As the size of functional and structural MRI datasets expands, it becomes increasingly important to establish a baseline from which diagnostic relevance may be determined, a processing strategy that efficiently prepares data for analysis, and a statistical approach that identifies important effects in a manner that is both robust and reproducible. In this paper, we introduce a multivariate analytic approach that optimizes sensitivity and reduces unnecessary testing. We demonstrate the utility of this mega-analytic approach by identifying the effects of age and gender on the resting-state networks (RSNs) of 603 healthy adolescents and adults (mean age: 23.4 years, range: 12–71 years). Data were collected on the same scanner, preprocessed using an automated analysis pipeline based in SPM, and studied using group independent component analysis. RSNs were identified and evaluated in terms of three primary outcome measures: time course spectral power, spatial map intensity, and functional network connectivity. Results revealed robust effects of age on all three outcome measures, largely indicating decreases in network coherence and connectivity with increasing age. Gender effects were of smaller magnitude but suggested stronger intra-network connectivity in females and more inter-network connectivity in males, particularly with regard to sensorimotor networks. These findings, along with the analysis approach and statistical framework described here, provide a useful baseline for future investigations of brain networks in health and disease.

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Background: Although the vaginal and urinary microbiomes have been increasingly wellcharacterized in health and disease, few have described the relationship between these neighboring environments. Elucidating this relationship has implications for understanding how manipulation of the vaginal microbiome may affect the urinary microbiome and treatment of common urinary conditions.Objective: To describe the relationship between urinary and vaginal microbiomes using 16S rRNA gene sequencing. We hypothesized that the composition of the urinary and vaginal microbiomes would be significantly associated, with similarities in predominant taxa.Study Design: This multicenter study collected vaginal swabs and catheterized urine samples from 186 women with mixed urinary incontinence (MUI) enrolled in a parent study and 84 similarly aged controls. Investigators decided a priori that if vaginal and/or urinary microbiomes differed between continent and incontinent women, the groups would be analyzed separately; if similar, samples from continent and incontinent women would be pooled and analyzed together. A central laboratory sequenced variable regions 1-3 (v1-3) and characterized bacteria to the genus level. Operational taxonomic unit (OTU) abundance was described for paired vaginal and urine samples. Pearson's correlation characterized the relationship between individual OTUs of paired samples. Canonical Correlation Analysis (CCA) evaluated the association between clinical variables (including MUI and control status) and vaginal and urinary OTUs, using the CCA function in the Vegan package (R version 3.5). Linear discriminant analysis effect size (LEfSe) was used to find taxa that discriminated between vaginal and urinary samples.Results: Urinary and vaginal samples were collected from 212 women [mean age 53 (±11 years)] and results from 197-paired samples were available for analysis. As OTUs in MUI and control samples were related in CCA and since taxa did not discriminate between MUI or controls in either vagina or urine, MUI and control samples were pooled for further analysis. CCA of vaginal and urinary samples indicated that that 60 of the 100 most abundant OTUs in the samples largely overlapped. Lactobacillus was the most abundant genus in both urine and vagina (contributing on average 53% to an individual's urine sample and 64% to an individual's vaginal sample) (Pearson correlation r=0.53). Though less abundant than Lactobacillus, other bacteria with high Pearson correlation coefficients also commonly found in vagina and urine included: Gardnerella (r=0.70), Prevotella (r=0.64), and Ureaplasma (r=0.50). LEfSe analysis identified Tepidomonas and Flavobacterium as bacteria that distinguished the urinary environment for both MUI and controls as these bacteria were absent in the vagina (Tepidimonas effect size 2.38, p<0.001, Flavobacterium effect size 2.15, p<0.001). Though Lactobacillus was the most abundant bacteria in both urine and vagina, it was more abundant in the vagina (LEfSe effect size 2.72, p<0.001).Conclusion...

We compared a large group of US women with severe urgency urinary incontinence (UUI) who received sacral neuromodulation (InterStim) or onabotulinumtoxinA (Botox A) therapy during a 2-yr period. We found that both therapies had similar success in reducing UUI symptoms, and adverse events were low. However, women in the BotoxA group had higher satisfaction and endorsement with their treatment, but with a higher chance of a urinary tract infection. We conclude that both therapies offer sustained reduction in daily incontinence over 2 yr.

Introduction & Hypothesis Previous studies have suggested that women with urinary incontinence have an altered urinary microbiome. We hypothesized that the microbiome in women with mixed urinary incontinence (MUI) differed from controls and tested this hypothesis using bacterial gene sequencing techniques. Methods This multicenter study compared the urinary microbiome in women with MUI and similarly aged controls. Catheterized urine samples were obtained; v4–6 regions of the 16S rRNA gene were sequenced to identify bacteria. Bacterial predominance (> 50% of an individual’s genera) was compared between MUI and controls. Bacterial sequences were categorized into “community-types” using Dirichlet multinomial mixture (DMM) methods. Generalized linear mixed models predicted MUI/control status based on clinical characteristics and community-type. Post-hoc analyses were performed in women <51 and ≥51 years. Sample size estimates required 200 samples to detect a 20% difference in Lactobacillus predominance with P<.05. Results Of 212 samples, 97.6% were analyzed (123 MUI/84 controls, mean age 53±11 years). Overall Lactobacillus predominance did not differ between MUI and controls (45/123=36.6% vs. 36/84=42.9%, P=0.36). DMM analyses revealed six community-types; communities differed by age (P=0.001). A High-Lactobacillus (89.2% Lactobacillus) community had a greater proportion of controls (19/84=22.6%, MUI 11/123=8.9%). Overall, bacterial community-types did not differ in MUI and controls. However, post-hoc analysis of women <51 years found that bacterial community-types distinguished MUI from controls (P=0.041); Moderate-Lactobacillus (aOR 7.78, CI 1.85–32.62) and Mixed (aOR 7.10, CI 1.32–38.10) community-types were associated with MUI. Community-types did not differentiate MUI and controls in women ≥51 years (P=0.94). Conclusions Women with MUI and controls did not differ in overall Lactobacillus predominance. In younger women, urinary bacterial community-types differentiated MUI from controls.

Introduction & Hypothesis Urinary incontinence (UI) is common and the relationship between its subtypes is complex. Our objective was to describe the natural history and predictors of incontinence subtypes, Stress, Urgency and Mixed, in mid-aged and older U.S. women. We hypothesized that past UI subtype history predicted future UI subtype status and sought to determine the extent to which this occurred. Methods We analyzed longitudinal urinary incontinence data in 10,572 community-dwelling women ≥50 in the 2004–2010 Health and Retirement Study database. Mixed, Stress, Urgency incontinence prevalence (2004,2006,2008,2010) and 2-year cumulative incidence and remissions (2004–6,2006–8 2008–10) were estimated. Patient characteristics and incontinence subtype status 2004–2008 were entered into a multivariable model to determine predictors for incontinence subtype occurrence in 2010. Results Prevalence of each subtype in this population (median age 63–66) was 2.6%–8.9%. Subtype incidence equaled 2.1–3.5% and remissions for each varied between 22.3–48.7%. Incontinence subtype incidence predictors included ethnicity/race, age, body mass index, functional limitations. Compared to White women, Black women had decreased odds of incident Stress Incontinence, Hispanic women had increased odds of Stress Incontinence remission. Age 80–90 and severe obesity predicted incident Mixed Incontinence. Functional limitations predicted Mixed and Urgency Incontinence. The strongest predictor of incontinence subtypes was incontinence subtype history. Presence of the respective incontinence subtypes in 2004 and 2006 strongly predicted 2010 recurrence [Odds Ratio (OR) Stress Incontinence=30.7, Urgency OR=47.4, Mixed OR=42.1]. Conclusions Although remissions were high, prior history of incontinence subtypes predicted recurrence. Incontinence status is dynamic but tends to recur over the longer term.

OBJECTIVE We sought to determine whether mental imagery improves surgical performance of residents novice to cystoscopy. STUDY DESIGN We performed a multicenter randomized controlled trial. Residents who had performed ≤ 3 cystoscopies were randomized to preoperative mental imagery sessions or reading a book chapter describing cystoscopy. The primary outcome was comparison of groups’ surgical performance scores. Secondary outcomes were measurements of operative times and resident ratings of helpfulness of their preparation. Scores were compared using 2-factor analysis of variance. RESULTS In all, 68 residents were randomized; 33 to imagery and 35 to control groups. Groups did not differ in age, cystoscopic experience, residency level, or sex. The imagery group’s surgical assessment scores were 15.9% higher than controls (P = .03). Operative times did not differ between groups. Imagery residents rated imagery preparation as more helpful than controls (P < .0001). CONCLUSION Residents considered mental imagery to be a more useful preoperative preparation. The mental imagery group’s surgical performance was superior to controls.

Background Treatment of urgency urinary incontinence has focused on pharmacologically treating detrusor overactivity. Recent recognition that altered perception of internal stimuli (interoception) plays a role in urgency urinary incontinence suggests that exploration of abnormalities of brain function in this disorder could lead to better understanding of urgency incontinence and its treatment. Objectives 1) To evaluate the relationship between bladder filling, perceived urgency and activation at brain sites within the interoceptive network in urgency urinary incontinence 2) To identify coactivation of other brain networks that could affect interoception during bladder filling in urgency incontinence 3) To demonstrate interaction between these sites prior to bladder filling by evaluating their resting state connectivity Study Design We performed an observational cohort study using functional magnetic resonance imaging to compare brain function in 53 women with urgency urinary incontinence and 20 Controls. Whole-brain voxel-wise ANCOVAs were performed to examine differences in functional brain activation between groups during a task consisting of bladder filling, hold (static volume) and withdrawal phases. The task was performed at three previously established levels of baseline bladder volume, the highest exceeding strong desire to void volume. All women continuously rated their urge on a 0–10 point Likert scale throughout the task and a mixed measures ANOVA was used to test for differences in urge ratings. Empirically derived regions of interest from analysis of activation during the task were used as seeds for examining group differences in resting state functional connectivity. Results In both urgency urinary incontinent participants and Controls changes in urge ratings were greatest during bladder filling initiated from a high baseline bladder volume and urgency incontinent participants’ rating changes were greater than Controls. During this bladder filling phase urgency incontinent participant’s activation of the interoceptive network was greater than Controls, including in the left insula and the anterior and middle cingulate cortex. Urgency Incontinent Participant’s activation was also greater than Controls at sites in the Ventral Attention Network and Posterior Default Mode Network. Urgency incontinent participant’s connectivity was greater than Controls between a middle cingulate seed point and the Dorsal Attention Network, a “top down” attentional network. Control connectivity was greater between the mid-cingulate seed point and the Ventral Attention Network, a “bottom up” attentional network, Conclusions Increasing urge was associated with greater urgency incontinent participant than Control activation of the interoceptive network and activation in networks that are determinants of self-awareness (Default Mode Network) and of response to unexpected external stimuli (Ventral Attention Network). Differences in connectivity between interoceptive networks and opposing attentional networks (Ventra...