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Zouki JJ, Eapen V, Efron D, Maxwell A, Corp DT, Silk TJ. Functional brain networks associated with the urge for action: Implications for pathological urge. Neurosci Biobehav Rev 2024; 163:105779. [PMID: 38936563 DOI: 10.1016/j.neubiorev.2024.105779] [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: 10/28/2023] [Revised: 05/26/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024]
Abstract
Tics in Tourette syndrome (TS) are often preceded by sensory urges that drive the motor and vocal symptoms. Many everyday physiological behaviors are associated with sensory phenomena experienced as an urge for action, which may provide insight into the neural correlates of this pathological urge to tic that remains elusive. This study aimed to identify a brain network common to distinct physiological behaviors in healthy individuals, and in turn, examine whether this network converges with a network we previously localized in TS, using novel 'coordinate network mapping' methods. Systematic searches were conducted to identify functional neuroimaging studies reporting correlates of the urge to micturate, swallow, blink, or cough. Using activation likelihood estimation meta-analysis, we identified an 'urge network' common to these physiological behaviors, involving the bilateral insula/claustrum/inferior frontal gyrus/supplementary motor area, mid-/anterior- cingulate cortex (ACC), right postcentral gyrus, and left thalamus/precentral gyrus. Similarity between the urge and TS networks was identified in the bilateral insula, ACC, and left thalamus/claustrum. The potential role of the insula/ACC as nodes in the network for bodily representations of the urge to tic are discussed.
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Affiliation(s)
- Jade-Jocelyne Zouki
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC 3220, Australia.
| | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, UNSW School of Clinical Medicine, University of New South Wales, Kensington, NSW 2052, Australia
| | - Daryl Efron
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3010, Australia; Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - Amanda Maxwell
- Discipline of Psychiatry and Mental Health, UNSW School of Clinical Medicine, University of New South Wales, Kensington, NSW 2052, Australia
| | - Daniel T Corp
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC 3220, Australia; Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, Turku, FI-20014, Finland
| | - Timothy J Silk
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC 3220, Australia; Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
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Li J, Zhang Y, Chen J, Du X, Di Y, Liu Q, Wang C, Zhang Q. Abnormal microstructure of corpus callosum in children with primary nocturnal enuresis: a DTI study. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02416-8. [PMID: 38514474 DOI: 10.1007/s00787-024-02416-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
Primary nocturnal enuresis (PNE) is a common childhood disorder with abnormal sleep or arousal. The corpus callosum (CC) continues to develop into adulthood and plays an important role in sleep arousal. This study aimed to evaluate the microstructure of the CC in children with PNE. Diffusion tensor imaging (DTI) indices were extracted throughout the CC and its seven subregions were compared between the children with PNE and healthy children (HC). The correlation between abnormal DTI indices of the CC and cognitive condition was also tested. Compared to HC, decreased fiber number (NF) (F = 8.492, PFDR = 0.032) and fractional anisotropy (FA) value (F = 8.442, PFDR = 0.040) were found in the posterior midbody of the CC, increased RD was found in the posterior midbody (F = 6.888, PFDR = 0.040) and isthmus (F = 7.967, PFDR = 0.040) in children with PNE. The reduction of FA value was more obvious in boys than girls with PNE. In children with PNE, there was a significant positive correlation between the NF of the posterior midbody and full IQ (r = 0.322, P = 0.025) and between the FA value and the general knowledge memory (r = 0.293, P = 0.043). This study provides imaging evidence for abnormalities in the microstructure of the CC in children with PNE, especially in male PNE, which might affect the children's cognitive performance.
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Affiliation(s)
- Jinqiu Li
- Department of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yang Zhang
- Department of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Jing Chen
- Department of Radiology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, 300134, China
| | - Xin Du
- Department of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yaqin Di
- Department of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Qiaohui Liu
- Department of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Chunxiang Wang
- Department of Radiology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, 300134, China.
| | - Quan Zhang
- Department of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China.
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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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Voorham J, Vaganée D, Voorham-van der Zalm P, Lycklama À Nijeholt G, Putter H, De Wachter S. Sacral Neuromodulation Changes Pelvic Floor Activity in Overactive Bladder Patients-Possible New Insights in Mechanism of Action: A Pilot Study. Neuromodulation 2021; 25:1180-1186. [PMID: 34547159 DOI: 10.1111/ner.13536] [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: 04/15/2021] [Revised: 07/27/2021] [Accepted: 08/17/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate if electrodiagnostic tools can advance the understanding in the effect of sacral neuromodulation (SNM) on pelvic floor activity, more specifically if SNM induces changes in pelvic floor muscle (PFM) contraction. MATERIALS AND METHODS Single tertiary center, prospective study (October 2017-May 2018) including patients with overactive bladder syndrome undergoing SNM. Electromyography of the PFM was recorded using the Multiple Array Probe Leiden. The procedure consisted of consecutive stimulations of the lead electrodes with increasing intensity (1-3, 5, 7, 10 V). Recordings were made after electrode placement (T0) and three weeks of SNM (T1). Patients with >50% improvement were defined as responders, others as nonresponders. For the analyses, the highest electrical PFM response (EPFMR), defined as the peak-to-peak amplitude of the muscle response, was identified for each intensity. The sensitivity (intensity where the first EPFMR was registered and the normalized EPFMR as percentage of maximum EPFMR) and the evolution (EMFPR changes over time) were analyzed using linear mixed models. RESULTS Fourteen patients were analyzed (nine responders, five nonresponders). For nonresponders, the PFM was significantly less sensitive to stimulation after three weeks (T0: 1.7 V, T1: 2.6 V). The normalized EPFMR was (significantly) lower after three weeks for the ipsilateral side of the PFM for the clinically relevant voltages (1 V: 36%-23%; p = 0.024, 2 V: 56%-29%; p = 0.00001; 3 V: 63%-37%; p = 0.0002). For the nonresponders, the mean EPFMR was significantly lower at 8/12 locations at T1 (T0: 109 μV, T1: 58 μV; mean p = 0.013, range <0.0001-0.0867). For responders, the sensitivity and evolution did not change significantly. CONCLUSIONS This is the first study to describe in detail the neurophysiological characteristics of the PFM, and the changes over time upon sacral spinal root stimulation, in responders and nonresponders to SNM. More research is needed to investigate the full potential of EPFMR as a response indicator.
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Affiliation(s)
- Jeroen Voorham
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Donald Vaganée
- Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Urology, Antwerp University Hospital, Edegem, Belgium
| | | | | | - Hein Putter
- Department of Biomedical Data sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Stefan De Wachter
- Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Urology, Antwerp University Hospital, Edegem, Belgium
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Quaghebeur J, Petros P, Wyndaele JJ, De Wachter S. The innervation of the bladder, the pelvic floor, and emotion: A review. Auton Neurosci 2021; 235:102868. [PMID: 34391125 DOI: 10.1016/j.autneu.2021.102868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/26/2021] [Accepted: 08/05/2021] [Indexed: 12/30/2022]
Abstract
The innervation of the pelvic region is complex and includes extensive neurologic pathways. The higher centres' organisation determining the pelvic floor and organs' function remains a challenge understanding the physiological and pain mechanisms. Psychological and emotional factors have a profound influence on the pelvic floor and organ dysfunction such as LUTS. LUTS are associated with stress, depression, and anxiety. Neuroception is a subconscious neuronal system for detecting threats and safety and might explain the permanent disturbance of higher brain centres maintaining functional urological and gastrointestinal disorders and sphincter dysfunction.
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Affiliation(s)
- Jörgen Quaghebeur
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium.
| | - Peter Petros
- Faculty of Medicine, University of New South Wales, Kensington, Sydney, Australia
| | | | - Stefan De Wachter
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
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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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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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Clarkson BD, Karim HT, Griffiths DJ, Resnick NM. Testing a new, intensified infusion-withdrawal protocol for urinary urgency provocation in brain-bladder studies. Neurourol Urodyn 2020; 40:131-136. [PMID: 33118637 DOI: 10.1002/nau.24559] [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: 08/12/2020] [Revised: 10/02/2020] [Accepted: 10/15/2020] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The brain's role in bladder control has become an important area of study in the last 15 years. Typically, the brain's role in urinary urgency has been studied by repeated infusion and withdrawal of fluid, per catheter, to provoke urgency sensation during a whole brain magnetic resonance imaging (MRI) scan. Since this technique generally requires a large group size, we tested a more intense infusion-withdrawal protocol in an attempt to improve signal to noise ratio and repeatability of the signal which would, in turn, allow us to further probe subtypes of urgency urinary incontinence. METHODS A total of 12 women over the age of 60 were recruited to test a new "intense" infusion withdrawal protocol. They underwent this new protocol during a functional brain MRI scan. The primary outcome was comparison of activity within the insula, medial pre-frontal cortex and dorsal anterior cingulate cortex/supplementary motor area (dACC/SMA). Immediate test-retest repeatability was measured using intraclass correlation. Secondary exploratory evaluation of differences in the whole brain between protocols was conducted. RESULTS There was no significant difference in signal in any of the a priori regions of interest between protocols. Test-retest repeatability in the new protocol was poor compared to the original protocol, and variability was higher. Three participants were not able to tolerate the "intense" protocol. CONCLUSION The small improvement in signal to noise ratio of the new protocol was not sufficient to overcome the poorly tolerated intense filling protocol.
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Affiliation(s)
- Becky D Clarkson
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Derek J Griffiths
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Neil M Resnick
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Holschneider DP, Wang Z, Chang H, Zhang R, Gao Y, Guo Y, Mao J, Rodriguez LV. Ceftriaxone inhibits stress-induced bladder hyperalgesia and alters cerebral micturition and nociceptive circuits in the rat: A multidisciplinary approach to the study of urologic chronic pelvic pain syndrome research network study. Neurourol Urodyn 2020; 39:1628-1643. [PMID: 32578247 DOI: 10.1002/nau.24424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/11/2020] [Accepted: 05/30/2020] [Indexed: 12/19/2022]
Abstract
AIMS Emotional stress plays a role in the exacerbation and development of interstitial cystitis/bladder pain syndrome (IC/BPS). Given the significant overlap of brain circuits involved in stress, anxiety, and micturition, and the documented role of glutamate in their regulation, we examined the effects of an increase in glutamate transport on central amplification of stress-induced bladder hyperalgesia, a core feature of IC/BPS. METHODS Wistar-Kyoto rats were exposed to water avoidance stress (WAS, 1 hour/day x 10 days) or sham stress, with subgroups receiving daily administration of ceftriaxone (CTX), an activator of glutamate transport. Thereafter, cystometrograms were obtained during bladder infusion with visceromotor responses (VMR) recorded simultaneously. Cerebral blood flow (CBF) mapping was performed by intravenous injection of [14 C]-iodoantipyrine during passive bladder distension. Regional CBF was quantified in autoradiographs of brain slices and analyzed in three dimensional reconstructed brains with statistical parametric mapping. RESULTS WAS elicited visceral hypersensitivity during bladder filling as demonstrated by a decreased pressure threshold and VMR threshold triggering the voiding phase. Brain maps revealed stress effects in regions noted to be responsive to bladder filling. CTX diminished visceral hypersensitivity and attenuated many stress-related cerebral activations within the supraspinal micturition circuit and in overlapping limbic and nociceptive regions, including the posterior midline cortex (posterior cingulate/anterior retrosplenium), somatosensory cortex, and anterior thalamus. CONCLUSIONS CTX diminished bladder hyspersensitivity and attenuated regions of the brain that contribute to nociceptive and micturition circuits, show stress effects, and have been reported to demonstrated altered functionality in patients with IC/BPS. Glutamatergic pharmacologic strategies modulating stress-related bladder dysfunction may be a novel approach to the treatment of IC/BPS.
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Affiliation(s)
| | - Zhuo Wang
- Departments of Psychiatry and Behavioral Sciences, Los Angeles, California
| | - Huiyi Chang
- Department of Urology, University of Southern California, Los Angeles, California.,Reeve-Irvine Research Center, University of California, Irvine, California
| | - Rong Zhang
- Department of Urology, University of Southern California, Los Angeles, California
| | - Yunliang Gao
- Department of Urology, University of Southern California, Los Angeles, California.,Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yumei Guo
- Departments of Psychiatry and Behavioral Sciences, Los Angeles, California
| | - Jackie Mao
- Department of Urology, University of Southern California, Los Angeles, California
| | - Larissa V Rodriguez
- Department of Urology, University of Southern California, Los Angeles, California
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10
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Halani PK, Andy UU, Rao H, Arya LA. Regions of the brain activated in bladder filling vs rectal distention in healthy adults: A meta-analysis of neuroimaging studies. Neurourol Urodyn 2019; 39:58-65. [PMID: 31816125 DOI: 10.1002/nau.24221] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/20/2019] [Indexed: 01/23/2023]
Abstract
AIMS Adults with pelvic floor disorders commonly present with overlapping bladder and bowel symptoms; however, the relationship between urinary and defecatory dysfunction is not well understood. Our aim was to compare and determine if overlapping brain regions are activated during bladder filling and rectal distention in healthy adults. METHODS We conducted separate Pubmed searches for neuroimaging studies investigating the effects of rectal distention and bladder filling on brain activation in healthy subjects. Coordinates of activated regions were extracted with cluster-level threshold P < .05 and compared using the activation likelihood estimate approach. Results from the various studies were pooled and a contrast analysis was performed to identify any common areas of activation between bladder filling and rectal distension. RESULTS We identified 96 foci of activation from 14 neuroimaging studies on bladder filling and 182 foci from 17 studies on rectal distension in healthy adults. Regions activated during bladder filling included right insula, right and left thalamus, and right periaqueductal grey. Regions activated during rectal distention included right and left insula, right and left thalamus, left postcentral gyrus, and right inferior parietal lobule. Contrast analysis revealed common activation of the right insula with both rectal distention and bladder filling. CONCLUSION Bladder filling and rectal distention activate several separate areas of the brain involved in sensory processing in healthy adults. The common activation of the insula, the region responsible for interoception, in these two conditions may offer an explanation for the coexistence of bladder and defecatory symptoms in pelvic floor disorders.
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Affiliation(s)
- Priyanka Kadam Halani
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Uduak U Andy
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hengyi Rao
- Center for Functional Neuroimaging, Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lily A Arya
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
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11
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Groenendijk IM, Luijten SPR, de Zeeuw CI, Holstege JC, Scheepe JR, van der Zwaag W, Blok BFM. Whole brain 7T-fMRI during pelvic floor muscle contraction in male subjects. Neurourol Urodyn 2019; 39:382-392. [PMID: 31724214 PMCID: PMC7004158 DOI: 10.1002/nau.24218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/25/2019] [Indexed: 12/18/2022]
Abstract
Aim The primary aim of this study is to demonstrate that 7‐tesla functional magnetic resonance imaging (7T‐fMRI) can visualize the neural representations of the male pelvic floor in the whole brain of a single subject. Methods In total, 17 healthy male volunteers (age 20‐47) were scanned in a 7T‐MRI scanner (Philips Achieva). The scanning protocol consisted of two functional runs using a multiband echo planar imaging sequence and a T1‐weighted scan. The subjects executed two motor tasks, one involving consecutive pelvic floor muscle contractions (PFMC) and a control task with tongue movements. Results In single subjects, results of both tasks were visualized in the cortex, putamen, thalamus, and the cerebellum. Activation was seen during PFMC in the superomedial and inferolateral primary motor cortex (M1), supplementary motor area (SMA), insula, midcingulate gyrus (MCG), putamen, thalamus, and in the anterior and posterior lobes of the cerebellum. During tongue movement, activation was seen in the inferolateral M1, SMA, MCG, putamen, thalamus, and anterior and posterior lobes of the cerebellum. Tongue activation was found in the proximity of, but not overlapping with, the PFMC activation. Connectivity analysis demonstrated differences in neural networks involved in PFMC and tongue movement. Conclusion This study demonstrated that 7T‐fMRI can be used to visualize brain areas involved in pelvic floor control in the whole brain of single subjects and defined the specific brain areas involved in PFMC. Distinct differences between brain mechanisms controlling the pelvic floor and tongue movements were demonstrated using connectivity analysis.
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Affiliation(s)
- Ilse M Groenendijk
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sven P R Luijten
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Chris I de Zeeuw
- Department of Neuroscience, Erasmus Medical Center, Rotterdam, The Netherlands.,Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Joan C Holstege
- Department of Neuroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jeroen R Scheepe
- 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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Roy HA, Green AL. The Central Autonomic Network and Regulation of Bladder Function. Front Neurosci 2019; 13:535. [PMID: 31263396 PMCID: PMC6585191 DOI: 10.3389/fnins.2019.00535] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/08/2019] [Indexed: 12/30/2022] Open
Abstract
The autonomic nervous system (ANS) is involved in the regulation of physiologic and homeostatic parameters relating particularly to the visceral organs and the co-ordination of physiological responses to threat. Blood pressure and heart rate, respiration, pupillomotor reactivity, sexual function, gastrointestinal secretions and motility, and urine storage and micturition are all under a degree of ANS control. Furthermore, there is close integration between the ANS and other neural functions such as emotion and cognition, and thus brain regions that are known to be important for autonomic control are also implicated in emotional functions. In this review we explore the role of the central ANS in the control of the bladder, and the implications of this for bladder dysfunction in diseases of the ANS.
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Affiliation(s)
- Holly Ann Roy
- Department of Neurosurgery, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | - Alexander L Green
- Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
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13
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Pérez DC, Chao CW, Jiménez LL, Fernández IM, de la Llave Rincón AI. Pelvic floor muscle training adapted for urinary incontinence in multiple sclerosis: a randomized clinical trial. Int Urogynecol J 2019; 31:267-275. [DOI: 10.1007/s00192-019-03993-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/20/2019] [Indexed: 12/22/2022]
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14
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[Interest of transcranial stimulation in pelvic and perineal disorders]. Prog Urol 2019; 29:349-359. [PMID: 31036483 DOI: 10.1016/j.purol.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/26/2019] [Accepted: 03/08/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this article was to describe the diagnostic and therapeutic value of transcranial stimulation in pelvic and perineal disorders. METHODS A literature review (Medline database and Google scholar) with no time limit was performed using keywords: "transcranial direct stimulation", "transcranial magnetic stimulation", "neurogenic bladder", "urinary incontinence", "Parkinson disease", "multiple sclerosis", "stroke", "muscle spasticity", "pelvic pain", "visceral pain". RESULTS Twelve articles have been selected. Transcranial magnetic or electrical stimulation is a noninvasive neuromodulation technique widely used to establish brain maps to highlight causal relationships between brain and function. Regarding pelvic-perineal disorders, repeated transcranial stimulation has shown significant effects for the treatment of overactive bladder in Parkinson's disease (P<0.05) and multiple sclerosis, but also for the treatment of refractory chronic pelvic pain (P=0.026). Finally, therapeutic effects have also been demonstrated in irritable bowel syndrome. No evidence of efficacy was found on genito-sexual disorders. CONCLUSION Data from the literature suggest that transcranial stimulation is a noninvasive treatment that may have a role in the management of pelvic and perineal disorders. Its promising field of action would require prospective and randomized studies on a larger scale.
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15
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[Evidence of sensory bladder inhibitor reflex]. Prog Urol 2018; 28:502-508. [PMID: 29903631 DOI: 10.1016/j.purol.2018.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 03/28/2018] [Accepted: 05/15/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Need to void level depends on two parameters, bladder volume and attentional process. If it is well known that the maximum voluntary contraction of the perineal muscles may transiently inhibit the micturition reflex itself, no work demonstrates the effect of this contraction on the intensity of the need itself. METHODS An experimental, prospective, open, monocentric study was conducted between March and April 2017. In total, 15 subjects with no neurological history or neuro-perineal disorders consulting for functional constipation were included. Need to void level was evaluated by means of an electronic urgentometer. A control contraction of the dominant hand muscles was compared to a voluntary contraction of the external anal sphincter during a strong desire to void (B3). These contractions were recorded by means of surface electromyography. The main evaluation criterion was the comparison between the difference in visual analogic scale of the desire to void before (VAS-base) and after control voluntary contraction (VAS-hand) versus the same index (BAS-base then VAS-anal) after contraction of the external anal sphincter during a new B3. The comparison of maximum bladder capacities (MBC) measured after each record was the secondary endpoint. Wilcoxon signed rank test was used for statistical analysis. RESULTS Voiding desire VAS decreased significantly (-13.14±12 vs -1.5±6; P=0.03) and MBC increased significantly (502.43±96.71mL vs 435.78±125.54mL; P=0.02) after anal compared to control contraction. CONCLUSION This study suggests the existence of sensitive pathways inhibition by perineal contraction through a sensitive perineo-vesical inhibitory reflex. LEVEL OF EVIDENCE 3.
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16
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Gupta A, Woodworth DC, Ellingson BM, Rapkin AJ, Naliboff B, Kilpatrick LA, Stains J, Masghati S, Tillisch K, Mayer EA, Labus JS. Disease-Related Microstructural Differences in the Brain in Women With Provoked Vestibulodynia. THE JOURNAL OF PAIN 2018; 19:528.e1-528.e15. [PMID: 29391213 DOI: 10.1016/j.jpain.2017.12.269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/06/2017] [Accepted: 12/17/2017] [Indexed: 12/13/2022]
Abstract
Provoked vestibulodynia (PVD) is a chronic pelvic pain disorder affecting 16% of the female population. Neuroimaging studies have highlighted central abnormalities in PVD, similar to other chronic pelvic pain disorders, including brain regions involved in sensory processing and modulation of pain. The aim of the study was to determine alterations in the subvoxel, microstructural organization within tissues in PVD compared with healthy control participants (HCs) and a disease control group (irritable bowel syndrome [IBS]). Diffusion tensor imaging magnetic resonance imaging was conducted in 87 age-matched premenopausal women (29 PVD, 29 HCs, 29 IBS). Statistical parameter mapping of fractional anisotropy (FA) and mean diffusivity (MD) maps were used to identify microstructural difference in the brain specific to PVD or shared with IBS. PVD alterations in microstructural organization of the brain were predominantly observed in fibers associated with sensorimotor integration and pain processing that relay information between the thalamus, basal ganglia, sensorimotor, and insular cortex. PVD, compared with HCs, showed extensive increases in the FA of somatosensory and basal ganglia regions. In contrast, PVD and IBS subjects did not show any FA-related group differences. PVD subjects showed greater MD in the basal ganglia compared with HCs (higher MD in the internal capsule and pallidum) and IBS (higher MD in the putamen and pallidum). Increases in MD were associated with increased vaginal muscle tenderness and vulvar pain. The current findings highlight possible shared mechanisms between 2 different pelvic pain disorders, but also highlight the widespread alterations observed specifically in PVD compared with HCs. PERSPECTIVE Alterations in microstructure in PVD were observed in fibers associated with sensorimotor integration and pain processing, which were also associated with increased vaginal muscle tenderness and vulvar pain. These alterations may be contributing to increased pain sensitivity and tenderness, highlighting the need for new therapies targeting the central nervous system.
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Affiliation(s)
- Arpana Gupta
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Davis C Woodworth
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Benjamin M Ellingson
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Department of Radiology at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Andrea J Rapkin
- Department of Obstetrics and Gynecology at UCLA, Los Angeles, California
| | - Bruce Naliboff
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Lisa A Kilpatrick
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jean Stains
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California
| | - Salome Masghati
- Department of Obstetrics and Gynecology at UCLA, Los Angeles, California
| | - Kirsten Tillisch
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Emeran A Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jennifer S Labus
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California.
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17
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Vigneswaran H, Abhyankar N, Kocjancic E. Using Advanced Imaging Including MRI to Detect Voiding Dysfunction in Neurogenic Bladder and Fowler Syndrome. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0453-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Chmielewska D, Stania M, Słomka K, Błaszczak E, Taradaj J, Dolibog P, Juras G. Static postural stability in women with stress urinary incontinence: Effects of vision and bladder filling. Neurourol Urodyn 2017; 36:2019-2027. [PMID: 28185317 DOI: 10.1002/nau.23222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/27/2016] [Accepted: 01/05/2017] [Indexed: 12/18/2022]
Abstract
AIMS This case-control study was designed to compare static postural stability between women with stress urinary incontinence and continent women and it was hypothesized that women with incontinence aged around 50 years also have balance disorders. METHODS Eighteen women with incontinence and twelve women without incontinence aged 50-55 years participated in two 60-s trials of each of four different testing conditions: eyes open/full bladder, eyes open/empty bladder, eyes closed/full bladder, eyes closed/empty bladder. The center of foot pressure (COP): sway range, root mean square, velocity (in the antero-posterior and medio-lateral directions), and COP area were recorded. The stabilograms were decomposed into rambling and trembling components. RESULTS The groups of women with and without incontinence differed during the full bladder condition in antero-posterior COP sway range, COP area, and rambling trajectory (range in the antero-posterior and medio-lateral directions, root mean square in the antero-posterior and medio-lateral directions and velocity in the antero-posterior direction). CONCLUSION The women with incontinence had more difficulty controlling their postural balance than continent women while standing with a full bladder. Therefore, developing therapeutic management focused on strengthening the women's core muscles and improving their postural balance seems advisable.
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Affiliation(s)
- Daria Chmielewska
- Faculty of Physiotherapy, Department of Physiotherapy Basics, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Magdalena Stania
- Faculty of Physiotherapy, Department of Physiotherapy Basics, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Kajetan Słomka
- Department of Human Motor Behavior, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Edward Błaszczak
- Department and Faculty of Medical Biophysics, Medical University of Silesia, Katowice, Poland
| | - Jakub Taradaj
- Faculty of Physiotherapy, Department of Physiotherapy Basics, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Patrycja Dolibog
- Department and Faculty of Medical Biophysics, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Juras
- Department of Human Motor Behavior, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
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19
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Barbe M, Gomez-Amaya S, Braverman A, Brown J, Lamarre N, Massicotte V, Lewis J, Dachert S, Ruggieri M. Evidence of vagus nerve sprouting to innervate the urinary bladder and clitoris in a canine model of lower motoneuron lesioned bladder. Neurourol Urodyn 2017; 36:91-97. [PMID: 26452068 PMCID: PMC4826634 DOI: 10.1002/nau.22904] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/25/2015] [Indexed: 12/18/2022]
Abstract
AIMS Complete spinal cord injury does not block perceptual responses or inferior solitary nucleus activation after genital self-stimulation, even though the vagus is not thought to innervate pelvic structures. We tested if vagus nerve endings sprout after bladder decentralization to innervate genitourinary structures in canines with decentralized bladders. METHODS Four reinnervation surgeries were performed in female hounds: bilateral genitofemoral nerve transfer to pelvic nerve with vesicostomy (GNF-V) or without (GFN-NV); and left femoral nerve transfer (FNT-V and FNT-NV). After 8 months, retrograde dyes were injected into genitourinary structures. Three weeks later, at euthanasia, reinnervation was evaluated as increased detrusor pressure induced by functional electrical stimulation (FES). Controls included un-operated, sham-operated, and decentralized animals. RESULTS Increased detrusor pressure was seen in 8/12 GFNT-V, 4/5 GFNT-NV, 5/5 FNT-V, and 4/5 FNT-NV animals after FES, but not decentralized controls. Lumbar cord segments contained cells labeled from the bladder in all nerve transfer animals with FES-induced increased detrusor pressure. Nodose ganglia cells labeled from the bladder were observed in 5/7 nerve transfer animals (1/2 GNT-NV; 4/5 FNT-V), and from the clitoris were in 6/7 nerve transfer animals (2/2 GFNT-NV; 4/5 FNT-V). Dorsal motor nucleus vagus cells labeled from the bladder were observed in 3/5 nerve transfer animals (1/2 GFNT-NV; 2/3 FNT-V), and from the clitoris in 4/5 nerve transfer animals (1/2 GFNT-NV; 3/3 FNT-V). Controls lacked this labeling. CONCLUSIONS Evidence of vagal nerve sprouting to the bladder and clitoris was observed in canines with lower motoneuron lesioned bladders. Neurourol. Urodynam. 36:91-97, 2017. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- M.F. Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA 19140
| | - S. Gomez-Amaya
- CAIF A1224, University of Pittsburgh, School of Medicine, 200 Lothrop St, Pittsburgh PA. 15213
| | - A.S. Braverman
- Department of Anatomy and Cell Biology, Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA 19140
| | - J.M. Brown
- Division of Neurosurgery, UCSD Medical Center, San Diego, CA 92103-8897
| | - N. Lamarre
- CAIF A1224, University of Pittsburgh, School of Medicine, 200 Lothrop St, Pittsburgh PA. 15213
| | - V.S. Massicotte
- Department of Anatomy and Cell Biology, Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA 19140
| | - J.K.S. Lewis
- Department of Anatomy and Cell Biology, Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA 19140
| | - S.R. Dachert
- Department of Anatomy and Cell Biology, Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA 19140
| | - M.R. Ruggieri
- Department of Anatomy and Cell Biology, Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA 19140
- Shriners Hospital of Philadelphia, Philadelphia, PA 19140
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20
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Leitner L, Walter M, Jarrahi B, Wanek J, Diefenbacher J, Michels L, Liechti MD, Kollias SS, Kessler TM, Mehnert U. A novel infusion-drainage device to assess lower urinary tract function in neuro-imaging. BJU Int 2016; 119:305-316. [PMID: 27617867 DOI: 10.1111/bju.13655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the applicability and precision of a novel infusion-drainage device (IDD) for standardized filling paradigms in neuro-urology and functional magnetic resonance imaging (fMRI) studies of lower urinary tract (LUT) function/dysfunction. SUBJECTS/PATIENTS AND METHODS The IDD is based on electrohydrostatic actuation which was previously proven feasible in a prototype setup. The current design includes hydraulic cylinders and a motorized slider to provide force and motion. Methodological aspects have been assessed in a technical application laboratory as well as in healthy subjects (n=33) and patients with LUT dysfunction (n=3) undergoing fMRI during bladder stimulation. After catheterization, the bladder was pre-filled until a persistent desire to void was reported by each subject. The scan paradigm comprised automated, repetitive bladder filling and withdrawal of 100 mL body warm (37 °C) saline, interleaved with rest and sensation rating. Neuroimaging data were analysed using Statistical Parametric Mapping version 12 (SMP12). RESULTS Volume delivery accuracy was between 99.1±1.2% and 99.9±0.2%, for different flow rates and volumes. Magnetic resonance (MR) compatibility was demonstrated by a small decrease in signal-to-noise ratio (SNR), i.e. 1.13% for anatomical and 0.54% for functional scans, and a decrease of 1.76% for time-variant SNR. Automated, repetitive bladder-filling elicited robust (P = 0.05, family-wise error corrected) brain activity in areas previously reported to be involved in supraspinal LUT control. There was a high synchronism between the LUT stimulation and the blood oxygenation level-dependent (BOLD) signal changes in such areas. CONCLUSION We were able to develop an MR-compatible and MR-synchronized IDD to routinely stimulate the LUT during fMRI in a standardized manner. The device provides LUT stimulation at high system accuracy resulting in significant supraspinal BOLD signal changes in interoceptive and LUT control areas in synchronicity to the applied stimuli. The IDD is commercially available, portable and multi-configurable. Such a device may help to improve precision and standardization of LUT tasks in neuro-imaging studies on supraspinal LUT control, and may therefore facilitate multi-site studies and comparability between different LUT investigations in the future.
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Affiliation(s)
- Lorenz Leitner
- Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.,Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Matthias Walter
- Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Behnaz Jarrahi
- Department of Neuroradiology, University Hospital Zürich, Zürich, Switzerland.,UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Johann Wanek
- Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | | | - Lars Michels
- Department of Neuroradiology, University Hospital Zürich, Zürich, Switzerland
| | - Martina D Liechti
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
| | - Spyros S Kollias
- Department of Neuroradiology, University Hospital Zürich, Zürich, Switzerland
| | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Ulrich Mehnert
- Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
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21
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Deruyver Y, Hakim L, Franken J, De Ridder D. The use of imaging techniques in understanding lower urinary tract (dys)function. Auton Neurosci 2016; 200:11-20. [PMID: 27477680 DOI: 10.1016/j.autneu.2016.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 12/22/2015] [Accepted: 05/23/2016] [Indexed: 12/11/2022]
Abstract
The ability to store urine in the bladder and to void at an appropriate time depends on several complex mechanisms in the lower urinary tract (LUT) and its neural control. Normal LUT function requires coordination of the urinary bladder, urethra, pelvic floor, efferent and afferent neurons and specific spinal cord and brain areas. These structures can be visualised using different imaging modalities, such as ultrasound, X-ray and magnetic resonance imaging. The supraspinal neural control of the LUT can be studied using functional brain imaging. During the last two decades, the many technological improvements of these imaging techniques have increased our knowledge of voiding dysfunction. Here, we review the different imaging modalities of the LUT and its neural control and discuss their importance for diagnosing and understanding voiding dysfunction.
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Affiliation(s)
- Yves Deruyver
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Lukman Hakim
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Airlangga University School of Medicine and Dr. Soetomo General Hospital, Department of Urology, Surabaya, Indonesia
| | - Jan Franken
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
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22
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Arya NG, Weissbart SJ, Xu S, Rao H. Brain activation in response to bladder filling in healthy adults: An activation likelihood estimation meta-analysis of neuroimaging studies. Neurourol Urodyn 2016; 36:960-965. [PMID: 27367364 DOI: 10.1002/nau.23058] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/30/2016] [Indexed: 01/23/2023]
Abstract
AIMS Recent studies have used different neuroimaging techniques and identified various brain regions that are activated during bladder filling. However, there is a lack of consensus regarding which of these brain regions regulate the process of urine storage. The aim of this meta-analysis is to identify brain regions that are commonly activated during bladder filling in healthy adults across different studies. METHODS PubMed was searched for neuroimaging studies investigating the effects of bladder filling on regional brain activation. Studies were excluded if they did not report brain activation differences from whole-brain group analysis by comparing the state of bladder filling with the state of bladder rest. The current version of the activation likelihood estimation (ALE) approach was used for meta-analysis. RESULTS We identified 14 neuroimaging studies examining brain activation in response to experimental bladder filling in 181 healthy subjects, which reported 89 foci for ALE analysis. The meta-analysis revealed significant activation in multiple brain regions including thalamus (bilaterally), right insula, cerebellum, and brainstem (bilaterally). CONCLUSIONS Several key brain regions involved in sensory processing are commonly activated during bladder filling in healthy adults across different studies. Neurourol. Urodynam. 36:960-965, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Nisha G Arya
- Division of Urogynecology, Department of Obstetrics and Gynecology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven J Weissbart
- Division of Urogynecology, Department of Obstetrics and Gynecology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sihua Xu
- Laboratory of Applied Brain and Cognitive Sciences, Shanghai International Studies University, Shanghai, China.,Center for Functional Neuroimaging, Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hengyi Rao
- Laboratory of Applied Brain and Cognitive Sciences, Shanghai International Studies University, Shanghai, China.,Center for Functional Neuroimaging, Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
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23
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Bladder Distension Increases Blood Flow in Pain Related Brain Structures in Subjects with Interstitial Cystitis. J Urol 2016; 196:902-10. [PMID: 27018508 DOI: 10.1016/j.juro.2016.03.135] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE In healthy control subjects certain brain regions of interest demonstrate increased regional cerebral blood flow in response to painful stimuli. We examined the effect of bladder distension on arterial spin label functional magnetic resonance imaging measures of regional cerebral blood flow in regions of interest in subjects with interstitial cystitis. MATERIALS AND METHODS A total of 11 female subjects with interstitial cystitis and 11 healthy controls underwent 3 brain perfusion scan studies using arterial spin label functional magnetic resonance imaging, including 1) with a full bladder, 2) with an empty bladder and 3) while experiencing heat pain. Regional cerebral blood flow was calculated using custom software and individual scans were spatially normalized to the MNI (Montreal Neurological Institute) template. Region of interest based, absolute regional cerebral blood flow was determined for each condition and for the within group/within subject regional cerebral blood flow distribution changes induced by each condition. RESULTS Bladder distension was associated with robust increases in regional cerebral blood flow in subjects with interstitial cystitis. The increases were greater than those in healthy controls in multiple regions of interest, including the supplemental motor area (mainly Brodmann area 6), the motor and sensory cortex, the insula bilaterally, the hippocampal structures bilaterally, and the middle and posterior cingulate areas bilaterally. During heat pain healthy controls had more robust regional cerebral blood flow increases in the amygdala bilaterally. At baseline with an empty bladder there was lower regional cerebral blood flow in the insula, and the mid and posterior cingulate cortex bilaterally in subjects with interstitial cystitis. CONCLUSIONS Compared to healthy controls, subjects with interstitial cystitis have limited differences in regional cerebral blood flow in baseline (empty bladder) conditions as well as during heat pain. However, they had robust regional cerebral blood flow increases in the full bladder state in regions of interest typically associated with pain, emotion and/or motor control, indicating altered processing of bladder related sensations.
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Disease-related differences in resting-state networks: a comparison between localized provoked vulvodynia, irritable bowel syndrome, and healthy control subjects. Pain 2016; 156:809-819. [PMID: 25735001 DOI: 10.1097/01.j.pain.0000461289.65571.54] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Localized provoked vulvodynia (LPVD) affects approximately 16% of the female population, but biological mechanisms underlying symptoms remain unknown. Like in other often comorbid chronic pain disorders, altered sensory processing and modulation of pain, including central sensitization, dysregulation of endogenous pain modulatory systems, and attentional enhancement of pain perception, have been implicated. The aim of this study was to test whether regions of interest showing differences in LPVD compared to healthy control subjects (HCs) in structural and evoked-pain neuroimaging studies, also show alterations during rest when compared with HCs and a chronic pain control group (irritable bowel syndrome [IBS]). Functional magnetic resonance imaging was performed during resting state in 87 age-matched premenopausal females (29 LPVD, 29 HCs, and 29 IBS). Group-independent component analysis and general linear models were applied to investigate group differences in the intrinsic connectivity of regions comprising sensorimotor, salience, and default mode resting-state networks. Subjects with LPVD showed substantial alterations in the intrinsic connectivity of these networks compared with HCs and IBS. The intrinsic connectivity of many of the regions showing group differences during rest were moderately associated with clinical symptom reports in LPVD. Findings were robust to controlling for affect and medication usage. The current findings indicate that subjects with LPVD have alterations in the intrinsic connectivity of regions comprising the sensorimotor, salience, and default mode networks. Although shared brain mechanisms between different chronic pain disorders have been postulated, the current findings suggest that some alterations in functional connectivity may show disease specificity.
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Krhut J, Tintera J, Bilkova K, Holy P, Zachoval R, Zvara P, Blok B. Brain activity on fMRI associated with urinary bladder filling in patients with a complete spinal cord injury. Neurourol Urodyn 2015; 36:155-159. [PMID: 26445209 DOI: 10.1002/nau.22901] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/16/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Patients with complete spinal cord injury (SCI) may maintain some perception of bladder fullness. The aim of the study was to evaluate brain activation arising from anticipated extraspinal sensory pathways. METHODS Fourteen patients ages 24-54 years were enrolled, all having experienced a complete SCI (ASIA A) at C7 to T5 an average of 17 months before study entry. Urodynamic equipment was used for repeated bladder filling and detrusor activity evaluation. All functional magnetic resonance imaging measurements were performed using a Siemens Trio 3T scanner with the GRE-EPI sequence (field of view = 192 × 192 mm, voxel 3 × 3 × 3 mm, TR/TE = 3000/30 ms, 45 slices). Nine hundred dynamic scans were acquired over 45 min. Statistical analysis was done in SPM8 using a general linear model. Statistics using t-tests were thresholded at P = 0.001. RESULTS We excluded results from two patients because of activation artifacts. In 8 of 12 patients, significant brain activity was observed during urinary bladder filling. We found significant activation clusters at the nucleus of the solitary tract (NTS) (3/8), parabrachial nucleus (PBN) (4/8), hypothalamus (4/8), thalamus (6/8), amygdala (7/8), insular lobe (5/8), anterior cingulate gyrus (5/8), and prefrontal cortex (8/8). Activations in nuclei involved in afferents likely from the vagal nerve (NTS and PBN) correlated significantly with reported bladder sensations. CONCLUSIONS These data suggest that extraspinal sensory pathways may develop following SCI and that vagal nerve may play a role in re-innervation of the urinary bladder. Neurourol. Urodynam. 36:155-159, 2017. © 2015 Wiley Periodicals, Inc.
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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 Tintera
- Radiodiagnostis and Interventional Radiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Karolina Bilkova
- Spinal Cord Rehabilitation Unit, Rehabilitation Center, Kladruby, Czech Republic
| | - Petr Holy
- Department of Urology, Thomayer Hospital and 1st and 3rd Faculty of Medicine of Charles University, Prague, Czech Republic
| | - Roman Zachoval
- Department of Urology, Thomayer Hospital and 1st and 3rd Faculty of Medicine of Charles University, Prague, Czech Republic
| | - Peter Zvara
- Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic.,Division of Urology, University of Vermont, Burlington, Vermont
| | - B Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, the Netherlands
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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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Kilpatrick LA, Kutch JJ, Tillisch K, Naliboff BD, Labus JS, Jiang Z, Farmer MA, Apkarian AV, Mackey S, Martucci KT, Clauw DJ, Harris RE, Deutsch G, Ness TJ, Yang CC, Maravilla K, Mullins C, Mayer EA. Alterations in resting state oscillations and connectivity in sensory and motor networks in women with interstitial cystitis/painful bladder syndrome. J Urol 2014; 192:947-55. [PMID: 24681331 PMCID: PMC4432915 DOI: 10.1016/j.juro.2014.03.093] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 01/23/2023]
Abstract
PURPOSE The pathophysiology of interstitial cystitis/painful bladder syndrome remains incompletely understood but is thought to involve central disturbance in the processing of pain and viscerosensory signals. We identified differences in brain activity and connectivity between female patients with interstitial cystitis/painful bladder syndrome and healthy controls to advance clinical phenotyping and treatment efforts for interstitial cystitis/painful bladder syndrome. MATERIALS AND METHODS We examined oscillation dynamics of intrinsic brain activity in a large sample of well phenotyped female patients with interstitial cystitis/painful bladder syndrome and female healthy controls. Data were collected during 10-minute resting functional magnetic resonance imaging as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network project. The blood oxygen level dependent signal was transformed to the frequency domain. Relative power was calculated for multiple frequency bands. RESULTS Results demonstrated altered frequency distributions in viscerosensory (post insula), somatosensory (postcentral gyrus) and motor regions (anterior paracentral lobule, and medial and ventral supplementary motor areas) in patients with interstitial cystitis/painful bladder syndrome. Also, the anterior paracentral lobule, and medial and ventral supplementary motor areas showed increased functional connectivity to the midbrain (red nucleus) and cerebellum. This increased functional connectivity was greatest in patients who reported pain during bladder filling. CONCLUSIONS Findings suggest that women with interstitial cystitis/painful bladder syndrome have a sensorimotor component to the pathological condition involving an alteration in intrinsic oscillations and connectivity in a cortico-cerebellar network previously associated with bladder function.
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Affiliation(s)
- Lisa A Kilpatrick
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California-Los Angeles (LAK, KT, BDN, JSL, ZJ, EAM), Los Angeles, California; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (JJK), California; Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center (SM, KTM), Stanford, California; Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange and Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (ZJ); Department of Physiology, Feinberg School of Medicine, Northwestern University (MAF, AVA), Chicago, Illinois; Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan (DJC, REH), Ann Arbor, Michigan; Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center (GD, TJN), Birmingham, Alabama; Department of Urology (CCY), University of Washington, Seattle, Washington; Department of Radiology (KTM), University of Washington, Seattle, Washington; National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (CM), Bethesda, Maryland
| | - Jason J Kutch
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California-Los Angeles (LAK, KT, BDN, JSL, ZJ, EAM), Los Angeles, California; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (JJK), California; Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center (SM, KTM), Stanford, California; Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange and Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (ZJ); Department of Physiology, Feinberg School of Medicine, Northwestern University (MAF, AVA), Chicago, Illinois; Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan (DJC, REH), Ann Arbor, Michigan; Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center (GD, TJN), Birmingham, Alabama; Department of Urology (CCY), University of Washington, Seattle, Washington; Department of Radiology (KTM), University of Washington, Seattle, Washington; National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (CM), Bethesda, Maryland
| | - Kirsten Tillisch
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California-Los Angeles (LAK, KT, BDN, JSL, ZJ, EAM), Los Angeles, California; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (JJK), California; Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center (SM, KTM), Stanford, California; Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange and Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (ZJ); Department of Physiology, Feinberg School of Medicine, Northwestern University (MAF, AVA), Chicago, Illinois; Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan (DJC, REH), Ann Arbor, Michigan; Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center (GD, TJN), Birmingham, Alabama; Department of Urology (CCY), University of Washington, Seattle, Washington; Department of Radiology (KTM), University of Washington, Seattle, Washington; National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (CM), Bethesda, Maryland
| | - Bruce D Naliboff
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California-Los Angeles (LAK, KT, BDN, JSL, ZJ, EAM), Los Angeles, California; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (JJK), California; Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center (SM, KTM), Stanford, California; Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange and Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (ZJ); Department of Physiology, Feinberg School of Medicine, Northwestern University (MAF, AVA), Chicago, Illinois; Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan (DJC, REH), Ann Arbor, Michigan; Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center (GD, TJN), Birmingham, Alabama; Department of Urology (CCY), University of Washington, Seattle, Washington; Department of Radiology (KTM), University of Washington, Seattle, Washington; National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (CM), Bethesda, Maryland
| | - Jennifer S Labus
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California-Los Angeles (LAK, KT, BDN, JSL, ZJ, EAM), Los Angeles, California; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (JJK), California; Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center (SM, KTM), Stanford, California; Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange and Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (ZJ); Department of Physiology, Feinberg School of Medicine, Northwestern University (MAF, AVA), Chicago, Illinois; Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan (DJC, REH), Ann Arbor, Michigan; Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center (GD, TJN), Birmingham, Alabama; Department of Urology (CCY), University of Washington, Seattle, Washington; Department of Radiology (KTM), University of Washington, Seattle, Washington; National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (CM), Bethesda, Maryland
| | - Zhiguo Jiang
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California-Los Angeles (LAK, KT, BDN, JSL, ZJ, EAM), Los Angeles, California; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (JJK), California; Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center (SM, KTM), Stanford, California; Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange and Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (ZJ); Department of Physiology, Feinberg School of Medicine, Northwestern University (MAF, AVA), Chicago, Illinois; Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan (DJC, REH), Ann Arbor, Michigan; Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center (GD, TJN), Birmingham, Alabama; Department of Urology (CCY), University of Washington, Seattle, Washington; Department of Radiology (KTM), University of Washington, Seattle, Washington; National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (CM), Bethesda, Maryland
| | - Melissa A Farmer
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California-Los Angeles (LAK, KT, BDN, JSL, ZJ, EAM), Los Angeles, California; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (JJK), California; Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center (SM, KTM), Stanford, California; Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange and Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (ZJ); Department of Physiology, Feinberg School of Medicine, Northwestern University (MAF, AVA), Chicago, Illinois; Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan (DJC, REH), Ann Arbor, Michigan; Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center (GD, TJN), Birmingham, Alabama; Department of Urology (CCY), University of Washington, Seattle, Washington; Department of Radiology (KTM), University of Washington, Seattle, Washington; National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (CM), Bethesda, Maryland
| | - A Vania Apkarian
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California-Los Angeles (LAK, KT, BDN, JSL, ZJ, EAM), Los Angeles, California; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (JJK), California; Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center (SM, KTM), Stanford, California; Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange and Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (ZJ); Department of Physiology, Feinberg School of Medicine, Northwestern University (MAF, AVA), Chicago, Illinois; Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan (DJC, REH), Ann Arbor, Michigan; Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center (GD, TJN), Birmingham, Alabama; Department of Urology (CCY), University of Washington, Seattle, Washington; Department of Radiology (KTM), University of Washington, Seattle, Washington; National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (CM), Bethesda, Maryland
| | - Sean Mackey
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California-Los Angeles (LAK, KT, BDN, JSL, ZJ, EAM), Los Angeles, California; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (JJK), California; Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center (SM, KTM), Stanford, California; Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange and Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (ZJ); Department of Physiology, Feinberg School of Medicine, Northwestern University (MAF, AVA), Chicago, Illinois; Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan (DJC, REH), Ann Arbor, Michigan; Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center (GD, TJN), Birmingham, Alabama; Department of Urology (CCY), University of Washington, Seattle, Washington; Department of Radiology (KTM), University of Washington, Seattle, Washington; National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (CM), Bethesda, Maryland
| | - Katherine T Martucci
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California-Los Angeles (LAK, KT, BDN, JSL, ZJ, EAM), Los Angeles, California; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (JJK), California; Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center (SM, KTM), Stanford, California; Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange and Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (ZJ); Department of Physiology, Feinberg School of Medicine, Northwestern University (MAF, AVA), Chicago, Illinois; Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan (DJC, REH), Ann Arbor, Michigan; Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center (GD, TJN), Birmingham, Alabama; Department of Urology (CCY), University of Washington, Seattle, Washington; Department of Radiology (KTM), University of Washington, Seattle, Washington; National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (CM), Bethesda, Maryland
| | - Daniel J Clauw
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California-Los Angeles (LAK, KT, BDN, JSL, ZJ, EAM), Los Angeles, California; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (JJK), California; Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center (SM, KTM), Stanford, California; Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange and Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (ZJ); Department of Physiology, Feinberg School of Medicine, Northwestern University (MAF, AVA), Chicago, Illinois; Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan (DJC, REH), Ann Arbor, Michigan; Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center (GD, TJN), Birmingham, Alabama; Department of Urology (CCY), University of Washington, Seattle, Washington; Department of Radiology (KTM), University of Washington, Seattle, Washington; National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (CM), Bethesda, Maryland
| | - Richard E Harris
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California-Los Angeles (LAK, KT, BDN, JSL, ZJ, EAM), Los Angeles, California; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (JJK), California; Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center (SM, KTM), Stanford, California; Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange and Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (ZJ); Department of Physiology, Feinberg School of Medicine, Northwestern University (MAF, AVA), Chicago, Illinois; Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan (DJC, REH), Ann Arbor, Michigan; Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center (GD, TJN), Birmingham, Alabama; Department of Urology (CCY), University of Washington, Seattle, Washington; Department of Radiology (KTM), University of Washington, Seattle, Washington; National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (CM), Bethesda, Maryland
| | - Georg Deutsch
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California-Los Angeles (LAK, KT, BDN, JSL, ZJ, EAM), Los Angeles, California; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (JJK), California; Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center (SM, KTM), Stanford, California; Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange and Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (ZJ); Department of Physiology, Feinberg School of Medicine, Northwestern University (MAF, AVA), Chicago, Illinois; Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan (DJC, REH), Ann Arbor, Michigan; Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center (GD, TJN), Birmingham, Alabama; Department of Urology (CCY), University of Washington, Seattle, Washington; Department of Radiology (KTM), University of Washington, Seattle, Washington; National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (CM), Bethesda, Maryland
| | - Timothy J Ness
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California-Los Angeles (LAK, KT, BDN, JSL, ZJ, EAM), Los Angeles, California; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (JJK), California; Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center (SM, KTM), Stanford, California; Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange and Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (ZJ); Department of Physiology, Feinberg School of Medicine, Northwestern University (MAF, AVA), Chicago, Illinois; Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan (DJC, REH), Ann Arbor, Michigan; Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center (GD, TJN), Birmingham, Alabama; Department of Urology (CCY), University of Washington, Seattle, Washington; Department of Radiology (KTM), University of Washington, Seattle, Washington; National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (CM), Bethesda, Maryland
| | - Claire C Yang
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California-Los Angeles (LAK, KT, BDN, JSL, ZJ, EAM), Los Angeles, California; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (JJK), California; Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center (SM, KTM), Stanford, California; Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange and Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (ZJ); Department of Physiology, Feinberg School of Medicine, Northwestern University (MAF, AVA), Chicago, Illinois; Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan (DJC, REH), Ann Arbor, Michigan; Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center (GD, TJN), Birmingham, Alabama; Department of Urology (CCY), University of Washington, Seattle, Washington; Department of Radiology (KTM), University of Washington, Seattle, Washington; National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (CM), Bethesda, Maryland
| | - Kenneth Maravilla
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California-Los Angeles (LAK, KT, BDN, JSL, ZJ, EAM), Los Angeles, California; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (JJK), California; Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center (SM, KTM), Stanford, California; Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange and Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (ZJ); Department of Physiology, Feinberg School of Medicine, Northwestern University (MAF, AVA), Chicago, Illinois; Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan (DJC, REH), Ann Arbor, Michigan; Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center (GD, TJN), Birmingham, Alabama; Department of Urology (CCY), University of Washington, Seattle, Washington; Department of Radiology (KTM), University of Washington, Seattle, Washington; National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (CM), Bethesda, Maryland
| | - Chris Mullins
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California-Los Angeles (LAK, KT, BDN, JSL, ZJ, EAM), Los Angeles, California; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (JJK), California; Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center (SM, KTM), Stanford, California; Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange and Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (ZJ); Department of Physiology, Feinberg School of Medicine, Northwestern University (MAF, AVA), Chicago, Illinois; Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan (DJC, REH), Ann Arbor, Michigan; Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center (GD, TJN), Birmingham, Alabama; Department of Urology (CCY), University of Washington, Seattle, Washington; Department of Radiology (KTM), University of Washington, Seattle, Washington; National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (CM), Bethesda, Maryland
| | - Emeran A Mayer
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California-Los Angeles (LAK, KT, BDN, JSL, ZJ, EAM), Los Angeles, California; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles (JJK), California; Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center (SM, KTM), Stanford, California; Human Performance and Engineering Laboratory, Kessler Foundation Research Center, West Orange and Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey (ZJ); Department of Physiology, Feinberg School of Medicine, Northwestern University (MAF, AVA), Chicago, Illinois; Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan (DJC, REH), Ann Arbor, Michigan; Departments of Radiology and Anesthesiology, University of Alabama, Birmingham Medical Center (GD, TJN), Birmingham, Alabama; Department of Urology (CCY), University of Washington, Seattle, Washington; Department of Radiology (KTM), University of Washington, Seattle, Washington; National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (CM), Bethesda, Maryland.
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Qu CY, Xu DF. Comprehensive urodynamics: Being devoted to clinical urologic practice. World J Clin Urol 2014; 3:96-112. [DOI: 10.5410/wjcu.v3.i2.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/12/2014] [Accepted: 06/16/2014] [Indexed: 02/06/2023] Open
Abstract
As a combined electrophysiological system for evaluating the lower urinary tract (LUT), comprehensive urodynamics (UDS) aims at duplicating patient’s micturition process, either normal or abnormal, and further seeking for possible causative origin, either neurogenic or non-neurogenic, in order to guide treatment. Through thorough analysis, some so-called cut-off values, for example, bladder outlet obstruction (BOO) degree or dyssynergic degree between the detrusor and sphincter, could be gained; however, in most cases, their qualitative description, such as stress urinary incontinence, idiopathic detrusor underactivity (DUA), detrusor overactivity (IDO), low compliance, and idiopathic sphincter overactivity (ISO), is more preferable and important. In aged neurologically intact male patients with symptoms of the LUT (LUTS) including benign prostatic hyperplasia, a combined UDS system, which coupled BOO with compliance, was constructed. The patients may be categorized into one of the seven subgroups, including equivocal or mild BOO with sphincter synergia with or without IDO (pattern A), equivocal or mild BOO with ISO (B), classic BOO with sphincter synergia (C) or ISO (D), BOO with only low compliance (E), BOO with both DUA and low compliance (F), and potential BOO with DUA (G). This new system can be used to optimize diagnosis and treatment according to a derived guideline diagram.
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Sakakibara R. Editorial Comment to Brain activity during bladder filling and pelvic floor muscle contractions: A study using functional magnetic resonance imaging and synchronous urodynamics. Int J Urol 2014; 21:174. [DOI: 10.1111/iju.12222] [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]
Affiliation(s)
- Ryuji Sakakibara
- Neurology Division; Department of Internal Medicine; Sakura Medical Center; Toho University; Sakura Japan
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