RESUMEN
AIMS: We compared brain activation patterns between female multiple sclerosis (MS) patients with voiding dysfunction (VD) and those without. We aim to expand current knowledge of supraspinal correlates of voiding initiation within a cohort of female MS patients with and without VD. MATERIALS AND METHODS: Twenty-eight ambulatory female MS patients with stable disease and lower urinary tract dysfunction were recruited for this study. Subjects were divided into group 1, without VD (n = 14), and group 2, with VD (n = 14), defined as postvoid residual urine of ≥40% of maximum cystometric capacity or need for self-catheterization. We recorded brain activity via functional magnetic resonance imaging (fMRI) with simultaneous urodynamic testing. Average fMRI activation maps (the Student t test) were created for both groups, and areas of significant activation were identified (P < .05). A priori regions of interest (ROIs), identified by prior meta-analysis to be involved in voiding, were selected. RESULTS: Group-averaged blood-oxygen level-dependent (BOLD) activation maps demonstrated significant differences between groups 1 and 2 during initiation of voiding with group 2 showing significantly lower levels of activation in all ROIs except for the left cerebellum and right cingulate gyrus. Interestingly, group 2 displayed negative BOLD signals, while group 1 displayed positive signals in the right and left pontine micturition center, right periaqueductal gray, left thalamus, and left cingulate gyrus. The activation map of group 1 was similar to healthy controls. CONCLUSIONS: Our results support the hypothesis that distinct supraspinal activation patterns exist between female MS patients with VD and those without.
Asunto(s)
Encéfalo/diagnóstico por imagen , Síntomas del Sistema Urinario Inferior/fisiopatología , Esclerosis Múltiple/diagnóstico por imagen , Vejiga Urinaria Neurogénica/fisiopatología , Trastornos Urinarios/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Encéfalo/fisiopatología , Estudios de Casos y Controles , Cerebelo/diagnóstico por imagen , Cerebelo/fisiopatología , Femenino , Neuroimagen Funcional , Giro del Cíngulo/diagnóstico por imagen , Giro del Cíngulo/fisiopatología , Humanos , Síntomas del Sistema Urinario Inferior/etiología , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/fisiopatología , Sustancia Gris Periacueductal/diagnóstico por imagen , Sustancia Gris Periacueductal/fisiopatología , Puente/diagnóstico por imagen , Puente/fisiopatología , Tálamo/diagnóstico por imagen , Tálamo/fisiopatología , Vejiga Urinaria/fisiopatología , Vejiga Urinaria Neurogénica/etiología , Micción/fisiología , Trastornos Urinarios/etiología , Urodinámica/fisiologíaAsunto(s)
Braquiterapia/efectos adversos , Neoplasias de la Próstata/cirugía , Traumatismos por Radiación/cirugía , Resección Transuretral de la Próstata/métodos , Cateterismo Urinario/métodos , Retención Urinaria/prevención & control , Estudios de Seguimiento , Humanos , Masculino , Neoplasias de la Próstata/radioterapia , Traumatismos por Radiación/etiología , Factores de Tiempo , Retención Urinaria/etiologíaRESUMEN
The majority of patients with overactive bladder (OAB) can be managed with office-based techniques. When medical therapy fails as treatment for OAB, surgical intervention ranging from electric stimulation administered in the office to extensive procedures, such as augmentation or urinary diversion, may be needed. Any surgical intervention should be tailored to the patient with consideration of the degree of his or her discomfort, underlying pathology, general health, and obviously, the patient's own motivation.