Vascular incontinence: incontinence in the elderly due to ischemic white matter changes

Abstract

This review article introduces the new concept of vascular incontinence, a disorder of bladder control resulting from cerebral white matter disease (WMD). The concept is based on the original observation in 1999 of a correlation between the severity of leukoareosis or WMD, urinary symptoms, gait disorder and cognitive impairment. Over the last 20 years, the realization that WMD is not a benign incidental finding in the elderly has become generally accepted and several studies have pointed to an association between geriatric syndromes and this type of pathology. The main brunt of WMD is in the frontal regions, a region recognized to be crucial for bladder control. Other disorders should be excluded, both neurological and urological, such as normal-pressure hydrocephalus, progressive supranuclear palsy, etc., and prostatic hyperplasia, physical stress incontinence, nocturnal polyuria, etc. Treatment involves management of small vessel disease risk factors and anticholinergic drugs that do not easily penetrate the blood brain barrier to improve bladder control.

Tolterodine activates the prefrontal cortex during bladder filling in OAB patients: A real‐time NIRS‐urodynamics study

“…The study population was nine males and four females with OAB; mean age 73 years, range 46–84 years; underlying diseases, eight Parkinson's disease (PD, a basal ganglia disease) and five ischemic white matter lesion (WML, a subcortical disease) . None of the patients had any distinct lesion in the frontal cortex.…”

Is overactive bladder a brain disease? The pathophysiological role of cerebral white matter in the elderly

“…The findings strongly indicated that the problem of incontinence in the frail elderly is age‐related changes in the bladder itself. In contrast, a recent view has emerged that there might also be a cerebral vascular component in vascular incontinence . Sakakibara et al .…”

“…Cerebral WMD is a common chronic ischemic brain disease in the elderly. WMD progresses insidiously, leading to three different geriatric syndromes: vascular dementia, vascular parkinsonism and “vascular incontinence” . As the likelihood of WMD increases significantly with age, WMD might become an anatomical substrate in the brain etiology of OAB.…”

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

“…Until recently, the role of the central nervous system (CNS) in bladder control has been little investigated. Several investigators have speculated that damage to the connectivity of the brain's voiding control network, manifested as white matter hyperintensities (WMH) on magnetic resonance imaging, might be linked to UUI . Since UUI occurs mainly in the elderly, however, other physiologic, pathologic, and drug‐related changes in the central nervous system and the lower urinary tract may also contribute, hindering interpretation.…”