Brain Mechanisms Underlying Urge Incontinence and its Response to Pelvic Floor Muscle Training.
Brain Mechanisms Underlying Urge Incontinence and its Response to Pelvic Floor Muscle Training.
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DOI：
10.1016/j.juro.2015.03.102
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发表时间：
2015-09
期刊：
影响因子：
--
通讯作者：
Resnick NM
中科院分区：
文献类型：
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作者：
Griffiths D;Clarkson B;Tadic SD;Resnick NM
急迫性尿失禁是一个主要问题，尤其是在老年人中，据我们所知，疾病和治疗的潜在机制是未知的。我们使用生物反馈辅助盆底肌肉训练和功能性脑成像（功能性磁共振成像）来研究大脑机制，旨在提高对脑膀胱控制和治疗的理解。在接受生物反馈辅助的功能完整的盆底肌肉训练之前，患有急迫性尿失禁的老年社区居民妇女以及正常对照者进行了全面的临床和膀胱日记评估，尿动力学测试和脑功能磁共振成像。对急迫性尿失禁患者进行盆底肌肉训练后重复评估。进行功能性磁共振成像，以确定大脑对膀胱快速充盈和紧迫感的反应。在65例急迫性尿失禁受试者中，28例对生物反馈辅助盆底肌肉训练有反应，日记上急迫性尿失禁频率改善50%或以上。然而，应答者和无应答者显示2种脑反应模式。在模式1中，在盆底肌肉训练之前，背侧前扣带皮层和邻近的辅助运动区以及背侧前扣带皮层被激活。训练后，背侧前扣带皮层/辅助运动区的激活减少，内侧前额叶皮层失活的趋势。在模式2中，在骨盆底肌肉训练前无反应者的内侧前额叶皮层被钝化，训练后变化不大。在老年女性急迫性尿失禁似乎有两种模式的大脑反应膀胱充盈，他们似乎预测的反应和无反应生物反馈辅助盆底肌肉训练。此外，扣带回激活减少似乎是训练引起的急迫性尿失禁改善的结果，而前额叶失活可能是训练成功的一种机制。在无应答者中，后一种机制不可用，这可以解释为什么需要另一种形式的治疗。
Urge urinary incontinence is a major problem, especially in the elderly, and to our knowledge the underlying mechanisms of disease and therapy are unknown. We used biofeedback assisted pelvic floor muscle training and functional brain imaging (functional magnetic resonance imaging) to investigate cerebral mechanisms, aiming to improve the understanding of brain-bladder control and therapy. Before receiving biofeedback assisted pelvic floor muscle training functionally intact, older community dwelling women with urge urinary incontinence as well as normal controls underwent comprehensive clinical and bladder diary evaluation, urodynamic testing and brain functional magnetic resonance imaging. Evaluation was repeated after pelvic floor muscle training in those with urge urinary incontinence. Functional magnetic resonance imaging was done to determine the brain reaction to rapid bladder filling with urgency. Of 65 subjects with urge urinary incontinence 28 responded to biofeedback assisted pelvic floor muscle training with 50% or greater improvement of urge urinary incontinence frequency on diary. However, responders and nonresponders displayed 2 patterns of brain reaction. In pattern 1 in responders before pelvic floor muscle training the dorsal anterior cingulate cortex and the adjacent supplementary motor area were activated as well as the insula. After the training dorsal anterior cingulate cortex/supplementary motor area activation diminished and there was a trend toward medial prefrontal cortex deactivation. In pattern 2 in nonresponders before pelvic floor muscle training the medial prefrontal cortex was deactivated, which changed little after the training. In older women with urge urinary incontinence there appears to be 2 patterns of brain reaction to bladder filling and they seem to predict the response and nonresponse to biofeedback assisted pelvic floor muscle training. Moreover, decreased cingulate activation appears to be a consequence of the improvement in urge urinary incontinence induced by training while prefrontal deactivation may be a mechanism contributing to the success of training. In nonresponders the latter mechanism is unavailable, which may explain why another form of therapy is required.