1609 IDENTIFYING ICS BLADDER SENSATIONS USING FUNCTIONAL BRAIN IMAGING (FMRI) AND CONVENTIONAL URODYNAMICS IN HEALTHY SUBJECTS AND OAB PATIENTS

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Urodynamic Testing1 Apr 20101609 IDENTIFYING ICS BLADDER SENSATIONS USING FUNCTIONAL BRAIN IMAGING (FMRI) AND CONVENTIONAL URODYNAMICS IN HEALTHY SUBJECTS AND OAB PATIENTS Woon Tsang, Joe Kong, Anupam Yadav, John O'Donaghue, Brian Andrews, Jeremy Noble, John Reynard, and Irene Tracey Woon TsangWoon Tsang More articles by this author , Joe KongJoe Kong More articles by this author , Anupam YadavAnupam Yadav More articles by this author , John O'DonaghueJohn O'Donaghue More articles by this author , Brian AndrewsBrian Andrews More articles by this author , Jeremy NobleJeremy Noble More articles by this author , John ReynardJohn Reynard More articles by this author , and Irene TraceyIrene Tracey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1389AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The International Continence Society (ICS) has recognised 3 distinct sensations during bladder filling: first sensation of filling (FSF), first desire to void (FDV) and strong desire to void (SDV). No previous study has attempted to correlate these sensations with simultaneous urodynamics and fMRI brain scanning. Our objectives were to identify brain regions correlating with FSF and SDV, measure their respective BOLD (Blood Oxygen Level Dependent) signal changes and determine differences in activity in these regions between healthy volunteers (HV) and overactive bladder (OAB) patients. METHODS fMRI scans wee performed with conventional urodynamics using a previously developed block paradigm of an infusion:pause sequence. Bladder sensation was rated according to ICS sensations (0=No sensation, 1=FSF, 2=FDV, 3=NDV, 4=SDV & 5=Maximum sensation). After image acquisition and pre-processing, BOLD signal changes were calculated in those brain regions which showed significant differences during bladder filling. RESULTS 11 HV (mean age 40 years) and 13 OAB subjects (mean age 54 years) completed the study. OAB subjects tolerated a smaller infusion volume (p=0.019) and experienced stronger sensations (SDV, p=<0.0001 and MCC, p=<0.0001) at lower bladder volumes than HVs. The pattern of bladder sensation from FSF to SDV (Figs 1 & 2 and Table 1) was different for HVs and OAB subjects. HVs showed greater BOLD signal changes at SDV compared to OAB in the frontal orbital cortex. In regions known to be associated with unpleasantness (insular cortex and anterior cingulate cortex, ACC), ‘fear' (amygdala) and anticipation (hippocampus), signal changes were greater for OAB at FSF. CONCLUSIONS We have developed a novel method for correlating brain activation during fMRI with ICS sensations and urodynamic bladder assessment. HVs showed greater BOLD signal changes at SDV compared to OAB in the frontal orbital cortex. Signal changes were greater for OAB patients at FSF in brain regions known to be associated with unpleasantness (the insular cortex and anterior cingulate cortex, ACC), ‘fear' (amygdala) and anticipation (hippocampus). It is conceivable that HVs and OAB patients may experience sensation differently. A possible neural cause of the abnormal sensation of urgency and the ‘fear of leakage' may be due to an increase in activation in the ACC, amygdala and hippocampus. Oxford, United Kingdom© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e621-e622 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Woon Tsang More articles by this author Joe Kong More articles by this author Anupam Yadav More articles by this author John O'Donaghue More articles by this author Brian Andrews More articles by this author Jeremy Noble More articles by this author John Reynard More articles by this author Irene Tracey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...