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Ren C, Hao X, Chen X, Liu X. Loneliness, functional disability and lower urinary tract symptoms suggestive of benign prostatic hyperplasia in aging men: Insights from the China health and retirement longitudinal study. Geriatr Nurs 2024; 58:304-309. [PMID: 38865784 DOI: 10.1016/j.gerinurse.2024.06.002] [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: 01/31/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Research has demonstrated that social isolation and loneliness are linked to functional disability in older adults. With the intensification of global aging, functional disability and lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) have become common public health issues affecting elderly men. METHODS This study utilized data from the CHARLS database. The functional status of participants was evaluated through activities of daily living (ADL) and instrumental activities of daily living (IADL). Logistic regression analyses were employed to investigate variables associated with LUTS/BPH. RESULTS Univariate logistic regression revealed associations between loneliness (OR: 1.26; 95 % CI: 1.08-1.46) (excluding social isolation), ADL (OR: 2.17; 95 % CI: 1.86-2.52), IADL disability (OR: 1.37; 95 % CI: 1.16-1.60), and LUTS/BPH. Following rigorous adjustment for potential confounding factors, it was determined that ADL disability independently correlated with LUTS/BPH (OR: 1.92; 95 % CI: 1.17-3.17). CONCLUSION ADL disability is significantly linked to an elevated risk of LUTS/BPH in Chinese elderly men. These findings enhance our understanding of the relationship between functional status and LUTS/BPH.
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Affiliation(s)
- Congzhe Ren
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xuexue Hao
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiangyu Chen
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China.
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Zhao P, Zhang G, Shen Y, Wang Y, Shi L, Wang Z, Wei C, Zhai W, Sun L. Urinary dysfunction in patients with vascular cognitive impairment. Front Aging Neurosci 2023; 14:1017449. [PMID: 36742205 PMCID: PMC9889668 DOI: 10.3389/fnagi.2022.1017449] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
Vascular cognitive impairment (VCI) is caused by vascular pathologies, with the spectrum of cognitive disorders ranging from subjective cognitive dysfunction to dementia. Particularly among older adults, cognitive impairment is often complicated with urinary dysfunction (UD); some patients may present with UD before cognitive impairment owing to stroke or even when there are white matter hyperintensities on imaging studies. Patients with cognitive impairment often have both language and movement dysfunction, and thus, UD in patients with VCI can often be underdiagnosed and remain untreated. UD has an impact on the quality of life of patients and caregivers, often leading to poor outcomes. Medical history is an important aspect and should be taken from both patients and their caregivers. Clinical assessment including urinalysis, voiding diary, scales on UD and cognitive impairment, post-void residual volume measurement, uroflowmetry, and (video-) urodynamics should be performed according to indication. Although studies on UD with VCI are few, most of them show that an overactive bladder (OAB) is the most common UD type, and urinary incontinence is the most common symptom. Normal urine storage and micturition in a specific environment are complex processes that require a sophisticated neural network. Although there are many studies on the brain-urinary circuit, the specific circuit involving VCI and UD remains unclear. Currently, there is no disease-modifying pharmacological treatment for cognitive impairment, and anti-acetylcholine drugs, which are commonly used to treat OAB, may cause cognitive impairment, leading to a vicious circle. Therefore, it is important to understand the complex interaction between UD and VCI and formulate individualized treatment plans. This review provides an overview of research advances in clinical features, imaging and pathological characteristics, and treatment options of UD in patients with VCI to increase subject awareness, facilitate research, and improve diagnosis and treatment rates.
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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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Central Network Dynamics Regulating Visceral and Humoral Functions. J Neurosci 2017; 37:10848-10854. [PMID: 29118214 DOI: 10.1523/jneurosci.1833-17.2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/03/2017] [Accepted: 10/08/2017] [Indexed: 02/07/2023] Open
Abstract
The brain processes information from the periphery and regulates visceral and immune activity to maintain internal homeostasis, optimally respond to a dynamic external environment, and integrate these functions with ongoing behavior. In addition to its relevance for survival, this integration underlies pathology as evidenced by diseases exhibiting comorbid visceral and psychiatric symptoms. Advances in neuroanatomical mapping, genetically specific neuronal manipulation, and neural network recording are overcoming the challenges of dissecting complex circuits that underlie this integration and deciphering their function. Here we focus on reciprocal communication between the brain and urological, gastrointestinal, and immune systems. These studies are revealing how autonomic activity becomes integrated into behavior as part of a social strategy, how the brain regulates innate immunity in response to stress, and how drugs impact emotion and gastrointestinal function. These examples highlight the power of the functional organization of circuits at the interface of the brain and periphery.
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Miyazato M, Kadekawa K, Kitta T, Wada N, Shimizu N, de Groat WC, Birder LA, Kanai AJ, Saito S, Yoshimura N. New Frontiers of Basic Science Research in Neurogenic Lower Urinary Tract Dysfunction. Urol Clin North Am 2017; 44:491-505. [PMID: 28716328 PMCID: PMC5647782 DOI: 10.1016/j.ucl.2017.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Minoru Miyazato
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan; Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Katsumi Kadekawa
- Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Takeya Kitta
- Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Naoki Wada
- Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Nobutaka Shimizu
- Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - William C de Groat
- Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15216, USA
| | - Lori A Birder
- Department of Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15216, USA
| | - Anthony J Kanai
- Department of Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15216, USA
| | - Seiichi Saito
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA; Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15216, USA.
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Suskind AM. The Aging Overactive Bladder: A Review of Aging-Related Changes from the Brain to the Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2017; 12:42-47. [PMID: 28947924 DOI: 10.1007/s11884-017-0406-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW To understand the current literature on age-related neural and detrusor changes associated with overactive bladder symptoms. RECENT FINDINGS Recent functional magnetic resonance imaging (fMRI) studies have unveiled an age-related decrease in the neural control of continence, represented in the insula, anterior cingulate cortex (ACC) and prefrontal cortex (PFC). Older individuals with overactive bladder symptoms also demonstrate heightened activation of the ACC with low volumes, representing increased bladder sensitivity or sense of urgency. At the level of the bladder, age-related changes in the urothelium, neurotransmitters/receptors (both muscarinic and purinergic), and inflammation [including nerve growth factor (NGF), monocyte chemoattractant protein-1 (MCP-1) and oxidative stress] are also associated with overactive bladder. SUMMARY Overactive bladder among older adults is a complex condition incorporating physiologic age-related changes from the brain to the bladder and beyond.
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Affiliation(s)
- Anne M Suskind
- Department of Urology, University of California, San Francisco, 400 Parnassus Ave, Box 0738, San Francisco, CA 94143, USA
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7
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Smith PP, Kuchel GA, Griffiths D. Functional Brain Imaging and the Neural Basis for Voiding Dysfunction in Older Adults. Clin Geriatr Med 2015; 31:549-65. [DOI: 10.1016/j.cger.2015.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Vrijens D, Drossaerts J, van Koeveringe G, Van Kerrebroeck P, van Os J, Leue C. Affective symptoms and the overactive bladder - a systematic review. J Psychosom Res 2015; 78:95-108. [PMID: 25499886 DOI: 10.1016/j.jpsychores.2014.11.019] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 11/17/2014] [Accepted: 11/20/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Overactive bladder syndrome (OAB) is characterised by urgency symptoms, with or without urgency incontinence, usually with frequency and nocturia. Although literature suggest an association between OAB, depression and anxiety, no systematic review has been presented. OBJECTIVE Systematically review the literature on the association of affective conditions with OAB. METHODS Systematic review according to the PRISMA guidelines. This review is registered in the PROSPERO register (CRD4201400664). RESULTS Forty-three articles were included, describing more than 80,000 subjects. Depression and OAB were positively associated in 26 studies, anxiety and OAB in 6 studies. Longitudinal studies reported: a) OAB subjects who developed depression/anxiety or b) depressed/anxious subjects developing OAB, or c) both. The quality of evidence in studies reporting an association between the co-occurrence of OAB and depression was rated level 3 in accordance with the GRADE framework. Evidence reporting on the co-occurrence of anxiety and OAB was rated GRADE level 2. Longitudinal associations between new onset of OAB in depressive subjects was GRADE level 2. Evidence reporting association of OAB with anxiety in longitudinal studies was of GRADE level 1. CONCLUSION To our knowledge, this systematic review is the first to give a comprehensive qualitative overview on the association between OAB and affective symptoms. Many evaluated studies failed to note longitudinal changes and lacked evidence of causality. Still, results revealed an association between OAB and affective symptoms and there is evidence for new onset of OAB in depressive subjects, but further research is necessary to examine the strength of the effect.
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Affiliation(s)
- Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Jamie Drossaerts
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Jim van Os
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands; King's College London, King's Health Partners, London, Institute of Psychiatry, United Kingdom.
| | - Carsten Leue
- Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Abstract
This article summarizes anatomical, neurophysiological, pharmacological, and brain imaging studies in humans and animals that have provided insights into the neural circuitry and neurotransmitter mechanisms controlling the lower urinary tract. The functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain, spinal cord, and peripheral autonomic ganglia that coordinates the activity of smooth and striated muscles of the bladder and urethral outlet. The neural control of micturition is organized as a hierarchical system in which spinal storage mechanisms are in turn regulated by circuitry in the rostral brain stem that initiates reflex voiding. Input from the forebrain triggers voluntary voiding by modulating the brain stem circuitry. Many neural circuits controlling the lower urinary tract exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. The major component of the micturition switching circuit is a spinobulbospinal parasympathetic reflex pathway that has essential connections in the periaqueductal gray and pontine micturition center. A computer model of this circuit that mimics the switching functions of the bladder and urethra at the onset of micturition is described. Micturition occurs involuntarily in infants and young children until the age of 3 to 5 years, after which it is regulated voluntarily. Diseases or injuries of the nervous system in adults can cause the re-emergence of involuntary micturition, leading to urinary incontinence. Neuroplasticity underlying these developmental and pathological changes in voiding function is discussed.
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Affiliation(s)
- William C. de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
| | - Derek Griffiths
- Department of Medicine (Geriatrics), University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
| | - Naoki Yoshimura
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
- Department of Urology, University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
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Griffiths D. Functional imaging of structures involved in neural control of the lower urinary tract. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:121-33. [PMID: 26003241 DOI: 10.1016/b978-0-444-63247-0.00007-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Recent functional brain imaging studies, building on earlier observations, suggest a working model of brain control of the lower urinary tract. It comprises a few cerebral neural circuits that, during the storage phase, act on the midbrain periaqueductal gray to inhibit the long-loop, spinobulbospinal voiding reflex, thus promoting continence. Circuit 1, centered on the medial prefrontal cortex, appears to be concerned with conscious control of both continence and voiding. Circuit 2, centered on the dorsal anterior cingulate (midcingulate) and supplementary motor area, is concerned with emotional aspects of bladder control: desire to void or urgency with concomitant urethral sphincter activation to delay leakage. A subcortical circuit 3 has been less well studied. Circuit 1 is bilateral with a right-sided preference. Scattered studies of the connectivity of the control network suggest that white-matter damage may contribute to urinary incontinence. A few studies confirm that isolated cerebral lesions, if in the medial prefrontal cortex or its connecting pathways, may lead to incontinence. Lower urinary tract dysfunction in other neurologic diseases (normal-pressure hydrocephalus, Parkinson's disease, and multiple systems atrophy) appears consistent with the working model, and even spinal or peripheral lesions have central effects. However, this model omits the contributions of brain regions already observed in some imaging studies and therefore is certainly oversimplified.
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Affiliation(s)
- Derek Griffiths
- Formerly Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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11
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Luef G, Madersbacher H. Sexual dysfunction in patients with epilepsy. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:383-94. [DOI: 10.1016/b978-0-444-63247-0.00022-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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12
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Neuroanatomy, neurophysiology, and dysfunction of the female lower urinary tract: a review. Female Pelvic Med Reconstr Surg 2014; 20:65-75. [PMID: 24566208 DOI: 10.1097/spv.0000000000000058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The 2 major functions of the lower urinary tract are the storage and emptying of urine. These processes are controlled by complex neurophysiologic mechanisms and are subject to injury and disease. When there is disruption of the neurologic control centers, dysfunction of the lower urinary tract may occur. This is sometimes referred to as the "neurogenic bladder." The manifestation of dysfunction depends on the level of injury and severity of disruption. Patients with lesions above the spinal cord often have detrusor overactivity with no disruption in detrusor-sphincter coordination. Patients with well-defined suprasacral spinal cord injuries usually present with intact reflex detrusor activity but have detrusor sphincter dyssynergia, whereas injuries to or below the sacral spinal cord usually lead to persistent detrusor areflexia. A complete gynecologic, urologic, and neurologic examination should be performed when evaluating patients with neurologic lower urinary tract dysfunction. In addition, urodynamic studies and neurophysiologic testing can be used in certain circumstances to help establish diagnosis or to achieve better understanding of a patient's vesicourethral functioning. In the management of neurogenic lower urinary tract dysfunction, the primary goal is improvement of a patient's quality of life. Second to this is the prevention of chronic damage to the bladder and kidneys, which can lead to worsening impairment and symptoms. Treatment is often multifactorial, including behavioral modifications, bladder training programs, and pharmacotherapy. Surgical procedures are often a last resort option for management. An understanding of the basic neurophysiologic mechanisms of the lower urinary tract can guide providers in their evaluation and treatment of patients who present with lower urinary tract disorders. As neurologic diseases progress, voiding function often changes or worsens, necessitating a good understanding of the underlying physiology in question.
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13
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Lee SH, Cho ST, Na HR, Ko SB, Park MH. Urinary incontinence in patients with Alzheimer's disease: Relationship between symptom status and urodynamic diagnoses. Int J Urol 2014; 21:683-7. [DOI: 10.1111/iju.12420] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Seong Ho Lee
- Department of Urology; College of Medicine; Hallym University; Seoul Korea
| | - Sung Tae Cho
- Department of Urology; College of Medicine; Hallym University; Seoul Korea
| | - Hae Ri Na
- Department of Neurology; Bobath Memorial Hospital; Seongnam-si Korea
| | - Seok Bum Ko
- Department of Neurology; Bobath Memorial Hospital; Seongnam-si Korea
| | - Moon Ho Park
- Department of Neurology; College of Medicine; Korea University; Seoul Korea
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Lussier M, Renaud M, Chiva-Razavi S, Bherer L, Dumoulin C. Are stress and mixed urinary incontinence associated with impaired executive control in community-dwelling older women? J Clin Exp Neuropsychol 2013; 35:445-54. [DOI: 10.1080/13803395.2013.789483] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Peters KM, Killinger KA, Gilleran J, Boura JA. Does patient age impact outcomes of neuromodulation? Neurourol Urodyn 2012; 32:30-6. [PMID: 22674536 DOI: 10.1002/nau.22268] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 04/19/2012] [Indexed: 11/10/2022]
Abstract
AIMS We evaluated whether patients stratified by age have the same level of risks/benefits after a staged neuromodulation procedure for refractory voiding symptoms. METHODS Urologic diagnosis, complications, and revisions were collected from medical records of adults enrolled in our prospective observational study. Symptoms were assessed over 2 years with diaries, Interstitial Symptom-Problem Indices (ICSI-PI), and the Overactive Bladder Questionnaire-SF (OAB-q SF). 12-item Short-Form Health Survey (SF-12v2®) mental (MCS) and physical (PCS) component summaries evaluated quality of life. Data were examined with Pearson Chi-square or Fisher's Exact test, Kruskal-Wallis tests, and repeated measures analyses. RESULTS Patients (83% female) were grouped by age (years): <40 (n = 46), 40-64 (n = 146), and ≥65 (n = 136). Urge incontinence was predominant in the older groups and more patients <40 had interstitial cystitis/painful bladder syndrome (IC/PBS). In the <40, 40-64, and ≥65 groups, respectively, generator implant (91%, 88%, and 89%) and explant (15%, 12%, and 10%) rates were similar. Complications (24%, 14%, and 9%; P = 0.031) and revisions (20%, 5%, and 6%; P = 0.0025) differed. For the three respective groups, urinary frequency (P < 0.0001 for all), nocturia (P < 0.0001 for all), incontinence episodes (P < 0.0001 for all), urgency (P = 0.0474, P < 0.0001, P = 0.0020), ICSI-PI (P = 0.0015, P < 0.0001, P < 0.0001), and OAB-q scores improved over time. Incontinence severity improved in those >65 (P = 0.0015). SF-12 PCS improved in those 40-64 (P = 0.0482) and MCS scores improved in the <40 and 40-64 age groups (P = 0.013 and P = 0.0440, respectively). CONCLUSIONS These data suggest that neuromodulation success is not age dependent, however continued study is needed to confirm findings.
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Affiliation(s)
- Kenneth M Peters
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
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16
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Abstract
The lower urinary tract (LUT) has two functions: (1) the storage of waste products in the form of urine and (2) the elimination of those wastes through micturition. The LUT operates in a simple "on-off" fashion, either storing urine or releasing it during voiding. While this activity may seem simple, micturition is controlled by a complex set of peripheral neurons that are, in turn, coordinated by cell groups in the spinal cord, brainstem, and brain. When this careful coordination is interrupted, the control of the bladder is lost, resulting in incontinence or retention of urine. The purpose of this chapter is to review how the neural systems coordinating the activity of the lower urinary tract form neural circuits that are responsible for either maintaining continence (the storage reflex) or inducing micturition (the voiding reflex). We will also discuss the brain centers that enable higher organisms to voluntarily choose the time and place for voiding. Finally, we will discuss how defects in the pathways controlling micturition can lead to urinary incontinence and which treatments may normalize LUT function.
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Affiliation(s)
- Jonathan M Beckel
- Department of Anatomy and Cell Biology, University of Pennsylvania, Philadelphia, PA 19104 USA.
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17
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Abstract
The coordination of pelvic visceral activity with appropriate elimination behaviors is a complex task that requires reciprocal communication between the brain and pelvic organs. Barrington's nucleus, located in the pons, is central to a circuit involved in this function. Barrington's nucleus neurons project to both pelvic visceral motorneurons and cerebral norepinephrine neurons that modulate behavior. This circuit coordinates the descending limb of the micturition reflex with a central limb that initiates arousal and shifts the focus of attention to facilitate elimination behavior. The same circuitry that links the bladder and brain enables pathological processes in one target of the circuit to be expressed in the other. Urological disorders can, therefore, have cognitive and behavioral consequences by affecting components of this circuit; and in the opposing direction, psychosocial stressors can produce voiding dysfunctions and bladder pathology. The stress-related neuropeptide, corticotropin-releasing factor, which is prominent in Barrington's nucleus neurons, is a potential mediator of these effects.
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Poonia MK, Kaur G, Chintamaneni M, Changela I. New insights into molecular targets for urinary incontinence. Indian J Pharmacol 2010; 42:261-6. [PMID: 21206614 PMCID: PMC2959205 DOI: 10.4103/0253-7613.69980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 05/29/2010] [Accepted: 07/21/2010] [Indexed: 11/17/2022] Open
Abstract
Urinary incontinence (UI) is a disease affecting quality of life of 200 million patients worldwide. It is characterized by involuntary loss of urine. The factors involved are cystitis, detrusor hyperreflexia, spinal injury, benign prostatic hyperplasia, etc. The surge in the number of reviews on this subject indicates the amount of research devoted to this field. The prevalence is increasing at an alarming rate but unfortunately, only a few medications are currently available for this condition. There are peripheral as well as central targets including cholinergic, vanilloid, prostaglandin, kinin, calcium channel, cannabinoid, serotonin, and GABA-receptors, which act by different mechanisms to treat different types of incontinence. Drugs acting on the central nervous system (CNS) increase urinary bladder capacity, volume, or pressure threshold for micturition reflex activation while peripherally acting drugs decrease the amplitude of micturition contraction and residual volume. Anticholinergic drugs specifically M3 receptor antagonists are the first choice but have frequent side effects such as dry mouth, CNS disturbances, etc. Therefore, there is a need to understand the biochemical pathways that control urinary dysfunction to determine the potential to which they can be exploited in the treatment of this condition. This article reviews the central and peripheral molecular targets and the potential therapeutic approaches to the treatment of UI.
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Affiliation(s)
- Manoj K. Poonia
- School of Pharmacy and Technology Management, SVKM’S NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai 400 056
| | - Ginpreet Kaur
- School of Pharmacy and Technology Management, SVKM’S NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai 400 056
| | - Meena Chintamaneni
- School of Pharmacy and Technology Management, SVKM’S NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai 400 056
| | - Ilesh Changela
- Department of Clinical Pharmacokinetics and Biopharmaceutics, Wockhardt Ltd., Mulund-Goregaon Link Road, Bhandup (W), Mumbai 400 078, India
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McAchran S, Rackley R, Vasavada S. Neuromodulation for Voiding Dysfunction. Neuromodulation 2009. [DOI: 10.1016/b978-0-12-374248-3.00079-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Impact of overactive bladder on the brain: central sequelae of a visceral pathology. Proc Natl Acad Sci U S A 2008; 105:10589-94. [PMID: 18645186 DOI: 10.1073/pnas.0800969105] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Neural circuits that allow for reciprocal communication between the brain and viscera are critical for coordinating behavior with visceral activity. At the same time, these circuits are positioned to convey signals from pathologic events occurring in viscera to the brain, thereby providing a structural basis for comorbid central and peripheral symptoms. In the pons, Barrington's nucleus and the norepinephrine (NE) nucleus, locus coeruleus (LC), are integral to a circuit that links the pelvic viscera with the forebrain and coordinates pelvic visceral activity with arousal and behavior. Here, we demonstrate that a prevalent bladder dysfunction, produced by partial obstruction in rat, has an enduring disruptive impact on cortical activity through this circuit. Within 2 weeks of partial bladder obstruction, the activity of LC neurons was tonically elevated. LC hyperactivity was associated with cortical electroencephalographic activation that was characterized by decreased low-frequency (1-3 Hz) activity and prominent theta oscillations (6-8 Hz) that persisted for 4 weeks. Selective lesion of the LC-NE system significantly attenuated the cortical effects. The findings underscore the potential for significant neurobehavioral consequences of bladder disorders, including hyperarousal, sleep disturbances, and disruption of sensorimotor integration, as a result of central noradrenergic hyperactivity. The results further imply that pharmacological manipulation of central NE function may alleviate central sequelae of these visceral disorders.
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Hruz P, Lövblad K, Nirkko A, Thoeny H, El-Koussy M, Danuser H. Identification of brain structures involved in micturition with functional magnetic resonance imaging (fMRI). J Neuroradiol 2008; 35:144-9. [DOI: 10.1016/j.neurad.2007.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mehnert U, Boy S, Svensson J, Michels L, Reitz A, Candia V, Kleiser R, Kollias S, Schurch B. Brain activation in response to bladder filling and simultaneous stimulation of the dorsal clitoral nerve—An fMRI study in healthy women. Neuroimage 2008; 41:682-9. [DOI: 10.1016/j.neuroimage.2008.03.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 02/29/2008] [Accepted: 03/05/2008] [Indexed: 11/15/2022] Open
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Lower Urinary Tract Symptoms in Older Adults Undergoing Hip Arthroplasty. J Wound Ostomy Continence Nurs 2008; 35:334-40. [DOI: 10.1097/01.won.0000319134.37101.c4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pettersen R, Haig Y, Nakstad PH, Wyller TB. Subtypes of urinary incontinence after stroke: relation to size and location of cerebrovascular damage. Age Ageing 2008; 37:324-7. [PMID: 18250094 DOI: 10.1093/ageing/afm196] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Renate Pettersen
- University of Oslo, Department of Geriatric Medicine, Ullevaal University Hospital, N-0407 Oslo, Norway.
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Association of urgency symptoms with self-rated health, mood and functioning in an older population. Aging Clin Exp Res 2007; 19:465-71. [PMID: 18172368 DOI: 10.1007/bf03324732] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Lower urinary tract symptoms (LUTS) with comorbidities are common in old age. The aim here was to investigate the associations of urgency symptoms with self-rated health, mood and functioning in a random older population adjusted for comorbid conditions. METHODS A population-based cross-sectional survey was made involving 343 people (159 men and 184 women) aged 70 years and over. LUTS were categorized as symptoms with or without urgency. Perceived inconvenience from LUTS, self-rated health, mood, social activity and activities of daily living (ADL), instrumental activities of daily living (IADL) and mobility disability were the outcome measures. Ageand gender-adjusted and multivariate logistic regression models were constructed in order to examine the associations of urgency and non-urgency symptoms with the outcomes. The covariates were age, gender, and self-reported cardiovascular, musculoskeletal, neurological and other chronic diseases. RESULTS Perceived inconvenience from urgency symptoms was more frequent than that from non-urgency symptoms (64% vs 20%, p<0.001). In the age- and gender-adjusted logistic regression models, LUTS with urgency were associated with poor self-rated health (OR [odds ratio] 2.35; 95% CI [confidence interval] 1.06-5.20), depressive mood (OR 7.29; 95% CI 2.91-18.30), ADL (OR 2.33; 95% CI 1.10-4.92), IADL (OR 2.16; 95% CI 1.19-3.92) and mobility disability (OR 2.44; 95% CI 1.37-4.36). LUTS without urgency were associated with depressive mood (OR 5.02; 95% CI 1.97-12.82) and mobility disability (OR 1.97; 95% CI 1.10-3.53). In the multivariate analyses in which comorbid conditions were added to the model, the associations of non-urgency and urgency symptoms persisted only with depressive mood (OR 4.00; 95% CI 1.52-10.53 and OR 6.16; 95% CI 2.39-15.84, respectively). CONCLUSION Urgency symptoms are associated with poor self-rated health, depressive mood and disability in older people. There is an independent association between both urgency and non-urgency LUTS and depressive mood. A careful assessment of the mental state of older individuals with LUTS is warranted.
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Perneczky R, Diehl-Schmid J, Förstl H, Drzezga A, May F, Kurz A. Urinary incontinence and its functional anatomy in frontotemporal lobar degenerations. Eur J Nucl Med Mol Imaging 2007; 35:605-10. [DOI: 10.1007/s00259-007-0626-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Accepted: 09/28/2007] [Indexed: 11/30/2022]
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Abstract
In the last 10 years, sacral neuromodulation has evolved from an experimental therapy to a safe and proven treatment option for patients with a variety of complex lower urinary tract disorders. It is currently Food and Drug Administration approved for the following indications: intractable urge incontinence, urgency-frequency, and nonobstructive urinary retention. Herein, we will discuss some of the factors complicating incontinence treatment in the elderly population paying particular attention to sacral neuromodulation, its history, indications, and applications within the elderly female population.
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Affiliation(s)
- Sarah E McAchran
- Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Abstract
Some of the most recent work investigating the cerebral mechanisms involved in bladder control has been very helpful in adding to our understanding of bladder dysfunction. The group behind this work, from London, presents a mini-review which will help to update our knowledge in this area. Authors from Australia present a review describing the interactions between bone and prostate cancer cells in metastatic disease. This area has generated much interest and is something for which we should develop a full understanding, to optimise our treatments for this condition.
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Affiliation(s)
- Ranan DasGupta
- National Hospital for Neurology, Uro-Neurology, London, UK.
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Huang AJ, Brown JS, Thom DH, Fink HA, Yaffe K. Urinary incontinence in older community-dwelling women: the role of cognitive and physical function decline. Obstet Gynecol 2007; 109:909-16. [PMID: 17400853 DOI: 10.1097/01.aog.0000258277.01497.4b] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine the association between cognitive decline, physical function decline, and urinary incontinence in older community-dwelling women. METHODS This was an observational study of 6,361 community-dwelling women aged 65 years and older participating in the Study of Osteoporotic Fractures. Clinical frequency and functional disruptiveness of incontinence were assessed by self-report questionnaires. Cognitive function was assessed at visits using the modified Mini-Mental State Examination, Trails B test, and Digit Symbol Substitution Test. Physical function was assessed by measuring walking speed over a 6-meter course and time needed to complete five chair stands. Women were considered to have recent, significant decline in cognitive or physical function if their cognitive or physical performance declined by greater than 1 standard deviation beyond the mean decline in the 6 years preceding assessment of incontinence. RESULTS Women with recent physical function decline were more likely to report weekly incontinence (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.09-1.56 for walking speed decline; OR 1.40, 95% CI 1.19-1.64 for chair stand decline), after adjusting for multiple characteristics. Women with recent cognitive decline were more likely to report incontinence that interfered with activities (OR 1.55, 95% CI 1.10-2.17 for modified Mini-Mental State Examination decline; OR 1.53, 95% CI 1.01-2.31 for Digit Symbol Substitution Test decline), after adjusting for multiple characteristics. CONCLUSION Both cognitive and physical function decline are likely important contributors to incontinence in community-dwelling women aged 65 years and older. Although cognitive decline may not be associated with greater frequency of incontinence, women with cognitive decline may have more difficulty coping with incontinence symptoms. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Alison J Huang
- Veterans Affairs Medical Center, San Francisco, and University of California San Francisco, San Francisco, California 94121, USA.
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Kuhtz-Buschbeck JP, van der Horst C, Wolff S, Filippow N, Nabavi A, Jansen O, Braun PM. Activation of the supplementary motor area (SMA) during voluntary pelvic floor muscle contractions—An fMRI study. Neuroimage 2007; 35:449-57. [PMID: 17293127 DOI: 10.1016/j.neuroimage.2006.12.032] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Revised: 11/06/2006] [Accepted: 12/13/2006] [Indexed: 12/30/2022] Open
Abstract
To identify cortical and subcortical regions involved in voluntary pelvic floor muscle control, functional magnetic resonance imaging (fMRI) was performed at 1.5 T in thirty healthy subjects (15 women, 15 men). The participants performed rhythmical (1 Hz) pelvic floor muscle contractions, which imitated the repetitive interruption of voiding. Since previous reports concerning the representation of pelvic floor muscles in the cortex of the medial wall are inconsistent, a conservative statistical threshold (FWE-corrected P<0.05) was used to detect the most robust foci of activation, and cytoarchitectonic probability maps were used to correlate the results with structural anatomical information. We found a strong and consistent recruitment of the supplementary motor area (SMA), with foci of peak activity located in the posterior portion of the SMA, suggesting that this region is specifically involved in voluntary pelvic floor muscle control. Further significant activations were identified bilaterally in the frontal opercula, the right insular cortex and the right supramarginal gyrus. They may reflect the attentive processing and evaluation of visceral sensations. Weaker signals were detected in the primary motor cortex (M1) and the dorsal pontine tegmentum. There was no significant correlation between bladder volumes and brain activation induced by pelvic floor muscle contractions. We found no significant gender-related differences.
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Affiliation(s)
- J P Kuhtz-Buschbeck
- Institute of Physiology, Christian-Albrechts University, Olshausenstr. 40, D-24098 Kiel, Germany.
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Kershen RT, Appell RA. Functional brain imaging and the bladder: Current insights into cerebral control over micturition. CURRENT BLADDER DYSFUNCTION REPORTS 2007. [DOI: 10.1007/s11884-007-0029-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sasaki H, Ishii K, Kono AK, Miyamoto N, Fukuda T, Shimada K, Ohkawa S, Kawaguchi T, Mori E. Cerebral perfusion pattern of idiopathic normal pressure hydrocephalus studied by SPECT and statistical brain mapping. Ann Nucl Med 2007; 21:39-45. [PMID: 17373335 DOI: 10.1007/bf03033998] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the specific pattern of cerebral blood flow (CBF) in subjects with idiopathic normal pressure hydrocephalus (iNPH) using voxel-based analysis. METHODS N-isopropyl-p-[123I]iodoamphetamine (IMP) single photon emission computed tomography (SPECT) images were performed in 30 iNPH patients, who met probable iNPH criteria, 30 Alzheimer disease (AD) patients and 15 normal control (NC) subjects. Inter-group comparisons between iNPH patients and NC subjects and between AD patients and NC subjects were performed using three-dimensional stereotactic surface projection (3D-SSP) analysis. Individual 3D-SSP images of the iNPH patients were assessed by visual inspection. RESULTS On the Z-score maps, areas of relative hypoperfusion were recognized around the corpus callosum in all 30 iNPH patients, as well as in the Sylvian fissure regions in 19 of 30 iNPH patients which included artifacts by dilated ventricles and the Sylvian fissures. Ten frontal dominant, eight parietotemporal dominant, and 12 diffuse hypoperfusion types were demonstrated. Inter-group comparison between iNPH and NC subjects showed relative hypoperfusion in the frontal and parietotemporal areas and severe hypoperfusion around the corpus callosum and Sylvian fissure regions, while parietotemporal and posterior cingulate CBF reduction was demonstrated between the AD and NC groups. CONCLUSION Voxel-based analysis showed a characteristic pattern of regional CBF reduction with frontal dominant or diffuse cerebral hypoperfusion accompanying severe hypoperfusion around the corpus callosum and Sylvian fissures with artifacts.
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Affiliation(s)
- Hiroki Sasaki
- Department of Radiology and Nuclear Medicine, Hyogo Brain and Heart Center, 520 Saisho-Ko, Himeji, Hyogo 670-0981, Japan
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Seseke S, Baudewig J, Kallenberg K, Ringert RH, Seseke F, Dechent P. Voluntary pelvic floor muscle control—an fMRI study. Neuroimage 2006; 31:1399-407. [PMID: 16574434 DOI: 10.1016/j.neuroimage.2006.02.012] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Revised: 02/03/2006] [Accepted: 02/07/2006] [Indexed: 11/15/2022] Open
Abstract
Storage and periodic expulsion of urine by the bladder are controlled by central pathways and organized as simple on-off switching circuits. Several reports concerning aspects of micturition control have identified distinct regions in the brainstem, like the pontine micturition center (PMC) and the periaqueductal gray (PAG), as well as the cerebellum, basal ganglia, limbic system, and cortical areas that are organized in a widespread network. The present study focused on the involvement of these specific brain regions in pelvic floor muscle control. Functional magnetic resonance imaging (fMRI) was performed at 3T in 11 healthy women with urge to void due to a filled bladder, who were instructed to either imitate voiding by releasing or to imitate interruption of voiding by contracting pelvic floor muscles. None of the subjects was able to start voiding during the experiments, presumably due to subconscious restraint resulting from the inconvenient situation. Relaxation and contraction of pelvic floor muscles induced strong and similar activation patterns including frontal cortex, sensory-motor cortex, cerebellum, and basal ganglia. Furthermore, well-localized activations in the PMC and the PAG were identified. To our knowledge, this is the first study using fMRI to demonstrate micturition-related activity in these brainstem structures. The presented approach proved to characterize the widespread central network in pelvic floor muscle control. Thus, in patients with voiding dysfunction, fMRI will be useful to elucidate the individual disturbance level.
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Affiliation(s)
- S Seseke
- Department of Urology, Georg-August-University, Robert-Koch-Strasse 40, 37075 Göttingen, Germany.
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Kavia RBC, Dasgupta R, Fowler CJ. Functional imaging and the central control of the bladder. J Comp Neurol 2006; 493:27-32. [PMID: 16255006 DOI: 10.1002/cne.20753] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The central control of the bladder is a complex, multilevel process. Recent advances in functional brain imaging have allowed research into this control in humans. This article reviews the functional imaging studies published to date and discusses the regions of the brain that have been implicated in the central control of continence. Brain regions that have been implicated include the pons (pontine micturition center, PMC), periaqueductal gray (PAG), thalamus, insula, anterior cingulate gyrus, and prefrontal cortices. The PMC and the PAG are thought to be key in the supraspinal control of continence and micturition. Higher centers such as the insula, anterior cingulate gyrus, and prefrontal regions are probably involved in the modulation of this control and cognition of bladder sensations, and in the case of the insula and anterior cingulate, modulation of autonomic function. Further work should aim to examine how the regions interact to achieve urinary continence.
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Affiliation(s)
- Rajesh Bharat Chhaganlal Kavia
- Department of Uro-Neurology, Institute of Neurology & National Hospital for Neurology and Neurosurgery, London WC1N 3BG, United Kingdom
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Kuhtz-Buschbeck JP, van der Horst C, Pott C, Wolff S, Nabavi A, Jansen O, Jünemann KP. CORTICAL REPRESENTATION OF THE URGE TO VOID: A FUNCTIONAL MAGNETIC RESONANCE IMAGING STUDY. J Urol 2005; 174:1477-81. [PMID: 16145475 DOI: 10.1097/01.ju.0000173007.84102.7c] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE The urge to void generally increases with bladder distention but the relationship between the 2 factors is complex. When the bladder is moderately filled, the desire to void can be called forth deliberately but it can also be suppressed. To elucidate human brain mechanisms that are active during such intentional modulations of the desire to void we performed functional magnetic resonance imaging in healthy volunteers. MATERIALS AND METHODS Brain activity was studied in 22 young women. At moderate bladder filling (about 350 ml) they periodically suppressed or enhanced the urge to void without allowing urine to pass. A manual task with a dynamometer, in which the current urge to void was expressed as grip force, demonstrated that the intensity of sensations could be influenced voluntarily. We also examined brain activity during repetitive (1 Hz) contractions of pelvic floor muscles after the bladder was emptied. RESULTS Significant brain activity associated with an increased urge to void was found in the insular cortex, frontal opercula, supplementary motor area (SMA), cingulate motor area (CMA), right posterior parietal cortex, left prefrontal cortex and cerebellum. Trends toward activation were detected in the thalamus, peri-aquaeductal gray matter and ventral pons. Suppression of the urge to void significantly activated the left superior frontal lobe. The SMA and CMA were active during voluntary rhythmical contractions of pelvic floor muscles. CONCLUSIONS Sensation intensity of the desire to void can be influenced intentionally. Frontoparietal cortical areas and the SMA/CMA seem to be involved in this process.
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Affiliation(s)
- Johann P Kuhtz-Buschbeck
- Institute of Physiology, Medical Faculty of Christian-Albrechts-Universität zu Kiel, Kiel, Germany.
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Amundsen CL, Romero AA, Jamison MG, Webster GD. Sacral neuromodulation for intractable urge incontinence: Are there factors associated with cure? Urology 2005; 66:746-50. [PMID: 16230129 DOI: 10.1016/j.urology.2005.04.031] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Revised: 03/24/2005] [Accepted: 04/19/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To determine the variables that affect the cure rate in patients with urge incontinence treated with sacral neuromodulation. METHODS This prospective analysis of patients with refractory urinary urge incontinence who underwent placement of a neuromodulator lead and generator was undertaken between October 2000 and December 2003. Quantitative assessment of the severity of their urinary leakage was assessed by preoperative and postoperative 3-day bladder diaries documenting leakage episodes, number of pads used per day, and a 24-hour pad weight assessment. Cure was defined as no daily leakage episodes after permanent implantation. Subjective outcome was assessed using the Incontinence Impact Questionnaire. Two-sample independent t tests, two-way chi-square tests, and tests of two proportions were performed when appropriate, with P < 0.05 considered significant. RESULTS The mean postimplantation follow-up was 29 months, and the average age was 60 years (range 29 to 83). The cure rate was associated with age, with individuals younger than 55 years having a statistically significant greater cure rate (65% versus 37% for older individuals; P < 0.05). Having three or more chronic conditions was associated with a lower cure rate in both younger and older individuals. Patients with a neurologic condition also had a lower cure rate, but no specific neurologic condition was associated. CONCLUSIONS Age older than 55 years and more than three chronic conditions were independent factors associated with a lower cure rate in patients implanted with a sacral neuromodulator for refractory urge incontinence. A neurologic condition may be associated with a decrease in the cure rate.
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Affiliation(s)
- Cindy L Amundsen
- Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Loddenkemper T, Kotagal P. Lateralizing signs during seizures in focal epilepsy. Epilepsy Behav 2005; 7:1-17. [PMID: 15975856 DOI: 10.1016/j.yebeh.2005.04.004] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Accepted: 04/14/2005] [Indexed: 11/27/2022]
Abstract
This article reviews lateralizing semiological signs during epileptic seizures with respect to prediction of the side of the epileptogenic zone and, therefore, presurgical diagnostic value. The lateralizing significance of semiological signs and symptoms can frequently be concluded from knowledge of the cortical representation. Visual, auditory, painful, and autonomic auras, as well as ictal motor manifestations, e.g., version, clonic and tonic activity, unilateral epileptic spasms, dystonic posturing and unilateral automatisms, automatisms with preserved responsiveness, ictal spitting and vomiting, emotional facial asymmetry, unilateral eye blinking, ictal nystagmus, and akinesia, have been shown to have lateralizing value. Furthermore, ictal language manifestations and postictal features, such as Todd's palsy, postictal aphasia, postictal nosewiping, postictal memory dysfunction, as well as peri-ictal water drinking, peri-ictal headache, and ipsilateral tongue biting, are reviewed. Knowledge and recognition of semiological lateralizing signs during seizures is an important component of the presurgical evaluation of epilepsy surgery candidates and adds further information to video/EEG monitoring, neuroimaging, functional mapping, and neuropsychological evaluation.
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Affiliation(s)
- Tobias Loddenkemper
- Department of Neurology, The Cleveland Clinic Foundation, Cleveland, OH, USA
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Overactive Bladder. J Wound Ostomy Continence Nurs 2005. [DOI: 10.1097/00152192-200505001-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Duffau H, Capelle L. Incontinence after brain glioma surgery: new insights into the cortical control of micturition and continence. J Neurosurg 2005; 102:148-51. [PMID: 15658106 DOI: 10.3171/jns.2005.102.1.0148] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ Cortical control of micturition and continence remains poorly understood. The authors report two cases of patients who presented with prolonged urinary disturbances after resection of a brain glioma. Accurate anatomofunctional correlations determined using postoperative magnetic resonance imaging support the following: 1) the implication of the posterior portion of the right anterior cingulate gyrus in the perception of bladder sensation and maintenance of continence; 2) the involvement of the right anterior insula in bladder relaxation; and 3) the role of the right inferior frontal cortex in the decision concerning whether to initiate a micturition. On the basis of these results, a preliminary model of a cortical network associated with micturition and continence is proposed.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Hôpital Salpêtrière, Paris, France.
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Kershen RT, Kalisvaart J, Appell RA. Functional brain imaging and the bladder: New insights into cerebral control over micturition. Curr Urol Rep 2003; 4:344-9. [PMID: 14499055 DOI: 10.1007/s11934-003-0004-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Mechanisms for cerebral control over the micturition process remain poorly elucidated. The knowledge is based largely on human pathophysiology and data derived from electrophysiologic testing in animals. Recent advances in dynamic functional brain imaging technologies including positron-emission tomography, single photon emission computed tomography, and functional magnetic resonance imaging have allowed new insights into how the human brain regulates this process. This article discusses animal studies, which provided the foundation for our understanding of cerebral control over micturition, and recent human studies, implementing functional brain imaging to enhance our knowledge of this complex phenomenon.
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Affiliation(s)
- Richard T Kershen
- Department of Surgery, University of Vermont College of Medicine, 1775 Williston Road, South Burlington, VT 05403, USA.
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Loddenkemper T, Foldvary N, Raja S, Neme S, Lüders HO. Ictal urinary urge: further evidence for lateralization to the nondominant hemisphere. Epilepsia 2003; 44:124-6. [PMID: 12581239 DOI: 10.1046/j.1528-1157.2003.26202.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the lateralizing value of ictal urinary urgency. METHODS A retrospective database search was performed for patients with ictal urinary urgency admitted to the Epilepsy Monitoring Unit at the Cleveland Clinic between 1994 and 2001. RESULTS Six patients were identified; intracarotid amytal test demonstrated left hemispheric speech dominance in five cases. The sixth patient continued to speak during right temporal seizures. EEG and imaging data supported right temporal or frontotemporal epilepsy in all six cases. Two patients were seizure free after focal right hemispheric resection. CONCLUSIONS Ictal urinary urge appears to be a lateralizing sign for nondominant temporal lobe epilepsy.
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Affiliation(s)
- Tobias Loddenkemper
- Section of Epilepsy and Sleep Disorders, Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Matsuura S, Kakizaki H, Mitsui T, Shiga T, Tamaki N, Koyanagi T. Human brain region response to distention or cold stimulation of the bladder: a positron emission tomography study. J Urol 2002; 168:2035-9. [PMID: 12394703 DOI: 10.1016/s0022-5347(05)64290-5] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Several kinds of perceptions, including distention and coldness, arise from the bladder. Information on bladder fullness conveyed by mechanoreceptors within the bladder wall contributes to the basic micturition reflex via the bulbospinal reflex pathway, whereas cold stimulation of the bladder is processed differently. To elucidate the human brain mechanisms of voluntary urine storage and bladder cold perception we performed positron emission tomography scanning to examine brain regions activated by bladder distention or cold stimulation. MATERIALS AND METHODS A total of 17 right-handed healthy male volunteers were catheterized via the urethra for bladder infusion. Subjects were divided into 2 groups for 2 types of positron emission tomography, namely the bladder distention group-11 who were 24 to 41 years old and the intravesical ice water group-6 who were 24 to 38 years old. Data were analyzed by the statistical parametric mapping procedure. RESULTS Significant brain activation during maximum urine storage (bladder distention) were found in the pons, midbrain periaqueductal gray, anterior insula, putamen, thalamus and anterior cingulate gyrus. On the other hand, intravesical ice water instillation significantly activated several regions in frontal and parietal lobes, amygdala-hippocampus area and crus cerebri ventral border. Distribution of the activated regions after intravesical instillation of ice water overlapped none of those observed after bladder distention. CONCLUSIONS Our data show that the brainstem as well as more rostral regions are involved in voluntary urine storage and these regions are functionally separated from those associated with bladder cold perception in healthy individuals.
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Affiliation(s)
- Shinobu Matsuura
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Human Brain Region Response to Distention or Cold Stimulation of the Bladder: A Positron Emission Tomography Study. J Urol 2002. [DOI: 10.1097/00005392-200211000-00033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Coppola L, Caserta F, Grassia A, Mastrolorenzo L, Altrui L, Tondi G, Verde S, Coppola A. Urinary incontinence in the elderly: relation to cognitive and motor function. Arch Gerontol Geriatr 2002; 35:27-34. [PMID: 14764341 DOI: 10.1016/s0167-4943(01)00213-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2001] [Revised: 10/30/2001] [Accepted: 11/06/2001] [Indexed: 11/27/2022]
Abstract
Urinary incontinence is a common problem in older subjects, very often wrongfully accepted as a normal part of the aging process. A total of 520 subjects (208 males and 312 females; mean age 74.8 +/- 11.8 years), from both private- and nursing-home dwelling populations, were included in this study aimed to estimate the incidence of urinary incontinence and identify factors associated with condition, in aged subjects. The incidence and type of urinary incontinence (stress, urge or mixed incontinence) were assessed by structured questionnaires and diagnosis was confirmed by a seven-day consecutive voiding diary. Assessment of physical, cognitive and emotional functions was performed on each subject using the Mini Mental State Examination (MMSE), Instrumental Activities of Daily Living Scale (IADL), Tinetti Scale (gait), Tinetti Scale (balance) and Geriatric Depression Scale (GDS) instruments. In the total population sample the incidence of urinary incontinence was 47.9%. The incontinence cases were classified, according to the different types, as: stress incontinence (males: 3.4%; females: 8.7%; males+females: 6.5%); urge incontinence (males: 27.4%; females: 31.4%; males+females: 29.8%); mixed incontinence (males: 20.2%; females: 5.8%; males+females: 11.5%). In the total population sample, no significant relationship was found between age and prevalence of urinary incontinence. In the elderly female group, age significantly correlated in a direct manner with urge incontinence (P<0.01) and inversely with stress incontinence (P<0.001). Only in the male sex group age significantly correlated with mixed incontinence (P<0.005). Multiple linear regression analysis showed that the dependent variable 'incontinence' could be predicted by MMSE (P<0.001) in the male sex group and by the Tinetti Scale (gait) (P<0.001) in the female sex group.
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Affiliation(s)
- Ludovico Coppola
- Department of Geriatric Medicine and Metabolic Diseases, II University of Naples, Policlinico Universitario, Piazza Miraglia 2, 80138 Naples, Italy.
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Specht JKP, Lyons SS, Maas ML. Patterns and treatments of Urinary incontinence on special care units. J Gerontol Nurs 2002; 28:13-21. [PMID: 12035821 DOI: 10.3928/0098-9134-20020501-06] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ahlberg J, Edlund C, Wikkelsö C, Rosengren L, Fall M. Neurological signs are common in patients with urodynamically verified "idiopathic" bladder overactivity. Neurourol Urodyn 2002; 21:65-70. [PMID: 11835426 DOI: 10.1002/nau.2094] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Overactive bladder dysfunction is an expression of defective neuromuscular control of the lower urinary tract. The causes and the way to classify this problem are currently under debate. In some patients the overactive bladder is one sign of a neurological disorder, in so called "idiopathic detrusor instability" the cause is less obvious. That an overactive bladder has a neurogenic cause is a reasonable hypothesis. We made a detailed neurological investigation in 45 patients with idiopathic overactive bladder. Cerebrospinal fluid (CSF) was examined and blood tests for vitamin B(12)and folic acid deficiency were checked, too. In 37 of the 45 patients (82%) pathological signs were observed in the neurological tests. The most common finding was central or peripheral paresis of the legs appearing in 24 patients (53%). Of the 45 patients, eight received a neurological diagnosis, definite or possible MS or dorsal column sensation neuropathy. The results of this study give an indication of the importance of the neurological examination and suggest that neuropathy might not be uncommon in patients with so-called idiopathic detrusor instability. This also invites to reconsideration of the current classification. It is possible that a new classification based on a functional view could provide a better fundament in the search of etiologic and pathogenetic factors and also guide in the selection of the treatment most optimal for the individual patient.
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Affiliation(s)
- Jarl Ahlberg
- Institute of Clinical Neurosciences, Department of Neurology, Göteborg University, Sweden
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Holstege G. The emotional motor system in relation to the supraspinal control of micturition and mating behavior. Behav Brain Res 1998; 92:103-9. [PMID: 9638952 DOI: 10.1016/s0166-4328(97)00182-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- G Holstege
- Department of Anatomy and Embryology, University of Groningen, The Netherlands
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