Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, Ohio; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; Urogynecology Unit, Sotero del Rio Hospital and Division Obstetricia y Ginecologia, Pontificia Universidad Catolica de Chile, Santiago, Chile.
J Urol. 2017 Dec;198(6):1379-1385. doi: 10.1016/j.juro.2017.06.074. Epub 2017 Jun 20.
We performed functional magnetic resonance imaging to identify changes in brain activity during sacral neuromodulation in women with overactive bladder who were responsive to therapy.
Women recruited into the study had nonneurogenic refractory overactive bladder, responded to sacral neuromodulation and had had a stable program for at least 3 months with no subsequent overactive bladder treatment. Enrolled patients completed validated symptom and quality of life instruments before functional magnetic resonance imaging. Stimulus settings were recorded, devices were switched off for a 5-day washout and instruments were repeated. Three functional magnetic resonance imaging scans with simultaneous sacral neuromodulation stimulation were performed below, at and above stimulus sensory threshold using a block design. This yielded brain activity maps represented by changes in blood oxygenation level dependence. A total of 5 stimulator off and 4 stimulator on cycles of 42 seconds each were imaged. Group analysis was done using a single voxel p value of 0.05 with a false-positive error of 0.05 on cluster analysis.
Six of the 13 patients enrolled completed functional magnetic resonance imaging. Median age was 52 years (range 36 to 64). Urinary symptoms and voiding diary data worsened with washout. Overall brain activation generally progressed with increasing stimulation amplitude. However, activation of the right inferior frontal gyrus remained stable while deactivation of the pons and the periacqueductal gray matter only occurred with subsensory stimulation. Sensory stimulation activated the insula but deactivated the medial and superior parietal lobes. Suprasensory stimulation activated multiple structures and the expected S3 somatosensory region. All devices had normal impedance after functional magnetic resonance imaging.
Functional magnetic resonance imaging confirmed that sacral neuromodulation influences brain activity in women with overactive bladder who responded to therapy. These changes varied with stimulus intensity.
我们通过功能磁共振成像来识别对治疗有反应的过度活跃膀胱女性患者骶神经调节过程中的大脑活动变化。
入组的女性患有非神经源性难治性过度活跃膀胱，对骶神经调节有反应，并且已经有至少 3 个月的稳定治疗方案，没有随后的过度活跃膀胱治疗。入组患者在功能磁共振成像前完成了经过验证的症状和生活质量工具。记录刺激设置，设备关闭 5 天进行冲洗，然后重复这些工具。使用块设计，在低于、等于和高于刺激感觉阈值下进行了 3 次具有同步骶神经调节刺激的功能磁共振成像扫描。这产生了代表血氧水平依赖变化的大脑活动图。总共对 5 次刺激关闭和 4 次刺激开启循环进行了 42 秒的成像。使用单体素 p 值 0.05 进行组分析，并在聚类分析中使用 0.05 的假阳性错误。
13 名入组患者中有 6 名完成了功能磁共振成像。中位年龄为 52 岁（范围 36 至 64 岁）。冲洗时，尿症状和排尿日记数据恶化。总体而言，大脑激活通常随着刺激幅度的增加而进展。然而，右侧额下回的激活保持稳定，而桥脑和导水管周围灰质的去激活仅在亚感觉刺激时发生。感觉刺激激活脑岛，但去激活内侧和上顶叶。超感觉刺激激活多个结构和预期的 S3 躯体感觉区域。所有设备在功能磁共振成像后都有正常的阻抗。
功能磁共振成像证实，骶神经调节会影响对治疗有反应的过度活跃膀胱女性的大脑活动。这些变化随刺激强度而变化。
