Brain Activity Measured by Functional Magnetic Resonance Imaging is Related to Patient Reported Urgency Urinary Incontinence Severity

Abstract

Purpose-To investigate the relationship between experimental neuroimaging and self-reported measures of urinary incontinence.Materials and Methods-We evaluated 14 functionally independent, community-dwelling older women (> 60 years) who had moderate to severe urgency urinary incontinence. All underwent detailed clinical assessment (3-day bladder diary, 24-hour pad test, and quality of life assessment), urodynamic testing, and functional brain scanning. Brain activity during reported urgency was assessed using a method that combines fMRI with simultaneous urodynamic monitoring during repeated cycles of bladder filling/emptying. We used SPM2, a statistical parametric mapping program, to correlate brain activity with relevant clinical covariates, including number of urgency incontinent episodes, amount of urine leakage, and psychological burden as assessed by the Urge Impact Scale (URIS-24) questionnaire.Results-Activity in rostral and subgenual anterior cingulate gyrus, insula, inferior frontal gyrus, orbitofrontal cortex, dorsal and posterior cingulate gyrus, parahippocampus, cuneus and parts of parieto-temporal lobe correlated positively with daytime incontinence frequency and urine loss. Different brain regions correlated with the psychological burden, and the associations were inverse: precuneus/cuneus and posterior cingulate gyrus, superior temporal, supramarginal, and transverse gyrus.Conclusions-Regional brain activity in the setting of self-reported urgency, as provoked by bladder filling, correlates significantly with the severity of incontinence in daily life as well as the associated psychological burden. Thus, observations made under experimental conditions correlate with patients' real-life experience and suggest neural correlates of urgency incontinence symptoms that could be used as potential targets for future investigations.

CNS and bladder (short review for clinicians)

“…In subjects who lost control of their bladder during bladder filling in the scanner, such activity amplifies (19). Regional brain activity during reported urgency in the scanner also correlates with reports of urgency incontinence on the bladder diary (17). One of the possible causes of such increased activity during urgency in older women with urinary incontinence may be due to the damage of white matter pathways that connect these centers in the brain.…”

“…For example, during voiding the activation of the right inferior frontal gyrus (adjacent to the dlPFC) and the medial PFC (adjacent/near to the anterior cingulate (6,7,13,16). Studies during filling of an already well-filled bladder and reported urgency also show significant activation in the dlPFC and deactivation in the ventromedial and medial part of PFC (17).…”

“…A group from the University of Pittsburgh (Geriatric Continence Research Unit) has published several studies on older women with urgency incontinence describing regional brain activity during urgency (8,9,17,23). Such activity encompasses abnormally strong activations in the SMA, dACG, insula and dlPFC, together with deactivations in the ventromedial cortex and parahippocampus (see Figure 5).…”

What was “hot” at the ICS annual meeting San Francisco 2009

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“…However, there were no statistical differences in any outcome measure between the TOT and TVT procedures. Johnson and Latini (Abstract 218) 71 showed that urethroplasty improves lower urinary tract symptoms as measured by the American Urological Association Symptom Index with no significant effect on continence or sexual function as measured by the ISI and Sexual Health Inventory for Men. Chung et al (Abstract 220) 72 found that MRI had a 22.5% diagnostic error rate in the evaluation of urethral diverticulae.…”