Neural Mechanisms of Poststroke Urinary Incontinence: Results From an fMRI Study

Area of Science:

• Neuroscience
• Urology
• Neurosurgery

Background:

• Post-stroke urinary incontinence significantly impacts patient quality of life.
• The neural mechanisms of urinary incontinence after stroke are not well understood.
• Uninhibited detrusor contractions are common but their brain basis is unclear.

Purpose of the Study:

• To investigate brain activity patterns during volitional and involuntary bladder contractions in stroke survivors.
• To identify neural mechanisms underlying urinary control deficits post-stroke.

Main Methods:

• A cohort study involving 15 stroke survivors with urinary incontinence and 9 healthy controls.
• Simultaneous functional magnetic resonance imaging (fMRI) and urodynamics were used.
• Analysis focused on brain activity during bladder filling and emptying events.

Main Results:

• Volitional voiding activated sensorimotor and executive control brain regions in both groups.
• Involuntary voiding showed minimal brain activity changes, suggesting limited cortical involvement.
• The salience network was active during bladder filling before volitional voiding but absent before involuntary voiding in stroke survivors.

Conclusions:

• The salience network is vital for maintaining urinary continence in stroke survivors.
• Impaired salience network activation may cause post-stroke urinary incontinence.
• Modulating the salience network could be a therapeutic strategy for urinary dysfunction.