Do brain structural abnormalities differentiate separate forms of urgency urinary incontinence?

Abstract

Many women with UUI have white-matter damage that interferes with pathways critical to bladder control; they can be taught by techniques like BFB to exert stronger control over the bladder. For others, in whom abnormalities of key brain areas are less marked, UUI's cause may reside elsewhere, and therapy targeting these brain centers may be less effective than therapy targeting the bladder or other brain centers.

Functional connectivity of the brain in older women with urgency urinary incontinence

“…Although these results are associations and do not prove causal effect, findings are congruent with our prior data and supportive of our hypothesis that there are two subsets of UUI: one in which the predominant contributor is within the brain and responds to PFMT; and another in which the predominant contributor is elsewhere and does not respond to biofeedback therapy which targets the brain.…”

“…Previously, we have postulated that there are two types of UUI, 6 both of which have some degree of underlying bladder dysfunction, but one in which abnormalities of brain control play a major role and one in which the brain's role is less important. Since the effect of PFMT is presumably mediated through brain mechanisms, then individuals with the first type of UUI-in which baseline brain connectivity is most abnormal-might be more likely to respond to PFMT, and develop connectivity closer to that seen in continent controls.…”

“…Results suggested that at baseline, those who responded well to PFMT initially had more overt structural damage which somewhat improved; we hypothesized that this may be a subset in which the main contributor to the UUI was brain-based. 6 Here we present the third approach, a hypothesis-driven secondary analysis of this data, focusing on the functional connectivity of a priori selected brain areas during rest and urinary urgency, specifically differences between continent women and those with UUI, and changes attributed to the effects of PFMT. We assessed "resting state" and "effective" task-based connectivity.…”

New Diagnostics for Male Lower Urinary Tract Symptoms

“…[78] Moving forward, fMRI is being used to evaluate the differences in signaling in patients with LUTS who respond to treatment, versus nonresponders to develop novel treatment targets for non-responders. [80] Brain fNIRS has been developed using NIRS technology as a method to evaluate activation of certain regions of the cerebral cortex. The concept behind how the imaging modality works is that active areas of the brain have a large increase in blood flow due to neurovascular coupling, which leads to an excess of oxygenated blood as the amount of oxygenated blood delivered exceeds that of the neuronal oxygen usage.…”

“…Development of new therapies for patients with DO that do not respond to anti-muscarinic medication. 80 fNIRS is able to demonstrate cerebral region functionality similarly to fMRI in a non-restrictive environment. [81][82][83][84][85] Tadic 75 , Khavari 76 , Clarkson 80 , Ferrari 81 , Matsumoto [82][83] , Sakakibara 84,85 DO = detrusor overactivity, OAB= overactive bladder, LUTS = lower urinary tract symptoms, SMA = supplementary motor area, fNIRS = functional near-infrared spectroscopy, fMRI = functional magnetic resonance imaging…”