Jang Yongchang, Tran Khue, Hubbard Logan, Choksi Darshil, Gonzalez Ricardo R, Karmonik Christof, Shi Zhaoyue, Khavari Rose
Department of Urology, Houston Methodist Hospital, Houston, TX, USA.
MRI Core, Houston Methodist Research Institute, Houston, TX, USA.
Int Neurourol J. 2022 Sep;26(3):219-226. doi: 10.5213/inj.2244018.009. Epub 2022 Sep 30.
Lower urinary tract symptoms (LUTS) associated with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) can negatively impact quality of life. We evaluated the structural connectivity of the brain in men with BPH with chronic BOO using diffusion tensor imaging (DTI).
Ambulatory male patients aged ≥45 years with BPH and BOO were recruited. LUTS was defined as an International Prostate Symptom Score (IPSS) ≥12 and a maximum urinary flow rate ≤15 mL/sec. Upon recruitment, uroflowmetry and validated questionnaires regarding bladder status were collected. DTI images from each subject were aligned with the ICBM-DTI-81 atlas, defining 50 white matter tracts (WMTs). The mean values of DTI parameters-fractional anisotropy and mean diffusivity-for each WMT were extracted. These measures were then utilized to compute Pearson correlation coefficients with clinical parameters. Objective clinical parameters included uroflowmetry parameters, postvoid residual (PVR) volume, and bladder capacity. Subjective clinical parameters were assessed using validated questionnaires: the IPSS, Incontinence Symptom Index, and Sexual Health Inventory for Men.
The correlation analysis revealed 15 WMTs that showed statistically significant associations (P<0.05) with objective and subjective clinical parameters. Eight tracts were associated with uroflowmetry parameters: maximum flow rate (Qmax), mean flow rate (Qmean), and PVR. Among these tracts, the middle cerebellar peduncles and left medial lemniscus were associated with Qmax; the genu of the corpus callosum, left superior corona radiata, corticospinal tract, right medial lemniscus, posterior corona radiata with Qmean; and the left posterior corona radiata with PVR. Seven tracts also demonstrated significant associations with the IPSS.
Our results suggest correlations between the preserved white matter integrity of specific WMTs and the severity of LUTS based on objective and subjective clinical parameters, leading us to believe that a distinct pathology of the central nervous system might exist.
良性前列腺增生（BPH）所致膀胱出口梗阻（BOO）相关的下尿路症状（LUTS）会对生活质量产生负面影响。我们使用弥散张量成像（DTI）评估了患有慢性BOO的BPH男性患者大脑的结构连通性。
招募年龄≥45岁的门诊BPH和BOO男性患者。LUTS定义为国际前列腺症状评分（IPSS）≥12且最大尿流率≤15毫升/秒。招募时，收集尿流率测定结果以及关于膀胱状态的有效问卷。将每个受试者的DTI图像与ICBM-DTI-81图谱对齐，确定50条白质束（WMT）。提取每个WMT的DTI参数（分数各向异性和平均扩散率）的平均值。然后利用这些测量值计算与临床参数的Pearson相关系数。客观临床参数包括尿流率测定参数、排尿后残余尿量（PVR）和膀胱容量。主观临床参数使用有效问卷进行评估：IPSS、尿失禁症状指数和男性性健康量表。
相关性分析显示，15条WMT与客观和主观临床参数存在统计学显著关联（P<0.05）。8条束与尿流率测定参数相关：最大尿流率（Qmax）、平均尿流率（Qmean）和PVR。在这些束中，小脑中脚和左侧内侧丘系与Qmax相关；胼胝体膝部、左侧放射冠上部、皮质脊髓束、右侧内侧丘系、放射冠后部与Qmean相关；左侧放射冠后部与PVR相关。7条束也与IPSS存在显著关联。
我们的结果表明，特定WMT保留的白质完整性与基于客观和主观临床参数的LUTS严重程度之间存在相关性，这使我们相信可能存在一种独特的中枢神经系统病理情况。
