Brain Activity Changes During Bladder Filling in Women With Overactive Bladder After Percutaneous Tibial...

Area of Science:

• Neuroscience
• Urology
• Medical Imaging

Background:

• Overactive bladder (OAB) affects many women, with percutaneous tibial neuromodulation (PTNM) as a common third-line treatment.
• The precise mechanism of action for PTNM in OAB remains incompletely understood.
• Functional neuroimaging offers a method to explore brain activity changes during the micturition cycle in OAB patients.

Purpose of the Study:

• To investigate brain perfusion changes during bladder filling in women with and without OAB using functional MRI (fMRI).
• To assess the impact of PTNM on brain perfusion patterns in women with OAB.
• To compare brain perfusion at discrete bladder volumes before and after PTNM treatment.

Main Methods:

• Enrolled women with and without OAB, collecting symptom data via validated questionnaires.
• Utilized arterial spin labeling (ASL) fMRI to measure brain perfusion during controlled bladder filling.
• Administered PTNM to OAB patients and conducted a second ASL fMRI scan post-treatment.

Main Results:

• OAB patients reported heightened bladder filling sensations at lower volumes compared to controls.
• Brain perfusion in the anterior cingulate cortex (ACC), insula, and supplemental motor area (SMA) did not show linear increases with bladder volume in either group.
• A single PTNM session induced non-linear changes in ACC, insula, and SMA perfusion during bladder filling in OAB patients.

Conclusions:

• Brain perfusion in the ACC, insula, and SMA does not exhibit linear changes with bladder filling, regardless of OAB status.
• PTNM treatment leads to non-linear alterations in brain perfusion within the ACC, insula, and SMA during bladder filling.
• These findings suggest a neurobiological mechanism for PTNM's efficacy in managing OAB symptoms.