Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Neurourol Urodyn. 2018 Nov;37(8):2597-2605. doi: 10.1002/nau.23591. Epub 2018 Apr 19.
Urgency urinary incontinence (UUI) is a major problem for seniors. The underlying mechanisms of disease and therapy are unknown. We sought structural brain abnormalities that might underlie the functional differences previously observed by functional Magnetic Resonance Imaging in UUI patients versus controls, or among UUI responders versus non-responders to therapy-and thereby reveal potential disease mechanisms and therapeutic targets.
Secondary study of a trial of biofeedback-assisted pelvic floor muscle training (BFB) in 60 women (>60 yrs) with UUI, plus 11 age-matched continent controls. Brain structural abnormalities were investigated using: (1) white-matter hyperintensities (WMH); (2) diffusion tensor imaging (DTI) to reveal white-matter pathways with impaired integrity; and (3) voxel-based morphometry (VBM) to show regions of atrophy or hypertrophy.
WMH burden was greater in UUI patients than controls (globally and in superior longitudinal fasciculus and cingulum), suggesting a possible causal connection. WMH burden was unexpectedly greater in responders than non-responders to BFB, and appeared to increase in non-responders but not in responders. DTI revealed even worse integrity of the cingulum than was apparent by WMH. VBM showed parahippocampal atrophy in UUI.
Many women with UUI have white-matter damage that interferes with pathways critical to bladder control; they can be taught by techniques like BFB to exert stronger control over the bladder. For others, in whom abnormalities of key brain areas are less marked, UUI's cause may reside elsewhere, and therapy targeting these brain centers may be less effective than therapy targeting the bladder or other brain centers.
急迫性尿失禁（UUI）是老年人的一个主要问题。疾病和治疗的潜在机制尚不清楚。我们寻求可能构成 UUI 患者与对照组之间功能差异的基础的结构脑异常，或者在 UUI 治疗反应者与非反应者之间的功能差异，从而揭示潜在的疾病机制和治疗靶点。
对 60 名（>60 岁）UUI 女性进行生物反馈辅助盆底肌训练（BFB）试验的二次研究，外加 11 名年龄匹配的对照组。使用以下方法研究结构脑异常：（1）脑白质高信号（WMH）；（2）弥散张量成像（DTI），以揭示完整性受损的白质通路；（3）体素形态计量学（VBM），以显示萎缩或肥大的区域。
UUI 患者的 WMH 负担高于对照组（整体和上纵束和扣带束），这表明可能存在因果关系。令人惊讶的是，BFB 治疗的反应者的 WMH 负担高于非反应者，而且似乎在非反应者中增加，而在反应者中没有增加。DTI 显示扣带束的完整性比 WMH 更为严重。VBM 显示 UUI 患者的海马旁回萎缩。
许多患有 UUI 的女性都有白质损伤，这会干扰对膀胱控制至关重要的通路；通过 BFB 等技术，他们可以对膀胱施加更强的控制。对于其他异常不那么明显的人来说，UUI 的原因可能在其他地方，针对这些大脑中心的治疗可能不如针对膀胱或其他大脑中心的治疗有效。
