OAB supraspinal control network, transition with age, and effect of treatment: A systematic review

Abstract

Objective In light of a better understanding of supraspinal control of nonneurogenic overactive bladder (OAB), the prevalence of which increases with age, functional imaging has gained significant momentum. The objective of this study was to perform a systematic review on the transition of supraspinal control of OAB with age, the effect of therapeutic modalities, and a coordinate‐based meta‐analysis of all neuroimaging evidence on supraspinal OAB control in response to bladder filling. Methodology We performed a systematic literature search of all relevant libraries in November 2021. The coordinates of brain activity were extracted from eligible neuroimaging studies to perform an activation likelihood estimation (ALE) meta‐analysis. Results A total of 16 studies out of 241 were selected for our systematic review. Coordinates were extracted from five experiments involving 70 patients. ALE meta‐analysis showed activation of the insula, supplementary motor area, dorsolateral prefrontal cortex, anterior cingulate gyrus, and temporal gyrus with a transition of activation patterns with age, using a threshold of uncorrected p < 0.001. Among young patients, neuroplasticity allows the activation of accessory circuits to maintain continence, as in the cerebellum and temporoparietal lobes. Anticholinergics, pelvic floor muscle training, sacral neuromodulation, and hypnotherapy are correlated with supraspinal changes attributed to adaptability and possibly a substratum of an intrinsic supraspinal component. The latter is better demonstrated by a resting‐state functional connectivity analysis, a promising tool to phenotype OAB with recent successful models of predicting severity and response to behavioral treatments. Conclusion Future neuroimaging studies are necessary to better define an OAB neurosignature to allocate patients to successful treatments.

A stepwise approach for functional near infrared spectroscopy measurement during natural bladder filling

“…fMRI studies have identified several key brain regions and processing pathways that may be different in OAB (increased urgency) as compared to normal voiding. These regions include the anterior cingulate gyrus and prefrontal cortex ( 21 - 25 ), which is the key region of focus in our current fNIRS investigation. Although fMRI enables visualization of the entire brain during filling, there are multiple issues with the technology.…”

Exploring lifelong overactive bladder: Transitions, evidence, and clinical implications; A modified Delphi process

“…This hypothesis posits that dysfunction at the supraspinal level plays a pivotal role in both the development and persistence of OAB symptoms across all age groups. 13 The brain regions activated during micturition in adults demonstrate comparable activation levels during micturition in children. These regions also hold a central role in the manifestation of common cooccurring psychiatric disorders in children with OAB, including attention deficit disorder and anxiety.…”

“…These advancements have allowed for a more robust demonstration of the role of an intrinsic supraspinal component in the development of OAB with stronger statistical inference. 13 In light of a lifelong concept, a more proactive approach to managing OAB throughout an individual's lifespan coupled with the different OAB profiles, may be possible. 4 In this regard, a personalized treatment can be offered not only based on the severity of the condition but adapted as well to the inherent pathophysiology.…”

Introductory editorial: Lifelong LUTS, a matter of transition?

“…Taking a broader perspective, bladder activity can be envisioned as a homeostatic equilibrium maintained by an intricate brain‐bladder control system 4 . This system is overseen by a complex supraspinal neural network and a baseline bladder tone influenced by local and physiological factors throughout one's lifespan.…”

“…Likewise, the maturation or aging of the supraspinal neural network and the bladder wall during transitional phases could influence OAB, reflecting changing patterns of detrusor overactivity across different age groups 4 . Advanced techniques in neuroimaging, tissue analysis, and ‐omics, coupled with the assistance of artificial intelligence, have illuminated shifts in the epidemiology of detrusor overactivity.…”