SUFU 2018: Association Between Overactive Bladder Severity and Bold FMRI Brain Activity
The authors reported that women with refractory overactive bladder who elected sacral neuromodulation therapy were invited to participate in the study. At baseline, subjects completed the ICIQ-FLUTS questionnaire and underwent blood-oxygen-level dependent (BOLD) fMRI brain imaging. During fMRI acquisition, subjects experienced multiple cycles of bladder filling via an infusion pump and were asked to signal their experience of urinary urgency by pressing a response button. Brain activity during urgency was compared to brain activity without urgency and was measured in brain regions known to be involved in the micturition cycle (ACC, PCC, insula, thalamus, frontal cortex, and pons).
They found 12 women with refractory idiopathic OAB were included in the study (median age 63.5 years, IQR 11). Median ICIQ-FLUTS storage, voiding, and incontinence subscale scores were 8.5 (IQR 4), 5 (IQR 3.5), and 10.5 (IQR 8), respectively, and the median bladder volume during urinary urgency was 112mL (IQR 85). Women with more severe baseline storage symptoms on the ICIQ-FLUTS had greater increases in brain activity during urgency in the right ACC (Rs=0.70; p=0.02) and left ACC (Rs=0.65; p=0.02) as well as the right insula (Rs=0.6; p=0.04). Women with more severe baseline incontinence had less brain activity during urgency in the left ACC (Rs=-0.06; p=0.04).
In conclusion there was a greater increase in brain activity in the ACC and right insula during urinary urgency appear to be associated with the severity of OAB symptoms. Patients with more severe OAB may experience an even greater increase in afferent signaling. Future research is needed to investigate if women with OAB and urgency incontinence have different brain activity patterns than women OAB who do not experience incontinence.
Presented by: Steven Weissbart MD
Authors: Steven Weissbart MD¹, Lily Arya MD², Rupal Bhavsar MD², Alan Wein MD, PhD ² and Ariana Smith MD
Author Information:
1. Stony Brook University, Stony Brook, NY
2. University of Pennsylvania, Philadelphia, PA
Written by: Bilal Farhan, MD, Female Urology Fellow and Voiding Dysfunction, Department of Urology, University of California, Irvine at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas