Brain responses to bladder filling in older women without urgency incontinence
| Autor: | Stasa Tadic, Cara Tannenbaum, Neil M. Resnick, Derek Griffiths |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
Urinary bladder Supplementary motor area business.industry Urology media_common.quotation_subject urologic and male genital diseases medicine.disease Brain mapping Urination female genital diseases and pregnancy complications Functional imaging medicine.anatomical_structure Cerebral blood flow Overactive bladder Internal medicine Anesthesia Cardiology Medicine Neurology (clinical) business Insula media_common |
| Zdroj: | Neurourology and Urodynamics. 32:435-440 |
| ISSN: | 0733-2467 |
| Popis: | In the past few decades, various methods of functional brain imaging have been used to study cerebral control of the bladder and urethra.1–9 Recent advances in the understanding of functional disorders such as urgency incontinence have been based largely on functional magnetic resonance imaging (fMRI) of regional brain responses to infusion of liquid into the bladder.10,11 Studies of older female subjects with urgency incontinence12,13 have linked bladder filling sensations such as desire to void and urgency14 to activation of a region near the insula and a region near the dorsal anterior cingulate cortex (dACC) and supplementary motor area (SMA). Similar bladder filling sensations are sometimes reported during daily life15,16 but in healthy individuals there is little awareness of bladder filling until a substantial volume of urine has accumulated, a desire to void is felt, and an opportunity to empty the bladder is sought.16 In normal subjects, brain responses to filling of the bladder when sensation is weak (or absent) have not been systematically investigated by functional imaging. In positron emission tomography studies1–4,17 bladder filling was continued until sensation was present; one fMRI study reported results for normal subjects, but not specifically when sensation was weak18; another was based on infusion and withdrawal of liquid by a rotary peristaltic pump.12 Its pulsatile flow may have provoked unrealistically strong sensations, making it unsuitable for addressing sensation-free brain responses. We therefore performed a study of brain responses to bladder filling in subjects without signs or symptoms of overactive bladder function. We included only older females. We carried out fMRI measurements of brain responses to bladder filling (taking care to avoid flow pulsations) at small bladder volumes, a situation which corresponds to weak or absent filling sensation. For comparison, we made similar measurements with full bladder (defined by the subject’s report of strong desire to void). We hypothesized that, with small bladder volume, responses to bladder filling in the insula and dACC/SMA regions would be weak or absent, while subcortical responses, if evident, would reflect activity related to unconscious monitoring of bladder events. With full bladder we expected to observe activation of insula and dACC/SMA.11,12,18 |
| Databáze: | OpenAIRE |
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