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Bashkami AA, Kaddumi EG, Al-Saghbini M, Kenana AJ. Brainstem nuclei responsive to cystometry in both endometriosis and cystitis rat models: C-fos immunohistochemistry study. Neurourol Urodyn 2024; 43:779-791. [PMID: 38348646 DOI: 10.1002/nau.25419] [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: 10/25/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE Although the co-occurrence of interstitial cystitis (IC) and endometriosis (ENDO) is remarkably high, the exact pathophysiology for this co-occurrence is unknown. The convergence of the inputs from the involved structures to the same neuronal centers may suggest neuronal hyperexcitability as a mechanism for this co-occurrence. METHODS The present study aimed to investigate the association between IC and ENDO, by studying the changes in brainstem responses to cystometry in a rat model of ENDO and cyclophosphamide (CYP)-induced IC using c-fos immunohistochemistry. RESULTS Following cystometry the brainstem areas that had significant increase in c-fos expression in ENDO alone included: periaqueductal gray (PAG) nuclei, dorsal raphe nucleus, raphe obscurus nucleus, kolliker- Fuse areas, and area postrema. However, the brainstem areas that had increased significantly in the c-fos expression in the ENDO and CYP treated animals included: gigantocellular nucleus, lateral paragigantocellular nucleus, caudoventrolateral nucleus, rostroventrolateral/caudoventrolateral nucleus, lateral reticular nucleus, locus coeruleus, lateral PAG, raphe pallidus nucleus, raphe magnus nucleus, rostroventrolateral nucleus, dorsal motor nucleus of vagus, and solitary tract nucleus. Whereas only lateral parabrachial nucleus showed significant increase in c-fos expression in CYP treated animals alone. CONCLUSIONS The results of the present study demonstrate the overlap of brainstem nuclei that are excited by urinary bladder under ENDO and IC conditions. The pattern of hyperexcitability of the brainstem nuclei may help in understating the pathophysiology of IC and ENDO conditions.
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Affiliation(s)
- Ayah A Bashkami
- Department of Medical Laboratory Sciences, Faculty of Science, Al-Balqa Applied University, Al-Salt, Jordan
| | - Ezidin G Kaddumi
- Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan
| | - Mohamad Al-Saghbini
- Department of Doctor of Dental Surgery, Faculty of Dentistry, Zarqa University, Zarqa, Jordan
| | - Afnan J Kenana
- Department of Medical Laboratory Sciences, Faculty of Science, Al-Balqa Applied University, Al-Salt, Jordan
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Wöllner J, Krebs J, Richter JK, Neuenschwander J, Gunziger A, Hunkeler N, Abramovic M, Vallesi V, Mahler J, Verma RK, Berger MF, Pannek J, Wyss PO. Identification of brain functional connectivity during acute transcutaneous tibial nerve stimulation: A 3T fMRI study. Neurourol Urodyn 2024; 43:236-245. [PMID: 37767637 DOI: 10.1002/nau.25293] [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: 12/19/2022] [Revised: 08/28/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVES A feasibility proof-of-concept study was conducted to assess the effects of acute tibial nerve stimulation (TNS) on the central nervous system in healthy volunteers using functional magnetic resonance imaging (fMRI). MATERIALS AND METHODS Fourteen healthy volunteers were included in a prospective, single-site study conducted on a clinical 3T MRI scanner. Four scans of functional MRI, each lasting 6 min, were acquired: two resting-state fMRI scans (prior and following the TNS intervention) and in-between two fMRI scans, both consisting of alternating rest periods and noninvasive acute transcutaneous TNS (TTNS). Whole brain seed-based functional connectivity (FC) correlation analysis was performed comparing TTNS stimulation with rest periods. Cluster-level familywise error (FWE) corrected p and a minimal cluster size of 200 voxels were used to explore FC patterns. RESULTS Increased FC is reported between inferior frontal gyrus, posterior cingulate gyrus, and middle temporal gyrus with the precuneus as central receiving node. In addition, decreased FC in the cerebellum, hippocampus, and parahippocampal areas was observed. CONCLUSIONS Altered FC is reported in areas which have been described to be also involved in lower urinary tract control. Although conducted with healthy controls, the assumption that the underlying therapeutic effect of TNS involves the central nervous system is supported and has to be further examined in patients with incomplete spinal cord injury.
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Affiliation(s)
- Jens Wöllner
- Department of Neuro-Urology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Jörg Krebs
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Johannes K Richter
- Department of Radiology, Swiss Paraplegic Centre, Nottwil, Switzerland
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University Hospital of Bern, University of Bern, Bern, Switzerland
- Institute of Radiology and Nuclear Medicine, GZO Hospital Wetzikon, Wetzikon, Switzerland
| | | | - Andrea Gunziger
- Department of Neuro-Urology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Nadine Hunkeler
- Department of Radiology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Mihael Abramovic
- Department of Radiology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Vanessa Vallesi
- Department of Radiology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Jasmin Mahler
- Department of Neuro-Urology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Rajeev K Verma
- Department of Radiology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Markus F Berger
- Department of Radiology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Jürgen Pannek
- Department of Neuro-Urology, Swiss Paraplegic Centre, Nottwil, Switzerland
- Department of Urology, Inselspital, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Patrik O Wyss
- Department of Radiology, Swiss Paraplegic Centre, Nottwil, Switzerland
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de Rijk MM, Drake MJ, von Gontard A, Solomon E, Dmochowski R, Schurch B, van Koeveringe GA. Functional neuroimaging related to lower urinary tract sensations: Future directions for study designs and selection of patient groups: ICI-RS 2023. Neurourol Urodyn 2023. [PMID: 37960970 DOI: 10.1002/nau.25333] [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: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVES Neuroimaging studies have advanced our understanding of the intricate central nervous system control network governing lower urinary tract (LUT) function, shedding light on mechanisms for urine storage and voiding. However, a lack of consensus in methodological approaches hinders the comparability of results among research groups and limits the translation of this knowledge to clinical applications, emphasizing the need for standardized methodologies and clinical utilization guidelines. METHODS This paper reports the discussions of a workshop at the 2023 meeting of the International Consultation on Incontinence Research Society, which reviewed uncertainties and research priorities to progress the field of neuroimaging in LUT control and dysfunction. RESULTS Neuroimaging holds great potential for improving our understanding of LUT control and pathophysiological conditions. To date, functional neuroimaging techniques have not yet achieved sufficient strength to make a direct clinical impact. Potential approaches that can improve the clinical utilization of neuroimaging were discussed and research questions proposed. CONCLUSIONS Neuroimaging offers a valuable tool for investigating LUT control, but it's essential to acknowledge the potential for oversimplification when interpreting brain activity due to the complex neural processing and filtering of sensory information. Moreover, technical limitations pose challenges in assessing key brain stem and spinal cord centers, particularly in cases of neurological dysfunction, highlighting the need for more reliable imaging of these centers to advance our understanding of LUT function and dysfunction.
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Affiliation(s)
- 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 Centre+, Maastricht, The Netherlands
| | - Marcus J Drake
- Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, London, UK
| | - Alexander von Gontard
- Parent-Child and Adolescent Department, Hochgebirgsklinik, Davos, Switzerland
- Governor Kremers Centre, Department of Urology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Eskinder Solomon
- Urology Centre, Guy's and St Thomas' NHS Trust, London, UK
- Paediatric Nephro-Urology, Evelina Children's Hospital, London, UK
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brigitte Schurch
- Neuourology Unit, Clinique des Grangettes, Genève, Switzerland
- Department of Neuroscience, University Hospital Lausanne, Lausanne, Switzerland
| | - Gommert A 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 Centre+, Maastricht, The Netherlands
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Schott B, Choksi D, Tran K, Karmonik C, Salazar B, Boone T, Khavari R. Is the Brainstem Activation Different Between Healthy Young Male and Female Volunteers at Initiation of Voiding? A High Definition 7-Tesla Magnetic Resonance Imaging Study. Int Neurourol J 2023; 27:174-181. [PMID: 37798884 PMCID: PMC10556429 DOI: 10.5213/inj.2346104.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/05/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE Assessing brainstem function in humans through typical neuroimaging modalities has been challenging. Our objective was to evaluate brain and brainstem activation patterns during initiation of voiding in healthy males and females utilizing a 7 Tesla magnetic resonance imaging (MRI) scanner and a noninvasive brain-bladder functional MRI (fMRI) protocol. METHODS Twenty healthy adult volunteers (10 males and 10 females) with no history of urinary symptoms were recruited. Each volunteer underwent a clinic uroflow and postvoid residual assessment and was asked to consume water prior to entering the scanner. Anatomical and diffusion tensor images were obtained first, followed by a blood oxygenation level dependent (BOLD) resting-state fMRI (rs-fMRI) during the empty bladder. Subjects indicated when they felt the urge to void, and a full bladder rs-fMRI was obtained. Once completed, the subjects began 5 voiding cycles, where the first 7.5 seconds of each voiding cycle was identified as "initiation of voiding." BOLD activation maps were generated, and regions of interests with a t-value greater than 2.1 were deemed statistically significant. RESULTS We present 5 distinct regions within the periaqueductal gray (PAG) and pontine micturition center (PMC) with statistically significant activation associated with an initiation of voiding in both men and women, 3 within the PAG and 2 within the PMC. Several additional areas in the brain also demonstrated activation as well. When comparing males to females, there was an overall lower BOLD activation seen in females throughout all regions, with the exception of the caudate lobe. CONCLUSION Our study effectively defines regions within the PAG and PMC involved in initiation of voiding in healthy volunteers. To our knowledge, this is the first study investigating differences between male and female brainstem activation utilizing an ultra-high definition 7T MRI.
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Affiliation(s)
- Bradley Schott
- Interdisciplinary College of Engineering Medicine, Texas A&M, Houston, TX, USA
| | - Darshil Choksi
- Interdisciplinary College of Engineering Medicine, Texas A&M, Houston, TX, USA
| | - Khue Tran
- Interdisciplinary College of Engineering Medicine, Texas A&M, Houston, TX, USA
| | | | - Betsy Salazar
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Timothy Boone
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Rose Khavari
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
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Mehnert U, Walter M, Leitner L, Kessler TM, Freund P, Liechti MD, Michels L. Abnormal Resting-State Network Presence in Females with Overactive Bladder. Biomedicines 2023; 11:1640. [PMID: 37371735 DOI: 10.3390/biomedicines11061640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Overactive bladder (OAB) is a global problem reducing the quality of life of patients and increasing the costs of any healthcare system. The etiology of OAB is understudied but likely involves supraspinal network alterations. Here, we characterized supraspinal resting-state functional connectivity in 12 OAB patients and 12 healthy controls (HC) who were younger than 60 years. Independent component analysis showed that OAB patients had a weaker presence of the salience (Cohen's d = 0.9) and default mode network (Cohen's d = 1.1) and weaker directed connectivity between the fronto-parietal network and salience network with a longer lag time compared to HC. A region of interest analysis demonstrated weaker connectivity in OAB compared to HC (Cohen's d > 1.6 or < -1.6), particularly within the frontal and prefrontal cortices. In addition, weaker seed (insula, ventrolateral prefrontal cortex) to voxel (anterior cingulate cortex, frontal gyrus, superior parietal lobe, cerebellum) connectivity was found in OAB compared to HC (Cohen's d > 1.9). The degree of deviation in supraspinal connectivity in OAB patients (relative to HC) appears to be an indicator of the severity of the lower urinary tract symptoms and an indication that such symptoms are directly related to functional supraspinal alterations. Thus, future OAB therapy options should also consider supraspinal targets, while neuroimaging techniques should be given more consideration in the quest for better phenotyping of OAB.
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Affiliation(s)
- Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Matthias Walter
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
- Department of Urology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London WC1N 3AR, UK
- Neuroscience Center Zürich, University of Zürich and Swiss Federal Institute of Technology Zürich, 8057 Zürich, Switzerland
| | - Martina D Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Lars Michels
- Neuroscience Center Zürich, University of Zürich and Swiss Federal Institute of Technology Zürich, 8057 Zürich, Switzerland
- Department of Neuroradiology, University Hospital Zürich, University of Zürich, 8091 Zürich, Switzerland
- Clinical Neuroscience Center, University Hospital Zürich, 8091 Zürich, Switzerland
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Krhut J, Tintěra J, Rejchrt M, Skugarevská B, Zachoval R, Zvara P, Blok BFM. Differences between brain responses to peroneal electrical transcutaneous neuromodulation and transcutaneous tibial nerve stimulation, two treatments for overactive bladder. Neurourol Urodyn 2023. [PMID: 37144657 DOI: 10.1002/nau.25197] [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: 01/24/2023] [Revised: 03/27/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To compare brain responses to peroneal electrical transcutaneous neuromodulation (peroneal eTNM®) and transcutaneous tibial nerve stimulation (TTNS), two methods for treating overactive bladder (OAB), using functional magnetic resonance imaging (fMRI). The present study was not designed to compare their clinical efficacy. MATERIALS AND METHODS This study included 32 healthy adult female volunteers (average age 38.3 years (range 22-73)). Brain MRI using 3 T scanner was performed during three 8-min blocks of alternating sequences. During each 8-min block, the protocol alternated between sham stimulation (30 s) and rest (30 s) for 8 repeats; then peroneal eTNM® stimulation (30 s) and rest (30 s) for 8 repeats; then, TTNS stimulation (30 s) and rest (30 s) for 8 repeats. Statistical analysis was performed at the individual level with a threshold of p = 0.05, family-wise error (FWE)-corrected. The resulting individual statistical maps were analyzed in group statistics using a one-sample t-test, p = 0.05 threshold, false discovery rate (FDR)-corrected. RESULTS During peroneal eTNM®, TTNS, and sham stimulations, we recorded activation in the brainstem, bilateral posterior insula, bilateral precentral gyrus, bilateral postcentral gyrus, left transverse temporal gyrus, and right supramarginal gyrus. During both peroneal eTNM® and TTNS stimulations, but not sham stimulations, we recorded activation in the left cerebellum, right transverse temporal gyrus, right middle frontal gyrus, and right inferior frontal gyrus. Exclusively during peroneal eTNM® stimulation, we observed activation in the right cerebellum, right thalamus, bilateral basal ganglia, bilateral cingulate gyrus, right anterior insula, right central operculum, bilateral supplementary motor cortex, bilateral superior temporal gyrus, and left inferior frontal gyrus. CONCLUSIONS Peroneal eTNM®, but not TTNS, induces the activation of brain structures that were previously implicated in neural control of the of bladder filling and play an important role in the ability to cope with urgency. The therapeutic effect of peroneal eTNM® could be exerted, at least in part, at the supraspinal level of neural control.
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Affiliation(s)
- Jan Krhut
- Department of Urology, University Hospital, Ostrava, Czech Republic
- Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic
| | - Jaroslav Tintěra
- Department of Radiodiagnostics and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Michal Rejchrt
- Department of Urology, 2nd Faculty of Medicine of Charles University and Motol University Hospital, Prague, Czech Republic
| | - Barbora Skugarevská
- Department of Urology, University Hospital, Ostrava, Czech Republic
- Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic
| | - Roman Zachoval
- Department of Urology, 1st Faculty of Medicine of Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Peter Zvara
- Department of Clinical Research, Biomedical Laboratory and Research Unit of Urology, University of Southern Denmark, Odense, Denmark
- Department of Urology, Odense University Hospital, Odense, Denmark
| | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
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Mazeaud C, Salazar BH, Braun M, Hossu G, Khavari R. Functional MRI in neuro-urology: A narrative review. Prog Urol 2023:S1166-7087(23)00082-9. [PMID: 37062631 DOI: 10.1016/j.purol.2023.03.002] [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: 03/01/2023] [Accepted: 03/26/2023] [Indexed: 04/18/2023]
Abstract
Neuro-imaging has given urologists a new tool to investigate the neural control of the lower urinary tract. Using functional magnetic resonance imaging (fMRI), it is now possible to understand which areas of the brain contribute to the proper function of the storage and voiding of the lower urinary tract. This field of research has evolved from simple anatomical descriptions to elucidating the complex micturition network. A keyword search of the Medline database was conducted by two reviewers for relevant studies from January 1, 2010, to August 2022. Of 2047 peer-reviewed articles, 49 are included in this review. In the last decade, a detailed understanding of the brain-bladder network has been described, elucidating a dedicated network, as well as activated areas in the brainstem, cerebellum, and cortex that share reproducible connectivity patterns. Research has shown that various urological diseases can lead to specific changes in this network and that therapies used by urologists to treat lower urinary tract symptoms (LUTS) are also able to modify neuronal activity. This represents a set of potential new therapeutic targets for the management of the lower urinary tract symptoms (LUTS). fMRI technology has made it possible to identify subgroups of responders to various treatments (biofeedback, anticholinergic, neuromodulation) and predict favourable outcomes. Lastly, this breakthrough understanding of neural control over bladder function has led to treatments that directly target brain regions of interest to improve LUTS. One such example is the use of non-invasive transcranial neuromodulation to improve voiding symptoms in individuals with multiple sclerosis.
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Affiliation(s)
- C Mazeaud
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States of America; Department of Urology, Nancy University Hospital, Nancy, France; Université de Lorraine, Inserm, IADI U1254, 54000 Nancy, France
| | - B H Salazar
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States of America
| | - M Braun
- Université de Lorraine, Inserm, IADI U1254, 54000 Nancy, France; Department of Diagnostic and Interventional Neuroradiology, Nancy University Hospital, Nancy, France
| | - G Hossu
- Université de Lorraine, Inserm, IADI U1254, 54000 Nancy, France
| | - R Khavari
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States of America.
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Clarkson BD, Karim HT, Chermansky CJ, Banihashemi L, Tyagi S, Griffiths DJ, Resnick NM. Changes in brain response to urgency before and after treatment of urgency urinary incontinence with onabotulinumtoxin A. Neurourol Urodyn 2022; 41:1703-1710. [PMID: 35904238 DOI: 10.1002/nau.25012] [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: 03/15/2022] [Revised: 05/31/2022] [Accepted: 07/14/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION To better understand the role of the brain in urgency urinary incontinence (UUI), we used onabotulinumtoxin A (BoNTA) as a probe to evaluate changes in the brain's response to urgency in successful and unsuccessful treatment. Because BoNTA acts peripherally, brain changes observed should represent a reaction to changes in bladder function caused by BoNTA, or changes in the brain's compensatory mechanisms, rather than a direct effect of BoNTA on the brain. METHODS We recruited 20 women aged over 60 years with nonneurogenic UUI who were to undergo treatment with onabotulinum A toxin injected intravesically. We performed a baseline evaluation which included a 3-day bladder diary and functional magnetic resonance imaging with an urgency provocation task; we repeated this evaluation 6 weeks posttreatment. We performed an analysis of variance on a priori selected regions of interest and post hoc voxel-wise analysis on responders and nonresponders to treatment. RESULTS We found a significant interaction in the right insula [F(1,18) = 5.5, p = 0.031]; activity was different during urgency provocation in responders and non-responders to therapy, before and after therapy. The supramarginal gyrus (SMG) and inferior frontal gyrus (IFG) also displayed significant interactions (p < 0.005). Activity in the periaqueductal gray and prefrontal cortex was correlated with number of leakage episodes (p < 0.05). CONCLUSION The changes seen in the brain control mechanism after therapy likely reflect reduced bladder sensation caused by BoNTA's peripheral action. We ascribe the SMG and IFG changes to a coping mechanism for urgency which is reduced in those who respond well to treatment.
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Affiliation(s)
- Becky D Clarkson
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Layla Banihashemi
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shachi Tyagi
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Derek J Griffiths
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Neil M Resnick
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Supraspinal Neural Changes in Men with Benign Prostatic Hyperplasia Undergoing Bladder Outlet Procedures: a Pilot Functional MRI Study. Urology 2022; 169:173-179. [PMID: 35863497 DOI: 10.1016/j.urology.2022.07.004] [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: 02/17/2022] [Revised: 06/19/2022] [Accepted: 07/04/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore brain activation patterns on functional MRI (fMRI) in men with BPH and BOO before and after outlet obstruction procedures. METHODS Men age ≥ 45 who failed conservative BPH therapy planning to undergo BOO procedures were recruited. Eligible men underwent a concurrent fMRI/urodynamics testing before and six months after BOO procedure. fMRI images were obtained via 3 Tesla MRI. Significant blood-oxygen-level-dependent (BOLD) signal activated voxels (p<0.05) were identified at strong desire to void and (attempt at) voiding initiation pre and post BOO procedure. RESULTS Eleven men were enrolled, of which seven men completed the baseline scan, and four men completed the six-month follow-up scan. Baseline decreased BOLD activity was observed in right inferior frontal gyrus (IFG), bilateral insula, inferior frontal gyrus (IFG) and thalamus. Significant changes in BOLD signal activity following BOO procedures were observed in the insula, IFG, and cingulate cortices. CONCLUSIONS This represents a pilot study evaluating cortical activity in men with BPH and BOO. Despite limitations we found important changes in supraspinal activity in men with BPH and BOO during filling and emptying phases at baseline and following BOO procedure, with the potential to improve our understanding of neuroplasticity secondary to BPH and BOO. This preliminary data may serve as the foundation for larger future trials.
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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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11
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Coolen RL, Cambier JC, Spantidea PI, van Asselt E, Blok BFM. Androgen receptors in areas of the spinal cord and brainstem: A study in adult male cats. J Anat 2021; 239:125-135. [PMID: 33619726 PMCID: PMC8197961 DOI: 10.1111/joa.13407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/22/2021] [Accepted: 02/01/2021] [Indexed: 12/16/2022] Open
Abstract
Sex hormones, including androgens and estrogens, play an important role in autonomic, reproductive and sexual behavior. The areas that are important in these behaviors lie within the spinal cord and brainstem. Relevant dysfunctional behavior in patients with altered androgen availability or androgen receptor sensitivity might be explained by the distribution of androgens and their receptors in the central nervous system. We hypothesize that autonomic dysfunction is correlated with the androgen sensitivity of spinal cord and brainstem areas responsible for autonomic functions. In this study, androgen receptor immunoreactive (AR‐IR) nuclei in the spinal cord and brainstem were studied using the androgen receptor antibody PG21 in four uncastrated young adult male cats. A dense distribution of AR‐IR nuclei was detected in the superior layers of the dorsal horn, including lamina I. Intensely stained nuclei, but less densely distributed, were found in lamina X and preganglionic sympathetic and parasympathetic cells of the intermediolateral cell column. Areas in the caudal brainstem showing a high density of AR‐IR nuclei included the area postrema, the dorsal motor vagus nucleus and the retrotrapezoid nucleus. More cranially, the central linear nucleus in the pons contained a dense distribution of AR‐IR nuclei. The mesencephalic periaqueductal gray (PAG) showed a dense distribution of AR‐IR nuclei apart from the most central part of the PAG directly adjacent to the ependymal lining. Other areas in the mesencephalon with a dense distribution of AR‐IR nuclei were the dorsal raphe nucleus, the retrorubral nucleus, the substantia nigra and the ventral tegmental area of Tsai. It is concluded that AR‐IR nuclei are located in specific areas of the central nervous system that are involved in the control of sensory function and autonomic behavior. Furthermore, damage of these AR‐IR areas might explain related dysfunction in humans.
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Affiliation(s)
- Rosa L Coolen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Els van Asselt
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
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12
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Walter M, Leitner L, Betschart C, Engeler DS, Freund P, Kessler TM, Kollias S, Liechti MD, Scheiner DA, Michels L, Mehnert U. Considering non-bladder aetiologies of overactive bladder: a functional neuroimaging study. BJU Int 2021; 128:586-597. [PMID: 33547746 DOI: 10.1111/bju.15354] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To better understand the neuropathophysiology of overactive bladder (OAB) in women by characterising supraspinal activity in response to bladder distention and cold stimulation. SUBJECTS/PATIENTS AND METHODS We recruited 24 female participants, 12 with OAB (median [interquartile range, IQR] age 40 [32-42] years) and 12 healthy controls (HCs) without lower urinary tract (LUT) symptoms (median [IQR] age 34 [28-44] years), and assessed LUT and cognitive function through neuro-urological examination, 3-day bladder diary, urodynamic investigation, and questionnaires. Functional magnetic resonance (MR) imaging using a 3-T scanner was performed in all participants during automated, repetitive bladder filling and draining (block design) with 100 mL body temperature (37 °C) saline using a MR-compatible and MR-synchronised infusion-drainage device until strong desire to void (HIGH-FILLING/DRAINING) and bladder filling with cold saline (4 °C, i.e. COLD). Whole-brain and region-of-interest analyses were conducted using Statistical Parametric Mapping, version 12. RESULTS Significant between-group differences were found for 3-day bladder diary variables (i.e. voiding frequency/24 h, P < 0.001; voided volume/void, P = 0.04; and urinary incontinence [UI] episodes/24 h, P = 0.007), questionnaire scores (International Consultation on Incontinence Questionnaire-Female LUT symptoms [overall, filling, and UI scores, all P < 0.001]; the Overactive Bladder Questionnaire short form [symptoms and quality-of-life scores, both P < 0.001]; the Hospital Anxiety and Depression Scale [anxiety P = 0.004 and depression P = 0.003 scores]), as well as urodynamic variables (strong desire to void, P = 0.02; maximum cystometric capacity, P = 0.007; and presence of detrusor overactivity, P = 0.002). Age, weight and cognitive function (i.e. Mini-Mental State Examination, P = 1.0) were similar between groups (P > 0.05). In patients with OAB, the HIGH task elicited activity in the superior temporal gyrus, ventrolateral prefrontal cortex (VLPFC), and mid-cingulate cortex; and the COLD task elicited activity in the VLPFC, cerebellum, and basal ganglia. Compared to HCs, patients with OAB showed significantly stronger cerebellar activity during HIGH-FILLING and significantly less activity in the insula and VLPFC during HIGH-DRAINING. CONCLUSIONS The present findings suggest a sensory processing and modulation deficiency in our OAB group, probably as part of their underlying pathophysiology, as they lacked activity in essential sensory processing areas, such as the insula. Instead, accessory areas, such as the cerebellum, showed significantly stronger activation compared to HCs, presumably supporting pelvic-floor motor activity to prevent UI. The novel findings of the present study provide physiological evidence of the necessity to consider non-bladder aetiologies of bladder symptoms.
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Affiliation(s)
- Matthias Walter
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.,Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Cornelia Betschart
- Department of Gynecology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Daniel S Engeler
- Department of Urology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, UK.,Department of Neurology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Spyros Kollias
- Department of Neuroradiology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Martina D Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - David A Scheiner
- Department of Gynecology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Lars Michels
- Department of Neuroradiology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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13
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Groenendijk IM, Mehnert U, Groen J, Clarkson BD, Scheepe JR, Blok BFM. A systematic review and activation likelihood estimation meta-analysis of the central innervation of the lower urinary tract: Pelvic floor motor control and micturition. PLoS One 2021; 16:e0246042. [PMID: 33534812 PMCID: PMC7857581 DOI: 10.1371/journal.pone.0246042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 01/13/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose Functional neuroimaging is a powerful and versatile tool to investigate central lower urinary tract (LUT) control. Despite the increasing body of literature there is a lack of comprehensive overviews on LUT control. Thus, we aimed to execute a coordinate based meta-analysis of all PET and fMRI evidence on descending central LUT control, i.e. pelvic floor muscle contraction (PFMC) and micturition. Materials and methods A systematic literature search of all relevant libraries was performed in August 2020. Coordinates of activity were extracted from eligible studies to perform an activation likelihood estimation (ALE) using a threshold of uncorrected p <0.001. Results 20 of 6858 identified studies, published between 1997 and 2020, were included. Twelve studies investigated PFMC (1xPET, 11xfMRI) and eight micturition (3xPET, 5xfMRI). The PFMC ALE analysis (n = 181, 133 foci) showed clusters in the primary motor cortex, supplementary motor cortex, cingulate gyrus, frontal gyrus, thalamus, supramarginal gyrus, and cerebellum. The micturition ALE analysis (n = 107, 98 foci) showed active clusters in the dorsal pons, including the pontine micturition center, the periaqueductal gray, cingulate gyrus, frontal gyrus, insula and ventral pons. Overlap of PFMC and micturition was found in the cingulate gyrus and thalamus. Conclusions For the first time the involved core brain areas of LUT motor control were determined using ALE. Furthermore, the involved brain areas for PFMC and micturition are partially distinct. Further neuroimaging studies are required to extend this ALE analysis and determine the differences between a healthy and a dysfunctional LUT. This requires standardization of protocols and task-execution.
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Affiliation(s)
- Ilse M. Groenendijk
- Department of Urology, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands
- * E-mail:
| | - Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands
| | - Becky D. Clarkson
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Jeroen R. Scheepe
- Department of Urology, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands
| | - Bertil F. M. Blok
- Department of Urology, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands
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14
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Shi Z, Tran K, Karmonik C, Boone T, Khavari R. High spatial correlation in brain connectivity between micturition and resting states within bladder-related networks using 7 T MRI in multiple sclerosis women with voiding dysfunction. World J Urol 2021; 39:3525-3531. [PMID: 33512570 PMCID: PMC8344374 DOI: 10.1007/s00345-021-03599-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/08/2021] [Indexed: 12/30/2022] Open
Abstract
Background Several studies have reported brain activations and functional connectivity (FC) during micturition using functional magnetic resonance imaging (fMRI) and concurrent urodynamics (UDS) testing. However, due to the invasive nature of UDS procedure, non-invasive resting-state fMRI is being explored as a potential alternative. The purpose of this study is to evaluate the feasibility of utilizing resting states as a non-invasive alternative for investigating the bladder-related networks in the brain. Methods We quantitatively compared FC in brain regions belonging to the bladder-related network during the following states: ‘strong desire to void’, ‘voiding initiation (or attempt at voiding initiation)’, and ‘voiding (or continued attempt of voiding)’ with FC during rest in nine multiple sclerosis women with voiding dysfunction using fMRI data acquired at 7 T and 3 T. Results The inter-subject correlation analysis showed that voiding (or continued attempt of voiding) is achieved through similar network connections in all subjects. The task-based bladder-related network closely resembles the resting-state intrinsic network only during voiding (or continued attempt of voiding) process but not at other states. Conclusion Resting states fMRI can be potentially utilized to accurately reflect the voiding (or continued attempt of voiding) network. Concurrent UDS testing is still necessary for studying the effects of strong desire to void and initiation of voiding (or attempt at initiation of voiding). Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03599-4.
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Affiliation(s)
- Zhaoyue Shi
- Translational Imaging Center, Houston Methodist Research Institute, Houston, TX, USA
| | - Khue Tran
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Christof Karmonik
- Translational Imaging Center, Houston Methodist Research Institute, Houston, TX, USA
| | - Timothy Boone
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Rose Khavari
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA.
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15
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de Rijk MM, van den Hurk J, Rahnama'i MS, van Koeveringe GA. Parcellation of human periaqueductal gray at 7-T fMRI in full and empty bladder state: The foundation to study dynamic connectivity changes related to lower urinary tract functioning. Neurourol Urodyn 2021; 40:616-623. [PMID: 33410553 PMCID: PMC7986391 DOI: 10.1002/nau.24602] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/05/2020] [Accepted: 12/17/2020] [Indexed: 01/23/2023]
Abstract
Aims The periaqueductal gray (PAG) is a brain stem area involved in processing signals related to urine storage and voiding. The PAG is proposed to be responsible for projecting afferent information from the bladder to cortical and subcortical brain areas and acts as a relay station projecting efferent information from cortical and subcortical areas to the pons and spinal cord. Here, we use 7‐Tesla functional magnetic resonance imaging to parcellate the PAG into functionally distinct clusters during a bladder filling protocol. Methods We assess the similarity between parcellation results in empty and full bladder states and show how these parcellations can be used to create dynamic response profiles of connectivity changes between clusters as a function of bladder sensations. Results For each of our six healthy female participants, we found that the agreement between at least one of the clusters in both states resulting from the parcellation procedure was higher than could be expected based on chance (p ≤ .05), and observed that these clusters are significantly organized in a symmetrical lateralized fashion (p ≤ .05). Correlations between clusters change significantly as a function of experienced sensations during bladder filling (p ≤ .05). Conclusions This opens new possibilities to investigate the effects of treatments of lower urinary tract symptoms on signal processing in the PAG, as well as the investigation of disease‐specific bladder filling related dynamic signal processing in this small brain structure.
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Affiliation(s)
- 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 (MUMC+), Maastricht, The Netherlands
| | - Job van den Hurk
- Scannexus Ultra High-Field MRI Center, Maastricht, The Netherlands
| | - Mohammad S Rahnama'i
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Urology, Uniklinik RWTH Aachen, Aachen, Germany
| | - Gommert A 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 (MUMC+), Maastricht, The Netherlands
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16
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Are White Matter Tract Integrities Different in Multiple Sclerosis Women With Voiding Dysfunction? Female Pelvic Med Reconstr Surg 2021; 27:e101-e105. [PMID: 32265400 PMCID: PMC9744261 DOI: 10.1097/spv.0000000000000830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Two white matter tracts (WMTs) are proposed to be involved in bladder function: anterior thalamic radiation and superior longitudinal fasciculus. Multiple sclerosis (MS) patients with voiding dysfunction (VD) may have distinct changes in these 2 WMTs. This study aims to compare the fractional anisotropy (FA) and mean diffusivity (MD) from diffusion tensor imaging of MS females with and without VD versus healthy controls (HCs). METHODS Prospective observational cohorts of 28 female MS patients and 11 HCs were recruited. Multiple sclerosis patients were divided into 2 groups: voiders (patients without VD, n = 14) and VD (patients with VD, n = 14). Diffusion tensor imaging of each subject was obtained, from which FA and MD maps were generated. The mean FA and MD of each WMT on both sides were analyzed using one-way analysis of variance and pairwise comparison with adjusted P values. RESULTS Overall MS patients had significantly lower mean FA (loss of coherence) and significantly higher mean MD (increased free diffusion) than HCs in both WMTs, indicating more damage. Furthermore, VD showed a trend of loss of integrity in both WMTs when compared with voiders with lower FA and higher MD. CONCLUSIONS There is damage reflected by lower FA and higher MD values in the proposed WMTs involved in bladder function in MS women. Voiding dysfunction in this patient population can be attributed to these damages considering women with VD demonstrated a trend of deterioration in these WMTs compared with women without VD. Future studies with larger sample sizes should be done to further confirm this correlation.
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17
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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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18
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Schellino R, Boido M, Vercelli A. The Dual Nature of Onuf's Nucleus: Neuroanatomical Features and Peculiarities, in Health and Disease. Front Neuroanat 2020; 14:572013. [PMID: 33013330 PMCID: PMC7500142 DOI: 10.3389/fnana.2020.572013] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022] Open
Abstract
Onuf's nucleus is a small group of neurons located in the ventral horns of the sacral spinal cord. The motor neurons (MNs) of Onuf's nucleus innervate striated voluntary muscles of the pelvic floor and are histologically and biochemically comparable to the other somatic spinal MNs. However, curiously, these neurons also show some autonomic-like features as, for instance, they receive a strong peptidergic innervation. The review provides an overview of the histological, biochemical, metabolic, and gene expression peculiarities of Onuf's nucleus. Moreover, it describes the aging-related pathologies as well as several traumatic and neurodegenerative disorders in which its neurons are involved: indeed, Onuf's nucleus is affected in Parkinson's disease (PD) and Shy-Drager Syndrome (SDS), whereas it is spared in Amyotrophic Lateral Sclerosis (ALS), Spinal Muscular Atrophy (SMA), Duchenne Muscular Dystrophy (DMD). We summarize here the milestone studies that have contributed to clarifying the nature of Onuf's neurons and in understanding what makes them either vulnerable or resistant to damage. Altogether, these works can offer the possibility to develop new therapeutic strategies for counteracting neurodegeneration.
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Affiliation(s)
- Roberta Schellino
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Turin, Turin, Italy
| | - Marina Boido
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Turin, Turin, Italy.,National Institute of Neuroscience, Turin, Italy
| | - Alessandro Vercelli
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Turin, Turin, Italy.,National Institute of Neuroscience, Turin, Italy
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19
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Netto JMB, Scheinost D, Onofrey JA, Franco I. Magnetic resonance image connectivity analysis provides evidence of central nervous system mode of action for parasacral transcutaneous electro neural stimulation - A pilot study. J Pediatr Urol 2020; 16:536-542. [PMID: 32873504 DOI: 10.1016/j.jpurol.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Parasacral transcutaneous electriconeural stimulation (pTENS) is a common treatment modality for patients with overactive bladder (OAB). Its mechanism of effectiveness has yet to be elucidated. Recent studies with fMRI in adults with implanted sacral nerve stimulators impute its effectiveness on changes in the brain involving the anterior cingulate cortex (ACC) and prefrontal cortex (PFC). AIM The study set out to evaluate brain connectivity utilizing functional MRI to the outline the mechanism of action of pTENS in the brain. METHODS Ten adult volunteers without urinary tract symptoms underwent fMRI. Electrodes were placed on the skin at sacral level (S2) (Experimental Stimulation - pTENS) and on the right scapular region (Sham Stimulation - sTENS). Stimulation was done twice on each site for 6 min at a frequency of 10 Hz and pulse width of 260 μs and intensity determined by the motor threshold. A 6 min resting state fMRI was also done twice as control. Functional connectivity data was acquired during each state (resting, pTENS and sTENS). Standard functional connectivity preprocessing was performed. Seed connectivity was examined to investigate changes in ACC functional connectivity between the stimulations and resting-state conditions. Significance was assessed at p < 0.05 corrected for multiple comparisons. RESULTS For all conditions (pTENS, sTENS, and rest), standard patterns of ACC connectivity were detectable with strong connectivity between the ACC and subcortical regions and between the ACC and the frontal lobe. Functional connectivity between ACC seed and the dorsal lateral prefrontal cortex (DLPFC) was significantly increased during pTENS compared to rest. sTENS did not increase connectivity between the ACC seed and DLPFC when compared to rest. DISCUSSION Preliminary results indicate that ACC is a major site of activation during pTENS. Increased connectivity between ACC and DLPFC may be a possible mechanism of pTENS effectiveness, which appears to be specific to pTENS compared to sTENS. This study is limited to the small size at this time which prevents further investigation at other sites in the brain. CONCLUSIONS The study confirms our original aim which was to define if parasacral TENS actually has a central effect.
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Affiliation(s)
- Jose Murillo B Netto
- Yale School of Medicine - Department of Urology, USA; Universidade Federal de Juiz de Fora - Division of Urology, Brazil.
| | - Dustin Scheinost
- Statistics & Data Science - Yale University, USA; Child Study Center - Yale University, USA; Radiology & Biomedical Imaging - Yale University, USA.
| | - John A Onofrey
- Yale School of Medicine - Department of Urology, USA; Radiology & Biomedical Imaging - Yale University, USA.
| | - Israel Franco
- Yale School of Medicine - Department of Urology, USA.
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20
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Kreydin EI, Gad P, Gao B, Liu CY, Ginsberg DA, Jann K. The effect of stroke on micturition associated brain activity: A pilot fMRI study. Neurourol Urodyn 2020; 39:2198-2205. [PMID: 32761953 DOI: 10.1002/nau.24473] [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: 05/25/2020] [Revised: 06/25/2020] [Accepted: 07/09/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Cerebral stroke is a unique model for studying the role of the brain in lower urinary tract (LUT) control. By its nature, stroke must change the activity of the brain to cause LUT dysfunction. The objective of this study was to describe changes in micturition-related brain activity in patients who develop LUT symptoms (LUTS) after a cerebral stroke. MATERIALS AND METHODS Healthy controls (HC, n = 10) and patients who developed storage LUTS after a cerebral stroke (n = 7) were recruited. Functional magnetic resonance imaging was used to assess brain activity in each subject. In the task-based block design, blood-oxygen-level-dependent (BOLD) signal was detected during rest, active bladder filling, and bladder voiding. BOLD signal intensity was compared between HCs and stroke subjects during bladder filling, voiding, and voiding initiation. RESULTS Stroke subjects exhibited higher activity in the periaqueductal gray and cerebellum during bladder filling and bladder voiding. HCs exhibited more intense activity in higher centers, such as the cingulate cortex, motor cortex, and the dorsolateral prefrontal cortex in each of the phases examined. CONCLUSIONS Subjects with stroke-related LUTS exhibit a specific pattern of brain activity during bladder filling and voiding. There appears to be a greater reliance on primitive centers (cerebellum, midbrain) than in healthy controls during both phases of the micturition cycle. We hypothesize that these findings may reflect loss of connectivity with higher brain centers after a stroke.
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Affiliation(s)
- Evgeniy I Kreydin
- Department of Urology, Keck School of Medicine of University of Southern California, Los Angeles, California.,Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California.,USC Neurorestoration Center, University of Southern California, Los Angeles, California
| | - Parag Gad
- Department of Neurobiology, University of California Los Angeles, Los Angeles, California
| | - Bingchen Gao
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Charles Y Liu
- Department of Urology, Keck School of Medicine of University of Southern California, Los Angeles, California.,Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California.,USC Neurorestoration Center, University of Southern California, Los Angeles, California
| | - David A Ginsberg
- Department of Urology, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Kay Jann
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, California
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21
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Abstract
PURPOSE OF REVIEW In this review, we summarize recent advances in the understanding of the neural control of the bladder, bowel and sexual function, in both men and women. RECENT FINDINGS Evidence of supraspinal areas controlling the storage of urine and micturition in animals, such as the pontine micturition centre, emerged in the early 20th century. Neurological stimulation and lesion studies in humans provided additional indirect evidence for additional bladder-related brain areas. Thereafter, functional neuroimaging in humans with PET and fMRI provided more direct evidence of the involvement of these brain areas. The areas involved in the storage and expulsion of urine also seem to be involved in the central control of storage and expulsion of feces. Furthermore, most knowledge on the brain control of sexual function is obtained from dynamic imaging in human volunteers. Relatively little is known about the dysfunctional central circuits in patients with pelvic organ dysfunction. SUMMARY fMRI has been the most widely used functional neuroimaging technique in the last decade to study the central control of bladder function, anorectal function and sexual function. The studies described in this review show which sensory and motor areas are involved, including cortical and subcortical areas. We propose the existence of a switch-like phenomenon located in the pons controlling micturition, defecation and orgasm.
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22
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Gao L, Wang T, Qian T, Xiao F, Bai L, Zhang J, Xu H. Severe asymptomatic carotid stenosis is associated with robust reductions in homotopic functional connectivity. Neuroimage Clin 2019; 24:102101. [PMID: 31835289 PMCID: PMC6911862 DOI: 10.1016/j.nicl.2019.102101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 10/05/2019] [Accepted: 11/18/2019] [Indexed: 12/01/2022]
Abstract
Severe (>70% narrowing) asymptomatic carotid stenosis (SACS) is associated with cognitive impairment and future strokes, and connectivity basis for the remote brain consequences is poorly understood. Here we explored homotopic connectivity and parenchymal lesions measured by multimodal magnetic resonance imaging (MRI) parameters in patients with SACS. Twenty-four patients with SACS (19 males/5 females; 64.25 ± 7.18 years), 24 comorbidities-matched controls (19 males/5 females; 67.16 ± 6.10 years), and an independent sample of elderly healthy controls (39 females/45 males; 57.92 ± 4.94 years) were included. Homotopic functional connectivity (FC) of resting-state functional MRI and structural connectivity (SC) of deterministic tractography were assessed. Arterial spin labeling based cerebral perfusion, susceptibility weighted imaging based microhemorrhagic lesions, and T2-weighted white matter hyperintensities were also quantified. Significant and robust homotopic reductions (validated by the independent dataset and support vector machine-based machine learning) were identified in the Perisylvian fissure in patients with SACS (false discovery rate corrected, voxel p < 0.05). These involved regions span across several large-scale brain systems, which include the somatomotor, salience, dorsal attention, and orbitofrontal-limbic networks. This significantly reduced homotopic FC can be partially explained by the corrected white matter hyperintensity size. Further association analyses suggest that the decreased homotopic FC in these brain regions is most closely associated with delayed memory recall, sensorimotor processing, and other simple cognitive functions. Together, these results suggest that SACS predominately affects the lower-order brain systems, while higher-order systems, especially the topographies of default mode network, are least impacted initially, but may serve as a hallmark precursor to vascular dementia. Thus, assessment of homotopic FC may provide a means of noninvasively tracking the progression of downstream brain damage following asymptomatic carotid stenosis.
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Affiliation(s)
- Lei Gao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City, Hubei Province 430071, China
| | - Tao Wang
- Department of Neurology, the First College of Clinical Medical Science, China Three Gorges University, Yichang, China; Department of Neurology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City, Hubei Province 430071, China
| | - Tianyi Qian
- MR Collaboration, Siemens Healthcare China, Beijing, China
| | - Feng Xiao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City, Hubei Province 430071, China
| | - Lijun Bai
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, China
| | - Junjian Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City, Hubei Province 430071, China.
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City, Hubei Province 430071, China.
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Abstract
Purpose of review Voiding dysfunction (VD) is morbid, costly, and leads to urinary tract infections, stones, sepsis, and permanent renal failure. Evaluation and diagnosis of VD in non-obstructed patients can be challenging. Potential diagnostic and therapeutic options beyond the bladder, such as brain centers involved in voiding have been proposed as promising targets. This review focuses on current and future applications of functional neuroimaging in human in voiding and in patients with VD. Recent findings The current understanding of brain centers, and their roles in initiating, maintaining and/or modulating voiding, is rudimentary in humans and in patients with VD. With the advent and advancement in functional neuroimaging we are gaining more insight into specific brain regions involved in the voiding phase of micturition. In healthy individuals, right dorsomedial pontine tegmentum, periaqueductal grey, hypothalamus, and the inferior, medial and superior frontal gyrus have been identified as regions of interest in voiding. Summary Functional neuroimaging could suggest new diagnostic methods and provides crucial steps towards therapeutic options for the morbid and intractable VD condition, in patients with neurogenic (e.g. MS or Strokes) or non-neurogenic VD (e.g. underactive bladder or Fowler's syndrome).
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Harvie C, Weissbart SJ, Kadam-Halani P, Rao H, Arya LA. Brain activation during the voiding phase of micturition in healthy adults: A meta-analysis of neuroimaging studies. Clin Anat 2018; 32:13-19. [PMID: 30069958 DOI: 10.1002/ca.23244] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 01/06/2023]
Abstract
Several studies have used a variety of neuroimaging techniques to measure brain activity during the voiding phase of micturition. However, there is a lack of consensus on which regions of the brain are activated during voiding. The aim of this meta-analysis is to identify the brain regions that are consistently activated during voiding in healthy adults across different studies. We searched the literature for neuroimaging studies that reported brain co-ordinates that were activated during voiding. We excluded studies that reported co-ordinates only for bladder filling, during pelvic floor contraction only, and studies that focused on abnormal bladder states such as the neurogenic bladder. We used the activation-likelihood estimation (ALE) approach to create a statistical map of the brain and identify the brain co-ordinates that were activated across different studies. We identified nine studies that reported brain activation during the task of voiding in 91 healthy subjects. Together, these studies reported 117 foci for ALE analysis. Our ALE map yielded six clusters of activation in the pons, cerebellum, insula, anterior cingulate cortex (ACC), thalamus, and the inferior frontal gyrus. Regions of the brain involved in executive control (frontal cortex), interoception (ACC, insula), motor control (cerebellum, thalamus), and brainstem (pons) are involved in micturition. This analysis provides insight into the supraspinal control of voiding in healthy adults and provides a framework to understand dysfunctional voiding. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Camryn Harvie
- Division of Urogynecology, Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven J Weissbart
- Department of Urology, Stony Brook School of Medicine, Stony Brook, New York
| | - Priyanka Kadam-Halani
- Division of Urogynecology, Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hengyi Rao
- Center for Functional Neuroimaging, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lily A Arya
- Division of Urogynecology, Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
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25
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A corticopontine circuit for initiation of urination. Nat Neurosci 2018; 21:1541-1550. [DOI: 10.1038/s41593-018-0256-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/20/2018] [Indexed: 12/31/2022]
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26
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Khavari R, Elias SN, Boone T, Karmonik C. Similarity of functional connectivity patterns in patients with multiple sclerosis who void spontaneously versus patients with voiding dysfunction. Neurourol Urodyn 2018; 38:239-247. [PMID: 30311665 DOI: 10.1002/nau.23837] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/08/2018] [Indexed: 12/15/2022]
Abstract
AIM To investigate if Multiple Sclerosis (MS) lesion characteristics affect functional brain connectivity (FC) during bladder voiding. METHODS Twenty-seven ambulatory female patients with MS completed our functional magnetic resonance imaging (fMRI)/urodynamic testing (UDS) platform. Individual fMRI activation maps were generated at initiation of voiding. FC patterns of these regions were calculated and compared. Similarity of the FC pattern from one patient relative to all others was expressed by a parameter FC_sim. A statistical analysis was performed to reveal the relationship of the existence of an enhancing brain lesion, the size of the largest lesion and the ability to void spontaneously to this FC similarity measure. RESULTS FC_sim values were significantly lower for patients with an enhancing MS lesion (11.7 ± 3.1 vs 5.3 ± 2.1 P < 0.001). Lesion size smaller than 20 mm inversely correlated significantly with FC_sim (R = -0.43, P = 0.05). Patients with the ability to void spontaneously had a higher FC_sim value (12.0 ± 2.8 vs 9.3 ± 4.4 s, P = 0.08). Patients that exhibited a decrease of compliance also showed a significantly lower FC_sim value (11.3 ± 3.5 vs 4.7 ± 0.7, P < 1e-5). CONCLUSION FC connectivity analysis derived from an fMRI task-based study including repetitive voiding cycles is able to quantify the heterogeneity of connectivity patterns in the brain of MS patients. FC similarity decreased with maximum lesion size or the presence of enhancing lesions affecting the ability to void spontaneously.
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Affiliation(s)
- Rose Khavari
- Department of Urology, Houston Methodist Hospital, Houston, Texas
| | - Saba N Elias
- Houston Methodist Research Institute, MRI Core, Huston, Texas
| | - Timothy Boone
- Department of Urology, Houston Methodist Hospital, Houston, Texas
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27
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Zare A, Jahanshahi A, Rahnama'i MS, Schipper S, van Koeveringe GA. The Role of the Periaqueductal Gray Matter in Lower Urinary Tract Function. Mol Neurobiol 2018; 56:920-934. [PMID: 29804231 PMCID: PMC6400878 DOI: 10.1007/s12035-018-1131-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 05/14/2018] [Indexed: 12/18/2022]
Abstract
The periaqueductal gray matter (PAG), as one of the mostly preserved evolutionary components of the brain, is an axial structure modulating various important functions of the organism, including autonomic, behavioral, pain, and micturition control. It has a critical role in urinary bladder physiology, with respect to storage and voiding of urine. The PAG has a columnar composition and has extensive connections with its cranially and caudally located components of the central nervous system (CNS). The PAG serves as the control tower of the detrusor and sphincter contractions. It serves as a bridge between the evolutionary higher decision-making brain centers and the lower centers responsible for reflexive micturition. Glutamatergic cells are the main operational neurons in the vlPAG, responsible for the reception and relay of the signals emerging from the bladder, to related brain centers. Functional imaging studies made it possible to clarify the activity of the PAG in voiding and filling phases of micturition, and its connections with various brain centers in living humans. The PAG may be affected in a wide spectrum of disorders, including multiple sclerosis (MS), migraine, stroke, Wernicke’s encephalopathy, and idiopathic normal pressure hydrocephalus, all of which may have voiding dysfunction or incontinence, in certain stages of the disease. This emphasizes the importance of this structure for the basic understanding of voiding and storage disorders and makes it a potential candidate for diagnostic and therapeutic interventions.
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Affiliation(s)
- Aryo Zare
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands.
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Science, Maastricht, The Netherlands.
| | - Ali Jahanshahi
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Science, Maastricht, The Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Sandra Schipper
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Science, Maastricht, The Netherlands
| | - Gommert A van Koeveringe
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands.
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Science, Maastricht, The Netherlands.
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28
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Tam J, Cohen T, Kim J, Weissbart S. Insight Into the Central Control of Overactive Bladder Symptoms by Functional Brain Imaging. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0464-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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29
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Abstract
Coordination between the brainstem and the cortex helps to ensure that urination occurs at an appropriate time.
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Affiliation(s)
- Anna P Malykhina
- Division of Urology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, United States
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30
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Roy HA, Pond D, Roy C, Forrow B, Foltynie T, Zrinzo L, Akram H, Aziz TZ, FitzGerald JJ, Green AL. Effects of pedunculopontine nucleus stimulation on human bladder function. Neurourol Urodyn 2017; 37:726-734. [DOI: 10.1002/nau.23321] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 04/11/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Holly A. Roy
- Department of Neurosurgery; Oxford University Hospitals Trust; Oxford UK
- Nuffield Department of Surgical Sciences; University of Oxford; Oxford UK
| | - Debbie Pond
- OUH Adult Continence Service, Infection Control Department; Oxford University Hospitals Trust; Oxford UK
| | | | - Beth Forrow
- Department of Neurosurgery; Oxford University Hospitals Trust; Oxford UK
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience and Movement Disorders; University College London, Institute of Neurology; London UK
| | - Ludvic Zrinzo
- Sobell Department of Motor Neuroscience and Movement Disorders; University College London, Institute of Neurology; London UK
| | - Harith Akram
- Sobell Department of Motor Neuroscience and Movement Disorders; University College London, Institute of Neurology; London UK
| | - Tipu Z. Aziz
- Department of Neurosurgery; Oxford University Hospitals Trust; Oxford UK
- Nuffield Department of Surgical Sciences; University of Oxford; Oxford UK
| | - James J. FitzGerald
- Department of Neurosurgery; Oxford University Hospitals Trust; Oxford UK
- Nuffield Department of Surgical Sciences; University of Oxford; Oxford UK
| | - Alexander L. Green
- Department of Neurosurgery; Oxford University Hospitals Trust; Oxford UK
- Nuffield Department of Surgical Sciences; University of Oxford; Oxford UK
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31
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Abstract
Results from functional brain scanning have shown that neural control of the bladder involves many different regions. Yet, many aspects of this complex system can be simplified to a working model in which a few forebrain circuits, acting mainly on the midbrain periaqueductal grey (PAG), advance or delay the triggering of the voiding reflex and generate bladder sensations according to the volume of urine in the bladder, the safety of voiding and the emotional and social propriety of doing so. Understanding these circuits seems to offer a route to treatment of conditions, such as urgency incontinence or overactive bladder, in patients without overt neurological disease. Two of these circuits include, respectively, the medial prefrontal cortex and the parahippocampal complex, as well as the PAG. These circuits belong to a well-known network that is active at rest and deactivated when attention is required. Another circuit, comprising the insula and the midcingulate or dorsal anterior cingulate cortex, is activated by bladder filling and belongs to a salience network that generates sensations such as the desire to void. Behavioural treatments of urgency incontinence lead to changes in brain function that support the working model and suggest the mechanism of this type of treatment.
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32
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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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33
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Ranson RN, Saffrey MJ. Neurogenic mechanisms in bladder and bowel ageing. Biogerontology 2015; 16:265-84. [PMID: 25666896 PMCID: PMC4361768 DOI: 10.1007/s10522-015-9554-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 01/28/2015] [Indexed: 01/18/2023]
Abstract
The prevalence of both urinary and faecal incontinence, and also chronic constipation, increases with ageing and these conditions have a major impact on the quality of life of the elderly. Management of bladder and bowel dysfunction in the elderly is currently far from ideal and also carries a significant financial burden. Understanding how these changes occur is thus a major priority in biogerontology. The functions of the bladder and terminal bowel are regulated by complex neuronal networks. In particular neurons of the spinal cord and peripheral ganglia play a key role in regulating micturition and defaecation reflexes as well as promoting continence. In this review we discuss the evidence for ageing-induced neuronal dysfunction that might predispose to neurogenic forms of incontinence in the elderly.
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Affiliation(s)
- Richard N Ranson
- Department of Applied Sciences (Biomedical Sciences), Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK,
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34
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Mehnert U, Kessler TM. The Swiss Continence Foundation Award: promoting the next generation in neuro-urology and functional urology. BJU Int 2014; 115 Suppl 6:26-7. [PMID: 25441149 DOI: 10.1111/bju.13008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ulrich Mehnert
- Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
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