Pd43-02 a Functional Mri Study of Voluntary and Involuntary Detrusor Contractions in Stroke Patients

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Overactive Bladder I (PD43)1 May 2024PD43-02 A FUNCTIONAL MRI STUDY OF VOLUNTARY AND INVOLUNTARY DETRUSOR CONTRACTIONS IN STROKE PATIENTS Luis Morales Ojeda, Aidin Abedi, Stefania Montero, Priya Kohli, Petr Gaburak, Nhi Ha, David Chapman, David Ginsberg, Kay Jann, and Evgeniy Kreydin Luis Morales OjedaLuis Morales Ojeda , Aidin AbediAidin Abedi , Stefania MonteroStefania Montero , Priya KohliPriya Kohli , Petr GaburakPetr Gaburak , Nhi HaNhi Ha , David ChapmanDavid Chapman , David GinsbergDavid Ginsberg , Kay JannKay Jann , and Evgeniy KreydinEvgeniy Kreydin View All Author Informationhttps://doi.org/10.1097/01.JU.0001009568.19060.25.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary urge incontinence is defined by detrusor overactivity, which occurs without conscious cortical control. Interestingly, brain activity associated with voluntary versus involuntary bladder contractions has not been previously assessed. In this study, we adopted a stroke model of urge incontinence to determine the brain activity associated with both voluntary and involuntary detrusor contractions. METHODS: 16 stroke survivors (12 men, 75%; mean age 57.1±8.5) who experienced overactive bladder symptoms were included in the study. They underwent simultaneous blood-oxygen-level-dependent (BOLD) fMRI and urodynamics assessment, involving four filling cycles. Participants were asked to void four times during the experiment after each filling. While some voids occurred at the designated time (volitional contraction), others occurred outside of this period (DOs). Each detrusor contraction was divided into four phases (early - 10 seconds before contraction, rise - from baseline Pdet to peak Pdet, plateau, and fall - from peak Pdet to baseline) and classified as either volitional or involuntary. Generalized linear models were generated for each condition, and second-level analysis was performed to compare BOLD signal changes during each phase of the contraction between volitional and involuntary contractions. Significance was set at p<0.01 with a minimum cluster size of 25 voxels. RESULTS: A total of 8 volitional and 23 involuntary detrusor contractions were identified. Overall, an increased BOLD signal intensity was observed in volitional contractions compared to DOs in each phase. There was variation in cluster size and peak intensity, but cluster coordinates remained consistent across the four contraction phases. Compared to DOs, the BOLD effect was markedly increased in the anterior cingulate gyri, insula, supplementary motor area, postcentral (primary somatosensory), and precentral (primary motor) gyri during voluntary contractions. Clusters located primarily in the cerebellum, but also in the hippocampus, temporal lobe, and frontal lobe exhibited a higher BOLD effect during DOs compared to volitional contractions. CONCLUSIONS: Brain activity significantly differs between voluntary and involuntary detrusor contractions. Activation of regions previously implicated in LUT control seems necessary for initiating a volitional detrusor contraction. The disruption of neural pathways due to a stroke likely disrupts proper communication between these regions, inhibiting the signaling required for volitional voiding. Source of Funding: Urology Care Foundation © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e898 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Luis Morales Ojeda More articles by this author Aidin Abedi More articles by this author Stefania Montero More articles by this author Priya Kohli More articles by this author Petr Gaburak More articles by this author Nhi Ha More articles by this author David Chapman More articles by this author David Ginsberg More articles by this author Kay Jann More articles by this author Evgeniy Kreydin More articles by this author Expand All Advertisement PDF downloadLoading ...