PD66-06 VALIDATION OF A NEW FMRI PROTOCOL TO INVESTIGATE VISUAL TRIGGERS IN URGENCY URINARY INCONTINENCE (UUI)

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction III (PD66)1 Sep 2021PD66-06 VALIDATION OF A NEW FMRI PROTOCOL TO INVESTIGATE VISUAL TRIGGERS IN URGENCY URINARY INCONTINENCE (UUI) Lynn Stothers, Andrew Macnab, Jennifer Locke, Martin McKeown, and Saurabh Garg Lynn StothersLynn Stothers More articles by this author , Andrew MacnabAndrew Macnab More articles by this author , Jennifer LockeJennifer Locke More articles by this author , Martin McKeownMartin McKeown More articles by this author , and Saurabh GargSaurabh Garg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002110.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Visual stimuli are recognized as triggers to urgency urinary incontinence (UUI). However, conventional investigation of UUI lacks evaluative methodology for the impact of visual triggers. Objective: validation of an fMRI protocol for urologic use exploring cerebral responses to patient specific visual triggers in subjects reporting trigger-related UUI. METHODS: Protocol: Following natural bladder filling, a 3 Tesla Philips Elition Scanner obtained structural T1 weighted images to define ∼200 brain regions based on a validated brain atlas; Diffusion Tensor Imaging and Myelin Water Fraction scans excluded myelin abnormalities; fMRI sequences included a series of subject-specific trigger images interspersed with neutral images in a pseudo-randomized sequence to minimize habituation (fig 1). Each subject’s sequence included selected regions from trigger images they supplied and neutral images; individualized 10 minute sequences were viewed 3 times. Analysis: AFNI toolbox, ‘epi_reg,’ ‘slicetimer.fsl’ and ‘mcflirt’; these accommodate for the time taken to acquire the complete fMRI sequence and small head movements during acquisition, maintain the correspondence between different brain volumes, and identify specific brain regions of interest. RESULTS: N=10 (6 asymptomatic controls, 4 with UUI). Clinical staging: IPSS, UGDI-6, history and physical exam. Debriefing confirmed images within the sequence had triggered symptoms of UUI. Tractography demonstrated that the limbic system and prefrontal cortex are key components in the pathway whereby visual triggers induce UUI. Robust structural connectivity was identified between the anterior cingulate cortex and periaqueductal grey matter. CONCLUSIONS: We describe a novel 1 hour 6 minute fMRI protocol for evaluation and quantification of the cortical mechanisms underlying visual triggers for UUI. Scan analysis showed structural connectivity between sensation and voiding control centres in the brain, & the protocol successfully identifies the pons by including measures to overcome recognized challenges associated with visualizing the brain stem. Source of Funding: n/a © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1160-e1160 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lynn Stothers More articles by this author Andrew Macnab More articles by this author Jennifer Locke More articles by this author Martin McKeown More articles by this author Saurabh Garg More articles by this author Expand All Advertisement Loading ...