary incontinence. Neurourol Urodyn 2012; 32:354-8. [PMID: 22965745 DOI: 10.1002/nau.22309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 08/09/2012] [Indexed: 11/12/2022]
Abstract
AIMS According to our knowledge, no study has attempted to explore the risk of urinary incontinence (UI) after traumatic brain injury (TBI). This study aimed to examine the relationship between TBI in Taiwanese women and their risk of developing UI. METHODS The study was based on 2,416 female patients newly diagnosed with TBI together with 12,080 matched enrollees without a history of TBI as a comparison group. All patients were tracked for a 1-year period from their index date to identify those who developed subsequent UI. The stratified Cox proportional hazards models were performed to compute the risk of UI between groups. RESULTS Of 14,496 patients, 104 (4.30%) from the TBI group and 192 (1.59%) from the comparison group had a diagnosis of UI during the follow-up period. The incidence rate of UI was 4.50 (95% CI: 3.69-5.43) per 100 person-years in patients with TBI and 1.62 (95% CI: 1.40-1.86) per 100 person-years in patients without TBI. The stratified Cox proportional analysis showed that after adjusting for socioeconomic status, obesity, hypertension, diabetes, and hysterectomy, the increased UI risk of patients with TBI persisted at about the same level as in the unadjusted analysis (hazard ratio = 2.78; 95% CI = 2.16-3.53). In addition, although patients with severe and moderate TBI had higher incidence rates of UI than patients with mild TBI, the difference did not reach a statistically significant level (P = 0.090). CONCLUSIONS Our results suggest that an increased risk of UI exists at the first year follow-up in patients with a TBI diagnosis.
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Affiliation(s)
- Joseph J Keller
- School of Public Health, Taipei Medical University, Taipei, Taiwan
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Sakakibara R, Tateno F, Tsuyusaki Y, Kishi M, Uchiyama T, Yamamoto T, Yamanishi T. Psychogenic Urinary Dysfunction in Children and Adults. CURRENT BLADDER DYSFUNCTION REPORTS 2012. [DOI: 10.1007/s11884-012-0144-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sakakibara R, Panicker J, Fowler CJ, Tateno F, Kishi M, Tsuyuzaki Y, Ogawa E, Uchiyama T, Yamamoto T. Vascular incontinence: incontinence in the elderly due to ischemic white matter changes. Neurol Int 2012; 4:e13. [PMID: 23139851 PMCID: PMC3490472 DOI: 10.4081/ni.2012.e13] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 12/17/2011] [Accepted: 01/16/2012] [Indexed: 01/21/2023] Open
Abstract
This review article introduces the new concept of vascular incontinence, a disorder of bladder control resulting from cerebral white matter disease (WMD). The concept is based on the original observation in 1999 of a correlation between the severity of leukoareosis or WMD, urinary symptoms, gait disorder and cognitive impairment. Over the last 20 years, the realization that WMD is not a benign incidental finding in the elderly has become generally accepted and several studies have pointed to an association between geriatric syndromes and this type of pathology. The main brunt of WMD is in the frontal regions, a region recognized to be crucial for bladder control. Other disorders should be excluded, both neurological and urological, such as normal-pressure hydrocephalus, progressive supranuclear palsy, etc., and prostatic hyperplasia, physical stress incontinence, nocturnal polyuria, etc. Treatment involves management of small vessel disease risk factors and anticholinergic drugs that do not easily penetrate the blood brain barrier to improve bladder control.
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Affiliation(s)
- Ryuji Sakakibara
- Neurology Department, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Jalesh Panicker
- Uro-Neurology, the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Clare J Fowler
- Uro-Neurology, the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Fuyuki Tateno
- Neurology Department, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Masahiko Kishi
- Neurology Department, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Yohei Tsuyuzaki
- Neurology Department, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Emina Ogawa
- Neurology Department, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
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Williams MP, Srikanth V, Bird M, Thrift AG. Urinary symptoms and natural history of urinary continence after first-ever stroke--a longitudinal population-based study. Age Ageing 2012; 41:371-6. [PMID: 22321907 DOI: 10.1093/ageing/afs009] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND there are limited population-based data on urinary symptoms and the natural history of urinary incontinence after a first stroke. AIM to study the prevalence of urinary symptoms, and the natural history and factors associated with urinary incontinence after first-ever stroke. METHODS we administered a standardised urinary symptom questionnaire at 3 and 12 months after stroke to patients enrolled in the North-East Melbourne Stroke Incidence Study. Urinary symptoms and evolution of urinary incontinence were recorded. Logistic regression was used to model associations between baseline factors and incontinence at 12 months. RESULTS more than 80% of survivors reported one or more abnormal urinary symptoms at 3 or 12 months, with nocturia most frequent. Incontinence was present in 43.5% of patients at 3 months, and 37.7% at 12 months, with urge incontinence being most common. Pre-stroke continence (P < 0.001) and female sex (P < 0.001) were independently associated with incontinence at 12 months, whereas the effect of greater stroke severity was magnified with advancing age (P for interaction = 0.05). CONCLUSION the majority of survivors reported abnormal urinary symptoms early and late after stroke. Around a third of patients had incontinence at 12 months, with pre-stroke UI, age, female sex and stroke severity predicting its presence.
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Affiliation(s)
- Maree P Williams
- Stroke and Ageing Research Centre, Department of Medicine, Monash University Medical Centre, Clayton, Australia
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Abstract
BACKGROUND Although prognostically and socially significant for both patients and their caregivers, poststroke urinary incontinence (PSUI) is often easily overlooked or is not well studied because of its clinical variety in humans. REVIEW SUMMARY A 45-year-old woman with poorly controlled hypertension presented with acute right-sided hemiparesis and dysarthria. Acute urinary retention was diagnosed 2 days after stroke onset, along with the clinical evolution (The National Institutes of Health Stroke Scale from 1 to 7; Medical Research Council scale from 4 to 2). Brain magnetic resonance imaging showed an acute left medial pontine infarction, whereas urodynamic study showed detrusor hyporeflexia 5 days after the stroke. PSUI started to improve along with urodynamic studies 10 days later and the Foley catheter was removed subsequently. CONCLUSIONS Left medial pontine infarct causes detrusor hyporeflexia, which has not, to our knowledge, been reported in the literature. More attention should be given to the appearance of PSUI because of its prognostic importance and because patients may not recognize their neurogenic bladder symptoms during the acute cerebral shock phase.
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