1946 HIPPOCAMPUS THE ‘PLAYMAKER' IN THE SENSATION OF URGENCY IN OAB

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Non-neurogenic Voiding Dysfunction1 Apr 20131946 HIPPOCAMPUS THE ‘PLAYMAKER' IN THE SENSATION OF URGENCY IN OAB Woon Tsang, Joe Kong, John Reynard, and Irene Tracey Woon TsangWoon Tsang Singapore, Singapore More articles by this author , Joe KongJoe Kong Oxford, United Kingdom More articles by this author , John ReynardJohn Reynard Oxford, United Kingdom More articles by this author , and Irene TraceyIrene Tracey Oxford, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2365AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urgency is the cornerstone symptom of overactive bladder (OAB). It is defined as a sudden compelling desire to pass urine, which is difficult to defer. Urgency is an abnormal sensation and the neural cause is not known. As a result of this symptom, OAB patients have increased awareness and know where the toilets are. This phenomenon is known as ‘toilet mapping'. A neural network involving the frontal orbital cortex (FOC), hippocampus and amygdala in the central mechanism of urgency has been postulated. The hippocampus is a centre known for spatial mapping and navigation and is activated strongly in people with good knowledge of direction. Our objective is to identify what role the hippocampus plays in the abnormal sensation of urgency. METHODS 13 OAB had fMRI with repeated conventional urodynamics using a previously developed block paradigm of an infusion pause sequence. OAB LUTS questionnaire was used to assess the severity of their urgency symptom. After image acquisition and pre-processing, BOLD signal changes were calculated in those brain regions, which showed significant differences during infusion. RESULTS In regions known to be associated with unpleasantness (the insular cortex and anterior cingulate cortex, ACC), ‘fear' (amygdala), anticipation and nociception (hippocampus), signal changes were greater at FSF in OAB patients with worsening symptom of urgency. In those with poor bladder control (FOC), these signal changes were weaker. The amygdala had greater signal changes at FSF and this could explain the ‘fear' of leakage commonly found in OAB. The hippocampus showed greater signal changes at SDV in those with worsening urgency. This may play a pivotal role in the central mechanism of urgency. CONCLUSIONS The neural cause of the abnormal sensation of urgency is complex and we are just beginning to identify the network of brain regions involved. Severe symptoms of urgency are associated with greater signal changes at FSF. The FOC (continence), amygdala (‘fear' of leakage) and hippocampus (spatial awareness, anticipation and nociception) all contribute to this extensive neural network with the hippocampus playing a pivotal role in the central mechanism of urgency. Mean %BOLD Signal Changes from FSF to SDV in OAB FSF SDV FSF SDV FSF SDV FSF SDV Insula 0 0.23 0.16 0.07 0.08 0 0.55 0 ACC 0 0.09 0.22 0.36 0.35 0 0 0.02 FOC 0 0.41 0.49 0.68 0.24 0 0.31 0 RightHippocampus 0.17 0 1.38 0.69 0.84 0 0.37 0.46 LeftHippocampus 0.30 0.42 1.37 0.83 1.19 0.11 0.14 1.42 RightAmygdala 0.19 0.02 1.34 0.86 0.47 0 0.47 0 LeftAmydala 0 0.62 2.32 1.19 2.24 0.66 0.73 0.14 Value expressed as %BOLD Signal Changes © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e797-e798 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Woon Tsang Singapore, Singapore More articles by this author Joe Kong Oxford, United Kingdom More articles by this author John Reynard Oxford, United Kingdom More articles by this author Irene Tracey Oxford, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...