Department of Urology, Stony Brook University School of Medicine, Stony Brook, New York.
Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania.
J Urol. 2018 Aug;200(2):382-388. doi: 10.1016/j.juro.2018.03.129. Epub 2018 Apr 6.
The mechanism of sacral neuromodulation is poorly understood. We compared brain activity during urgency before and after sacral neuromodulation in women with overactive bladder and according to the response to treatment.
Women with refractory overactive bladder who elected sacral neuromodulation were invited to undergo functional magnetic resonance imaging before and after treatment. During imaging the bladder was filled until urgency was experienced. Regions of interest were identified a priori and brain activity in these regions of interest was compared before and after treatment as well as according to the treatment response. Whole brain exploratory analysis with an uncorrected voxel level threshold of p <0.001 was also performed to identify additional brain regions which changed after sacral neuromodulation.
Of the 12 women who underwent a pretreatment functional magnetic resonance imaging examination 7 were successfully treated with sacral neuromodulation and underwent a posttreatment examination. After sacral neuromodulation brain activity decreased in the left anterior cingulate cortex, the bilateral insula, the left dorsolateral prefrontal cortex and the bilateral orbitofrontal cortex (each p <0.05). No new brain regions showed increased activity after sacral neuromodulation. Pretreatment brain activity levels in the bilateral anterior cingulate cortex, the right insula, the bilateral dorsolateral prefrontal cortex, the right orbitofrontal cortex, the right supplementary motor area and the right sensorimotor cortex were higher in women who underwent successful treatment (each p <0.05).
Brain activity during urgency changes after successful sacral neuromodulation. Sacral neuromodulation may be more effective in women with higher levels of pretreatment brain activity during urgency.
骶神经调节的作用机制尚未完全阐明。本研究比较了逼尿症女性在接受骶神经调节治疗前后急迫感期间的大脑活动，并根据治疗反应进行了比较。
邀请选择骶神经调节的难治性逼尿症女性在治疗前后进行功能磁共振成像。在成像过程中，膀胱被填充至出现急迫感。预先确定感兴趣区域，并比较治疗前后以及根据治疗反应这些感兴趣区域的大脑活动。还进行了全脑探索性分析，未校正的体素水平阈值为 p <0.001，以确定骶神经调节后发生变化的其他大脑区域。
在接受预处理功能磁共振成像检查的 12 名女性中，7 名成功接受骶神经调节治疗并进行了治疗后检查。骶神经调节后，左前扣带回、双侧岛叶、左背外侧前额叶和双侧眶额皮质的大脑活动减少（均 p <0.05）。骶神经调节后没有新的大脑区域显示活动增加。双侧前扣带回、右侧岛叶、双侧背外侧前额叶、右侧眶额皮质、右侧辅助运动区和右侧感觉运动皮质的预处理大脑活动水平在成功治疗的女性中更高（均 p <0.05）。
成功的骶神经调节后，急迫感期间的大脑活动发生变化。骶神经调节在急迫感期间预处理大脑活动水平较高的女性中可能更有效。
