Changes in brain response to urgency before and after treatment of urgency urinary incontinence with onabotulinumtoxin A.

Introduction: To better understand the role of the brain in urgency urinary incontinence (UUI), we used onabotulinumtoxin A (BoNTA) as a probe to evaluate changes in the brain's response to urgency in successful and unsuccessful treatment. Because BoNTA acts peripherally, brain changes observed should represent a reaction to changes in bladder function caused by BoNTA, or changes in the brain's compensatory mechanisms, rather than a direct effect of BoNTA on the brain.

Methods: We recruited 20 women aged over 60 years with nonneurogenic UUI who were to undergo treatment with onabotulinum A toxin injected intravesically.

Testing a new, intensified infusion-withdrawal protocol for urinary urgency provocation in brain-bladder studies.

Introduction: The brain's role in bladder control has become an important area of study in the last 15 years. Typically, the brain's role in urinary urgency has been studied by repeated infusion and withdrawal of fluid, per catheter, to provoke urgency sensation during a whole brain magnetic resonance imaging (MRI) scan. Since this technique generally requires a large group size, we tested a more intense infusion-withdrawal protocol in an attempt to improve signal to noise ratio and repeatability of the signal which would, in turn, allow us to further probe subtypes of urgency urinary incontinence.

Investigation of urinary storage symptoms in Parkinson's disease utilizing structural MRI techniques.

Background: Lower urinary tract symptoms occur in 27% to 86% of patients with Parkinson's disease (PD), however, the mechanisms responsible for bladder dysfunction are not fully understood. This study utilized magnetic resonance imaging (MRI) to test the hypothesis that key brainstem bladder control areas (including the pontine micturition center and the pontine continence center (PCC) and their links with the basal ganglia are important in the development of urinary storage symptoms in PD.

Methods: Seventeen patients with PD completed a "bladder symptom questionnaire" and underwent diffusion-weighted MRI (1.

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

Background: The brain's role in continence is critical but poorly understood. Although regions activated during bladder stimulation have been identified, little is known about the interaction between regions. In this secondary analysis we evaluate resting state and effective connectivity in older women treated for urgency urinary incontinence (UUI).

Test-retest repeatability of patterns of brain activation provoked by bladder filling.

Objective: To assess short-term repeatability of an fMRI protocol widely used to assess brain control of the bladder. fMRI offers the potential to discern incontinence phenotypes as well as the mechanisms mediating therapeutic response. If so, this could enable more targeted efforts to enhance therapy.

The CNS and bladder dysfunction.

The brain's role in the development and maintenance of bladder control is critical, although its precise role in patient-reported complaints such as urgency and urine leakage is unknown. Functional brain imaging studies have advanced our knowledge of brain activity during the micturition cycle, showing multiple neuronal circuits involved as parts of a 'brain-bladder control network.' Yet, new advances need to be made in order to incorporate this knowledge into existing models of neuroanatomy and of clinical syndromes of bladder dysfunction and related clinical practice.

Use of functional imaging to monitor central control of voiding in humans.

Bladder problems are frequently disorders of control, which is exercised from the brain. In such disorders, brain responses to bladder events are abnormal; therapy is accompanied by regional changes that may be measured by functional imaging and used to monitor the effect of treatment. The regional responses may be understood in terms of a tentative model of the bladder control system.

Cerebral control of the lower urinary tract: how age-related changes might predispose to urge incontinence.

Loss of bladder control (urge incontinence) is common in elderly; the cause is usually unknown. Functional imaging has revealed the brain network controlling responses to bladder filling. Age-related changes in this network might predispose to urge incontinence.

A decade of functional brain imaging applied to bladder control.

Over the last 10 years functional brain imaging has emerged as the most powerful technique for studying human brain function. Although the literature is now vast, including studies of every imaginable aspect of cortical function, the number of studies that have been carried out examining brain control of bladder function is relatively limited. Nevertheless those that have been reported have transformed our thinking.

Parameters of bladder function in pre-, peri-, and postmenopausal continent women without detrusor overactivity.

Aims: To determine normative data for lower urinary tract function in asymptomatic continent women without detrusor overactivity (DO) across the age span.

Methods: Healthy female volunteers aged > or =20 years were recruited from the community. Comprehensive assessment included bladder diary, physical examination, uroflowmetry, and video-urodynamics.

Omnibus permutation tests of the overall null hypothesis in datasets with many covariates.

Tests of the overall null hypothesis in datasets with one outcome variable and many covariates can be based on various methods to combine the p-values for univariate tests of association of each covariate with the outcome. The overall p-value is computed by permuting the outcome variable. We discuss the situations in which this approach is useful and provide several examples.

The impact of detrusor overactivity on bladder function in younger and older women.

Purpose: We examined the relationship of DO and aging, and bladder function in female volunteers.

Materials And Methods: We recruited 85 cognitively competent, fully functional female volunteers who were 22 to 90 years old (median age 54) with and without symptoms suggestive of DO. Comprehensive assessment included a bladder diary, uroflowmetry and videourodynamics.

The effect of age on lower urinary tract function: a study in women.

Objectives: To identify age-associated changes in female lower urinary tract function across a wide age spectrum, controlling for detrusor overactivity (DO).

Design: Secondary analysis of a cross-sectional study of DO and aging. Eligible volunteers were stratified by age group and presence of DO.

Factors that distinguish continent from incontinent older adults with detrusor overactivity.

Purpose: In older adults detrusor overactivity (DO) is almost as common in continent individuals as in those with urge incontinence (UUI). Thus, UUI likely reflects the contribution of additional factors. We postulated that of functionally independent individuals in whom transient causes were excluded those in whom DO was accompanied by UUI would be more likely to have smaller functional bladder capacity, less warning and less ability to avert urine loss in the face of DO.

Cerebral control of bladder function.

Symptoms such as overactive bladder represent disorders of bladder control. Functional brain scanning by positron emission tomography and functional magnetic resonance imaging suggest that normal control is exerted by a network of regions in the emotional nervous system, including periaqueductal gray, thalamus, insula, anterior cingulate, and prefrontal cortex. The network receives afferent signals, converts them to bladder sensations, and brings them to conscious attention, together with an unpleasant affect (desire to void) that motivates bladder emptying and thus maintains homeostasis.

The pontine micturition centres.

Objective: To review recent literature on the function of the two postulated pontine regions (the M- and L-regions) concerned with lower urinary tract control.

Material And Methods: The work reviewed is based on stimulation and lesion experiments and post-operative follow-up in the cat, supported by acute chemical stimulation and blocking experiments in the rat and PET functional brain scanning in humans.

Results And Conclusions: The M-region in the cat, homologous to Barrington's micturition centre and to a similar area in humans, is a small region both specific and necessary to voiding, the origin of the final common pathway to bladder and urethra, and the locus of co-ordination of the bladder and the striated sphincter.

Urge incontinence and impaired detrusor contractility in the elderly.

Among the elderly, both urge incontinence and elevated residual urine are common. When they occur together, they present a challenging clinical problem, called detrusor hyperactivity with impaired contractile function (DHIC). Impaired detrusor contractility has two aspects: elevated post-void residual urine volume and reduced detrusor contraction strength.