Control Of Lower Urinary Tract Research Articles

Functional neuroimaging related to lower urinary tract sensations: Future directions for study designs and selection of patient groups: ICI-RS 2023.

Neuroimaging studies have advanced our understanding of the intricate central nervous system control network governing lower urinary tract (LUT) function, shedding light on mechanisms for urine storage and voiding. However, a lack of consensus in methodological approaches hinders the comparability of results among research groups and limits the translation of this knowledge to clinical applications, emphasizing the need for standardized methodologies and clinical utilization guidelines. This paper reports the discussions of a workshop at the 2023 meeting of the International Consultation on Incontinence Research Society, which reviewed uncertainties and research priorities to progress the field of neuroimaging in LUT control and dysfunction. Neuroimaging holds great potential for improving our understanding of LUT control and pathophysiological conditions. To date, functional neuroimaging techniques have not yet achieved sufficient strength to make a direct clinical impact. Potential approaches that can improve the clinical utilization of neuroimaging were discussed and research questions proposed. Neuroimaging offers a valuable tool for investigating LUT control, but it's essential to acknowledge the potential for oversimplification when interpreting brain activity due to the complex neural processing and filtering of sensory information. Moreover, technical limitations pose challenges in assessing key brain stem and spinal cord centers, particularly in cases of neurological dysfunction, highlighting the need for more reliable imaging of these centers to advance our understanding of LUT function and dysfunction.

Identification of brain functional connectivity during acute transcutaneous tibial nerve stimulation: A 3T fMRI study.

A feasibility proof-of-concept study was conducted to assess the effects of acute tibial nerve stimulation (TNS) on the central nervous system in healthy volunteers using functional magnetic resonance imaging (fMRI). Fourteen healthy volunteers were included in a prospective, single-site study conducted on a clinical 3T MRI scanner. Four scans of functional MRI, each lasting 6 min, were acquired: two resting-state fMRI scans (prior and following the TNS intervention) and in-between two fMRI scans, both consisting of alternating rest periods and noninvasive acute transcutaneous TNS (TTNS). Whole brain seed-based functional connectivity (FC) correlation analysis was performed comparing TTNS stimulation with rest periods. Cluster-level familywise error (FWE) corrected p and a minimal cluster size of 200 voxels were used to explore FC patterns. Increased FC is reported between inferior frontal gyrus, posterior cingulate gyrus, and middle temporal gyrus with the precuneus as central receiving node. In addition, decreased FC in the cerebellum, hippocampus, and parahippocampal areas was observed. Altered FC is reported in areas which have been described to be also involved in lower urinary tract control. Although conducted with healthy controls, the assumption that the underlying therapeutic effect of TNS involves the central nervous system is supported and has to be further examined in patients with incomplete spinal cord injury.

MP03-12 FUNCTIONAL MRI EXPLORATION OF THE SACRAL SPINAL CORD: A BULBOCAVERNOSUS REFLEX TASK-BASED STIMULATION

You have accessJournal of UrologyCME1 Apr 2023MP03-12 FUNCTIONAL MRI EXPLORATION OF THE SACRAL SPINAL CORD: A BULBOCAVERNOSUS REFLEX TASK-BASED STIMULATION Charles Mazeaud, Betsy Salazar, Kris Hoffman, Christof Karmonik, and Rose Khavari Charles MazeaudCharles Mazeaud More articles by this author , Betsy SalazarBetsy Salazar More articles by this author , Kris HoffmanKris Hoffman More articles by this author , Christof KarmonikChristof Karmonik More articles by this author , and Rose KhavariRose Khavari More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003214.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lower urinary tract (LUT) is under the control of the central nervous system. Functional MRI (fMRI) is designed to explore neuronal activity, however, its application at the level of the spinal cord has been challenging and not explored. The bulbocavernosus reflex (BCR) is a reliable means of assessing the integrity of the spinal cord, particularly at the sacral level of the LUT control. The BCR is usually triggered by a gentle squeezing of the penis glans or the clitoris, especially with a full bladder. A similar and more convenient method is to tap on the midline of the suprapubic region when the bladder is full. The objectives of this project are twofold: (1) to establish a feasible and MRI compatible BCR assessment within the MRI scanner, (2) to assess the feasibility of spinal cord fMRI during a full bladder BCR in regard to LUT control in healthy individuals. METHODS: An MRI compatible hammer was designed and generated to deliver the stimulation within the MRI tunnel to elicit BCR. Two healthy males with no previous history of LUT symptoms or spinal cord injury were recruited for this trial. The participants were instructed to consume 500 ml of water and empty their bladder immediately before entering the MRI. When they reported a full bladder, they underwent a task-based fMRI of four blocks of 40 seconds of tapping (BCR) and 40 seconds of control (rest). The regions of interest (ROIs) involved in the BCR, were defined as the area of the terminal cone (S1-S4 roots) known to be involved in LUT control. The blood level oxygen-dependent (BOLD) signal within ROIs was analyzed with the FSL software. RESULTS: The ROIs identified in the sacral spinal cord showed a significant increase in signal upon BCR stimulation. BOLD activations were present and time-related to the stimulation period (Figure 1). CONCLUSIONS: This is the first study to demonstrate that: There is a feasible and modest approach to elicit BCR within the MRI to assess spinal cord integrity in regard to LUT control. The activity of the sacral spinal cord during the BCR stimulation can be revealed in fMRI. These preliminary results pave the way for further study of the functional role of the spinal cord in larger cohorts of healthy individuals and in individuals with spinal cord injury. Source of Funding: Funding provided by the National Institute of Health, NIDDK R03DK126994-01 award and the CAIRIBU Core collaboration award © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e26 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Charles Mazeaud More articles by this author Betsy Salazar More articles by this author Kris Hoffman More articles by this author Christof Karmonik More articles by this author Rose Khavari More articles by this author Expand All Advertisement PDF downloadLoading ...

MP49-19 TIME COURSE CHANGES IN VOIDING INTERVAL IN RATS WITH FOCAL CEREBRAL INFARCTION INDUCED BY PHOTOCHEMICALLY-INDUCED THROMBOSIS

You have accessJournal of UrologyCME1 May 2022MP49-19 TIME COURSE CHANGES IN VOIDING INTERVAL IN RATS WITH FOCAL CEREBRAL INFARCTION INDUCED BY PHOTOCHEMICALLY-INDUCED THROMBOSIS Yuya Ota, Yasue Kubota, Yuji Hotta, Mami Matsumoto, Nayuka Matsuyama, Taiki Kato, Takashi Hamakawa, Tomoya Kataoka, Kazunori Kimura, Kazunobu Sawamoto, and Takahiro Yasui Yuya OtaYuya Ota More articles by this author , Yasue KubotaYasue Kubota More articles by this author , Yuji HottaYuji Hotta More articles by this author , Mami MatsumotoMami Matsumoto More articles by this author , Nayuka MatsuyamaNayuka Matsuyama More articles by this author , Taiki KatoTaiki Kato More articles by this author , Takashi HamakawaTakashi Hamakawa More articles by this author , Tomoya KataokaTomoya Kataoka More articles by this author , Kazunori KimuraKazunori Kimura More articles by this author , Kazunobu SawamotoKazunobu Sawamoto More articles by this author , and Takahiro YasuiTakahiro Yasui More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002624.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Photochemically-induced thrombosis (photothrombosis), which is easy to implement and minimally invasive, can create focal cerebral infarcts in the superficial layers of the cerebrum. Using this, we aimed to establish a new rat model of increases in urinary frequency after focal cerebral infarction, characterized by its simplicity, nonlethal nature, and high reproducibility. METHODS: A total of 90 11-week-old female Wistar-ST rats were assigned to the sham or photothrombosis-treated (PT) group. Photothrombosis was used to induce focal infarcts in the prefrontal and anterior cingulate cortices, which are involved in lower urinary tract control. A fiber optic cable delivering a light source was placed stereotactically onto the skull 1 mm anterior to the bregma on the midline. Rose Bengal solution (30 mg/mL/kg) was injected into the tail vein, and the skull was irradiated. Neurological, cystometric, and immunohistochemical evaluation of the brain were performed preoperatively and on postoperative days 1, 7, 14, and 28. RESULTS: Cystometric analysis indicated that micturition intervals significantly shortened in photothrombosis-treated rats compared with that in the sham group on Days 1 and 7 (P < 0.01), and prolonged after 14 days, with no difference between the groups (Figure A). Baseline pressure, micturition threshold pressure, and maximum intravesical pressure did not differ between the groups. Neurological evaluation revealed that only motor disturbances in the hind limbs improved with time in the PT group. Immunopathological evaluation revealed an accumulation of activated microglia, and subsequent increase in reactive astrocytes, at the peri-infarct zone after photothrombotic stroke. Throughout the study, all postphotothrombosis rats showed cerebral infarction in the prefrontal cortex and anterior cingulate cortex; no rats showed fatal cerebral infarction. CONCLUSIONS: This novel photothrombosis model, combining non-lethality and high reproducibility, observed changes in micturition status. This photothrombosis method may be able to contribute to the understanding of neural control of urinary function by regulating the number and volume of the infarcted areas. Source of Funding: GSK Japan Research Grant 2019 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e861 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yuya Ota More articles by this author Yasue Kubota More articles by this author Yuji Hotta More articles by this author Mami Matsumoto More articles by this author Nayuka Matsuyama More articles by this author Taiki Kato More articles by this author Takashi Hamakawa More articles by this author Tomoya Kataoka More articles by this author Kazunori Kimura More articles by this author Kazunobu Sawamoto More articles by this author Takahiro Yasui More articles by this author Expand All Advertisement PDF DownloadLoading ...

Change in the central control of the bladder function of rats with focal cerebral infarction induced by photochemically-induced thrombosis.

The photochemically-induced thrombosis (photothrombosis) method can create focal cerebral infarcts anywhere in the relatively superficial layers of the cerebrum; it is easy to implement and minimally invasive. Taking advantage of this versatility, we aimed to establish a new rat model of urinary frequency with focal cerebral infarction, which was characterized by its simplicity, nonlethal nature, and high reproducibility. The prefrontal cortex and the anterior cingulate cortex, which are involved in lower urinary tract control, were targeted for focal cerebral infarction, and urinary parameters were measured by cystometrogram. Cystometric analysis indicated that micturition intervals significantly shortened in photothrombosis-treated rats compared with those in the sham operative group on Days 1 and 7 (P < 0.01), but prolonged after 14 days, with no difference between the two groups. Immunopathological evaluation showed an accumulation of activated microglia, followed by an increase in reactive astrocytes at the peri-infarct zone after photothrombotic stroke. Throughout this study, all postphotothrombosis rats showed cerebral infarction in the prefrontal cortex and anterior cingulate cortex; there were no cases of rats with fatal cerebral infarction. This model corresponded to the clinical presentation, in that the micturition status changed after stroke. In conclusion, this novel model combining nonlethality and high reproducibility may be a suitable model of urinary frequency after focal cerebral infarction.

A systematic review and activation likelihood estimation meta-analysis of the central innervation of the lower urinary tract: Pelvic floor motor control and micturition.

PurposeFunctional 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 methodsA 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.Results20 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.ConclusionsFor 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.

Reliability of supraspinal correlates to lower urinary tract stimulation in healthy participants – A fMRI study

Previous functional neuroimaging studies provided evidence for a specific supraspinal network involved in lower urinary tract (LUT) control. However, data on the reliability of blood oxygenation level-dependent (BOLD) signal changes during LUT task-related functional magnetic resonance imaging (fMRI) across separate measurements are lacking. Proof of the latter is crucial to evaluate whether fMRI can be used to assess supraspinal responses to LUT treatments.Therefore, we prospectively assessed task-specific supraspinal responses from 20 healthy participants undergoing two fMRI measurements (test-retest) within 5–8 weeks. The fMRI measurements, conducted in a 3T magnetic resonance (MR) scanner, comprised a block design of repetitive bladder filling and drainage using an automated MR-compatible and MR-synchronized infusion-drainage device. Following transurethral catheterization and bladder pre-filling with body warm saline until participants perceived a persistent desire to void (START condition), fMRI was recorded during repetitive blocks (each 15 s) of INFUSION and WITHDRAWAL of 100 mL body warm saline into respectively from the bladder. BOLD signal changes were calculated for INFUSION minus START. In addition to whole brain analysis, we assessed BOLD signal changes within multiple ‘a priori’ region of interest (ROI), i.e. brain areas known to be involved in the LUT control from previous literature. To evaluate reliability of the fMRI results between visits, we applied different types of analyses: coefficient of variation (CV), intraclass correlation coefficient (ICC), Sørensen-Dice index, Bland-Altman method, and block-wise BOLD signal comparison.All participants completed the study without adverse events. The desire to void was rated significantly higher for INFUSION compared to START or WITHDRAWAL at both measurements without any effect of visit. At whole brain level, significant (p < 0.05, cluster corrected, k ≥ 41 voxels) BOLD signal changes were found for the contrast INFUSION compared to START in several brain areas. Overlap of activation maps from both measurements were observed in the orbitofrontal cortex, insula, ventrolateral prefrontal cortex (VLPFC), and inferior parietal lobe. The two highest ICCs, based on a ROI's mean beta weight, were 0.55 (right insular cortex) and 0.47 (VLPFC). Spatial congruency (Sørensen-Dice index) of all voxels within each ROI between measurements was highest in the insular cortex (left 0.55, right 0.44). In addition, the mean beta weight of the right insula and right VLPFC demonstrated the lowest CV and narrowest Bland and Altman 95% limits of agreement.In conclusion, the right insula and right VLPFC were revealed as the two most reliable task-specific ROIs using our automated, MR-synchronized protocol. Achieving high reliability using a viscero-sensory/interoceptive task such as repetitive bladder filling remains challenging and further endeavour is highly warranted to better understand which factors influence fMRI outcomes and finally to assess LUT treatment effects on the supraspinal level.

Supraspinal lower urinary tract control in spinal cord injury patients undergoing intradetrusor onabotulinumtoxinA injections: An MRI study

Supraspinal lower urinary tract control in spinal cord injury patients undergoing intradetrusor onabotulinumtoxinA injections: An MRI study

Harntraktfunktionsstörungen bei Guillain-Barré-Syndrom

Guillain-Barré syndrome (GBS) as acute inflammatory demyelinating polyradiculoneuropathy frequently leads to lower urinary tract dysfunction. The available knowledge in the medical literature is limited and good recommendations for diagnosis and therapy are rare. In this study, 189 patients with GBS were screened for lower urinary tract dysfunction. In symptomatic patients, aurodynamic study was performed. Detrusor contractility, post-void residual, and changes of the symptoms over time were studied. Overall Barthel index and urinary control Barthel index as well as the relationship of time after onset of the disease and post-void residual were studied as possible screening criteria for urodynamic assessment. According to the urinary control Barthel index (BI), 115 of 189 patients (61%) presented lower urinary tract symptoms sometime during the course of disease. In 28patients, these symptoms were temporary during the acute phase. At the time of urological assessment, 87patients had lower urinary tract symptoms. At the end of rehabilitation, 37had no symptoms anymore (BI10), 20were able to control micturition to acertain extent (BI5), and 30had no lower urinary tract control (BI0). There was asignificant negative correlation between post-void residual volume and overall BI (ρ -0.5823, p< 0.0001) and BI for urinary tract control (ρ -0.6430, p< 0.0001). Overall BI and BI for urinary tract control are suitable screening criteria for urodynamic assessment.

Peripheral repetitive magnetic stimulation for the treatment of neurogenic urinary disorders: literature review and investigational study

Urinary disorders caused by peripheral nervous system injury are characterized by weakness of neural control of lower urinary tract. Clini cal and urodynamic examination demonstrate detrusor-hyporeflexia and its reduced contractility. Magnetic stimulation influences autonomic and somatic nerves innervating pelvic organs but the mechanism of action is still unclear. This paper presents literature review on diagnostics and treatment of neurogenic urinary disorders by using magnetic stimulation and the results of our investigational study. 7 patients with neurogenic urinary retention were included in a prospective study of peripheral repetitive magnetic stimulation. Prolonged clinical improvement during the follow-up of 3 months was observed in all patients.

Tanshinone IIA improves functional recovery in spinal cord injury-induced lower urinary tract dysfunction.

Tanshinone IIA, extracted from Salvia miltiorrhiza Bunge, exerts neuroprotective effects through its anti-inflammatory, anti-oxidative and anti-apoptotic properties. This study intravenously injected tanshinone IIA 20 mg/kg into rat models of spinal cord injury for 7 consecutive days. Results showed that tanshinone IIA could reduce the inflammation, edema as well as compensatory thickening of the bladder tissue, improve urodynamic parameters, attenuate secondary injury, and promote spinal cord regeneration. The number of hypertrophic and apoptotic dorsal root ganglion (L6-S1) cells was less after treatment with tanshinone IIA. The effects of tanshinone IIA were similar to intravenous injection of 30 mg/kg methylprednisolone. These findings suggested that tanshinone IIA improved functional recovery after spinal cord injury-induced lower urinary tract dysfunction by remodeling the spinal pathway involved in lower urinary tract control.

A novel infusion-drainage device to assess lower urinary tract function in neuro-imaging.

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. 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). 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. 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.

305 Supraspinal lower urinary tract control in spinal cord injury patients: A structural and functional MRI study

305 Supraspinal lower urinary tract control in spinal cord injury patients: A structural and functional MRI study

Grey and White Matter Magnetisation Transfer Ratio Measurements in the Lumbosacral Enlargement: A Pilot In Vivo Study at 3T

Magnetisation transfer (MT) imaging of the central nervous system has provided further insight into the pathophysiology of neurological disease. However, the use of this method to study the lower spinal cord has been technically challenging, despite the important role of this region, not only for motor control of the lower limbs, but also for the neural control of lower urinary tract, sexual and bowel functions. In this study, the feasibility of obtaining reliable grey matter (GM) and white matter (WM) magnetisation transfer ratio (MTR) measurements within the lumbosacral enlargement (LSE) was investigated in ten healthy volunteers using a clinical 3T MRI system. The mean cross-sectional area of the LSE (LSE-CSA) and the mean GM area (LSE-GM-CSA) were first obtained by means of image segmentation and tissue-specific (i.e. WM and GM) MTR measurements within the LSE were subsequently obtained. The reproducibility of the segmentation method and MTR measurements was assessed from repeated measurements and their % coefficient of variation (%COV). Mean (± SD) LSE-CSA across 10 healthy subjects was 59.3 (± 8.4) mm2 and LSE-GM-CSA was 17.0 (± 3.1) mm2. The mean intra- and inter-rater % COV for measuring the LSE-CSA were 0.8% and 2.3%, respectively and for the LSE-GM-CSA were 3.8% and 5.4%, respectively. Mean (± SD) WM-MTR was 43.2 (± 4.4) and GM-MTR was 40.9 (± 4.3). The mean scan-rescan % COV for measuring WM-MTR was 4.6% and for GM-MTR was 3.8%. Using a paired t-test, a statistically significant difference was identified between WM-MTR and GM-MTR in the LSE (p<0.0001). This pilot study has shown that it is possible to obtain reliable tissue-specific MTR measurements within the LSE using a clinical MR system at 3T. The MTR acquisition and analysis protocol presented in this study can be used in future investigations of intrinsic spinal cord diseases that affect the LSE.

The Swiss Continence Foundation Award: promoting the next generation in neuro-urology and functional urology.

Neuro-urology and functional urology are usually under-represented in the oncology dominated urological world. However, the prevalence of lower urinary tract symptoms (LUTS) is high and will increase further due to the increasing ageing population 1. Also more and more neurological patients will require professional neuro-urological consultation and management due to the high prevalence and incidence of several neurological diseases with frequent and severe impairment of lower urinary tract (LUT) function. LUT dysfunction not only impairs the quality of life of affected patients but also decreases productivity at home and work, resulting subsequently not only in the directly related costs of diagnosis and treatment but also in a significant economic burden for each society and healthcare system 2-4. Hence, neuro-urology and functional urology are highly relevant medical specialties in great demand. Moreover, neuro-urology and functional urology are young, innovative, and highly dynamic disciplines bridging neurological, gynecological, gastroenterological, and urological aspects of diagnosis and management allowing a significant look beyond each medical specialty and thus offering many career options in the clinic and research or both. Only in recent decades has it been progressively appreciated that the bladder is more than just a simple sack storing and releasing urine. The bladder wall is literally ‘alive’ comprising highly interactive layers communicating through a variety of receptors and neurotransmitters 5. Also, we have learnt about the supraspinal network influencing LUT control and its alterations in disease or in response to interventions 6, 7. Despite such advances, many physiological and pathophysiological questions still remain unanswered. In addition, there is a limited choice of treatments and the existing treatments have resulted in only slight improvements. Hence, there is urgent need for more: More development and improvement of diagnostics and treatments, more basic understanding on the pathophysiology of LUT dysfunction, and, most importantly, more young clinicians and researchers taking care of patients and future research. We need young appropriately trained and highly motivated clinicians and researchers to build the future of this speciality. Thus, it is our duty to support and encourage young talents in neuro-urology and functional urology, to retain them in the field, and to attract more to join. The Swiss Continence Foundation Award (http://www.swisscontinencefoundation.ch) represents such support for young talents. It comes with prize money of CHF 10 000 and is awarded to the best of the candidates who have been invited from all incoming award applications to present their current work in neuro-urology and functional urology to an international expert jury and the auditorium of the International Neuro-Urology Meeting. This year, The Swiss Continence Foundation Award has been awarded for the second time during the International Neuro-Urology Meeting in Zürich, Switzerland (Figs 1,2) and the prize-winning work of Véronique Phé entitled ‘Foxp3 expression serves as a marker of squamous cell differentiation and aggressive pathology of urothelial carcinomas in neurological patients’, is published in this BJUI supplement 8. Assembly of the award jury and award candidates at The Swiss Continence Foundation Award ceremony 2014. The invited candidates presented their current work in neuro-urology and functional urology during the 3rd International Neuro-Urology Meeting, 28–30 August 2014 in Zürich, Switzerland. From left to right, back row: Thomas M. Kessler, Ulrich Mehnert, Gommert A. van Koeveringe, Emmanuel Chartier-Kastler, Helmut Madersbacher, Francisco Cruz, Véronique Phé, Claudius Füllhase, Bahareh Abtahi. Front row: Jetske van Breda, Katarina Tudor, Tom Macrelissen, Saladin H. M. Alloussi, Mohammad Rahnama'i. The Chairmen of The Swiss Continence Foundation together with the current Swiss Continence Foundation Award 2014 winner Véronique Phé and the very first award winner form last year, Claudius Füllhase. All Swiss Continence Award winners become members of the Swiss Continence Foundation Award Alumni Circle and will be invited to all future International Neuro-Urology Meetings as guests of honour. From left to right: Thomas M. Kessler, Véronique Phé, Claudius Füllhase, Ulrich Mehnert. It was a great pleasure for all to have these young talents in the field among the more established experts, thereby providing them a platform for knowledge exchange, making new contacts, and career building. We are delighted to announce next year's Award and encourage all young (age ≤35 years) clinicians and researchers but also all research group leaders and clinical programme directors working in the field of neuro-urology and functional urology to motivate their suitable candidates to apply for The Swiss Continence Foundation Award 2015. Detailed application criteria are available at http://www.swisscontinencefoundation.ch. The authors declare that they have no conflict of interest.

PD1-10 SUPRASPINAL CONTROL OF LOWER URINARY TRACT FUNCTION IN PATIENTS WITH SPINAL CORD INJURY: AN FMRI STUDY

INTRODUCTION AND OBJECTIVES: The control of the lower urinary tract (LUT) is a complex, multilevel process involving both the peripheral and central nervous system. Most patients with spinal cord injury (SCI) suffer from neurogenic LUT dysfunction and LUT symptoms severely impair the patients’ health-related quality of life. Although there are several concepts regarding neuronal control and perception in the normal and pathological LUT condition, the exact mechanisms involved remain to be elucidated. METHODS: In this functional magnetic resonance imaging (fMRI) study, we prospectively assessed 20 patients (mean age 43 years old, range 25e75) with cervical and thoracic SCI (12 with complete and 8 with incomplete lesion) suffering from neurogenic detrusor overactivity. All subjects underwent data acquisition in a 3 Tesla scanner. The scan paradigm (SP) comprised 3 different bladder stimulations: (1) repetitive bladder filling of 100mL body warm saline starting with an empty bladder, (2) repetitive infusion and withdrawal (100mL) of body warm saline starting with a pre-filled bladder and (3) repetitive bladder filling of 100mL cold saline. Date was analysed using SPM8. Second-level random effects group analysis (at a voxel-threshold of P<0.001 using false discovery rate correction at cluster level) was performed to account for between subject variability. Only subjects with significant activity (first-level analysis, P1⁄40.05 familywise error rate) were included. RESULTS: 6 subjects had to be excluded from certain analysis due to excessive head motions, autonomic dysreflexia or urinary incontinence during data acquisition. At first-level analysis, we found significant activation in 67% (12/17), 56% (9/15) and 66% (10/15) for SP (1), (2) and (3), respectively. At second-level analysis, significant activation was found in all 3 SP. (1): right inferior frontal gyrus (BA 45), left middle frontal gyrus (BA 10/46), left superior medial frontal gyrus, dorsal posterior cingulate area (BA 31) and bilateral middle temporal gyrus (BA21); (2): anterior left insula and inferior parietal lobe; (3): right precentral gyrus (BA 6) and left superior parietal lobe (BA 7). Activations were seen in both complete and incomplete SCI patients. CONCLUSIONS: In our patients with SCI, significant brain activation similar as reported for healthy subjects, non-neurological and other neurological patients with detrusor overactivity was detected. SP (1) showed activation in more brain areas than (2) and (3). Our findings suggest that extra-spinal sensory pathways might also be involved in LUT control.

MP12-06 SUPRASPINAL ACTIVITY TO AUTOMATED, REPETITIVE BLADDER FILLING - AN FMRI STUDY

INTRODUCTION AND OBJECTIVES: Recent fMRI studies revealed supraspinal networks in response to bladder filling involved in perception and processing of bladder distension. However significance of supraspinal network activity and network localizations varied largely due to the different filling protocols. Therefore, our aim was to standardize filling paradigms using a MR-synchronized pump system for accurate timing and filling volume. METHODS: 31 right-handed healthy subjects, 16 women and 15 men, mean age 34 years (range 19e54) with no history of urinary urgency and/or urinary incontinence were included, were prospectively investigated using a 3 Tesla Phillips scanner. After catheterization, bladder was pre-filled until a persistent desire to void was perceived by each subject. The scan paradigm comprised automated, repetitive bladder filling of 100 mL body warm saline over 15sec by using a MRcompatible pump system, i.e. block design study. Neuroimaging data was analyzed with SPM8. Blood-oxygenation-level dependent signal analysis during bladder filling was compared to rest, i.e. pre-filled bladder. Second-level random effects group analysis was corrected for gender, age and total intracranial volume and was performed to account for between-subject variability, i.e. within-group results at P1⁄40.05 familywise error rate (FWE). RESULTS: 3 subjects, 2 women and 1 man, were excluded from further analysis due to excessive head motions. Within-group results from the remaining 28 subjects revealed activation in the following brain regions: bilateral insula, left inferior parietal lobe (BA40) and right frontal inferior operculum (BA44). CONCLUSIONS: Automated, repetitive bladder filling of body warm saline elicited robust brain activity on a high significance level in specific areas known to be involved in supraspinal lower urinary tract control.

MP12-07 THE ROLE OF GLYCINE IN PUDENDAL NERVE STIMULATION AND BLADDER OVERACTIVITY

INTRODUCTION AND OBJECTIVES: Recent fMRI studies revealed supraspinal networks in response to bladder filling involved in perception and processing of bladder distension. However significance of supraspinal network activity and network localizations varied largely due to the different filling protocols. Therefore, our aim was to standardize filling paradigms using a MR-synchronized pump system for accurate timing and filling volume. METHODS: 31 right-handed healthy subjects, 16 women and 15 men, mean age 34 years (range 19e54) with no history of urinary urgency and/or urinary incontinence were included, were prospectively investigated using a 3 Tesla Phillips scanner. After catheterization, bladder was pre-filled until a persistent desire to void was perceived by each subject. The scan paradigm comprised automated, repetitive bladder filling of 100 mL body warm saline over 15sec by using a MRcompatible pump system, i.e. block design study. Neuroimaging data was analyzed with SPM8. Blood-oxygenation-level dependent signal analysis during bladder filling was compared to rest, i.e. pre-filled bladder. Second-level random effects group analysis was corrected for gender, age and total intracranial volume and was performed to account for between-subject variability, i.e. within-group results at P1⁄40.05 familywise error rate (FWE). RESULTS: 3 subjects, 2 women and 1 man, were excluded from further analysis due to excessive head motions. Within-group results from the remaining 28 subjects revealed activation in the following brain regions: bilateral insula, left inferior parietal lobe (BA40) and right frontal inferior operculum (BA44). CONCLUSIONS: Automated, repetitive bladder filling of body warm saline elicited robust brain activity on a high significance level in specific areas known to be involved in supraspinal lower urinary tract control.

Neural control of lower urinary tract and targets for pharmacological therapy.

Studies on the physiology and pharmacology of the lower urinary tract have brought new information and concepts about the complex neural control of micturition. There are many mechanisms, some proven and others not yet completely understood, in which pharmacological agents may act facilitating the filling, storage, and emptying of the bladder. This review describes the peripheral innervation and the main pathways involved in lower urinary tract control. It also presents potential targets for the treatment of voiding dysfunctions.

Bladder function in patients with dystonia undergoing deep brain stimulation.

Neurogenic bladder dysfunction is well described in Parkinson's disease and has a major impact on quality of live. In contrast, little is known about the extent of urinary symptoms in other movement disorders such as dystonia and about the role of the basal ganglia in bladder control.. A consecutive series of 11 patients with severe dystonia undergoing deep brain stimulation (DBS) of the globus pallidus internus was prospectively enrolled. Bladder function was assessed by the International Prostate Symptom Score and urodynamic investigation (UDI) before DBS surgery and afterwards in the conditions with and without DBS. In UDI before DBS surgery, detrusor overactivity was found in 36% (4/11) of dystonia patients. With pallidal DBS ON, maximum flow rate significantly decreased, post-void residual significantly increased and detrusor overactivity disappeared.. Pathological urodynamic changes can be found in a relevant percentage of dystonia patients. Pallidal DBS has a relaxing effect on detrusor function indicating a role of the basal ganglia in lower urinary tract control. Thus, a better understanding on how subcortical networks influence lower urinary tract function might open new therapeutic perspectives..