Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Neurourol Urodyn. 2022 Jan;41(1):166-173. doi: 10.1002/nau.24800. Epub 2021 Sep 27.
Situational triggers for urinary urgency and incontinence (UUI) such as "latchkey incontinence" and running water are often reported clinically, but no current clinical tools exist to directly address symptoms of UUI provoked by environmental stimuli. Previously we have shown that urgency and leakage can be reproduced during urodynamic studies with exposure to personal urgency-related images. Here we investigate the neural signatures associated with such situational triggers to inform potential therapies for reducing reactivity to these personal urgency-related cues among women with situational UUI.
We recruited 23 women with situational UUI who took photographs of their personal "urgency trigger" and "safe" situations and were exposed to them in a magnetic resonance imaging (MRI) scanner. We identified brain areas that were more active during urgency versus safe image exposure.
We found that, during urgency image exposure, main components of the attention network and decision-related processes, the middle and medial frontal gyri, were more active (p < 0.01). In addition, areas well known to be involved in the continence mechanism, such as the cingulate and parahippocampal areas, were also more active during urgency image exposure.
Exposure to personal situational urgency images activated different areas of the brain compared with safe environments, highlighting the complex brain mechanisms that provoke real-world urgency. Using brain and behavioral-based therapies which target the attentional areas identified here and extinguish cue reactivity might reduce symptom burden in this subset of UUI sufferers.
情境性尿急和尿失禁（UUI）的触发因素，如“挂钥匙性尿失禁”和流水声，临床上常被报道，但目前尚无临床工具可直接解决环境刺激引起的 UUI 症状。我们之前已经表明，在进行尿动力学研究时，通过暴露于与个人尿急相关的图像，可以复制尿急和漏尿。在这里，我们研究了与这些情境性触发因素相关的神经特征，为减少情境性 UUI 女性对这些与个人尿急相关线索的反应性提供潜在的治疗方法。
我们招募了 23 名有情境性 UUI 的女性，她们拍摄了个人的“尿急触发”和“安全”情景的照片，并在磁共振成像（MRI）扫描仪中对这些照片进行了暴露。我们确定了在尿急与安全图像暴露期间更活跃的大脑区域。
我们发现，在尿急图像暴露期间，注意力网络和决策相关过程的主要组成部分，即中脑和中脑回，更为活跃（p<0.01）。此外，与控制机制相关的区域，如扣带回和海马旁回，在尿急图像暴露期间也更为活跃。
与安全环境相比，个人情境性尿急图像的暴露激活了大脑的不同区域，突出了引发真实世界尿急的复杂大脑机制。使用针对这里确定的注意力区域的基于大脑和行为的治疗方法，以及消除线索反应性，可能会减轻这部分 UUI 患者的症状负担。
