Mawla Ishtiaq, Schrepf Andrew, Kutch Jason J, Helmuth Margaret E, Smith Abigail R, Ichesco Eric, Yang Claire C, Andreev Victor P, Kreder Karl J, Bradley Catherine S, Magnotta Vincent A, Kirkali Ziya, Harris Richard E, Lai H Henry, Harte Steven E
Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California.
J Urol. 2024 Jan;211(1):111-123. doi: 10.1097/JU.0000000000003699. Epub 2023 Oct 5.
Overactive bladder (OAB) may be attributed to dysfunction in supraspinal brain circuits. Overactive bladder participants enrolled in the LURN (Symptoms of Lower Urinary Tract Dysfunction Research Network) study reported sensations of urinary urgency during a bladder-filling paradigm while undergoing brain functional MRI to map supraspinal dysfunction.
OAB participants and controls (CONs) completed 2 resting-state functional MRI scans following consumption of 350 mL water. Scans were conducted at fuller and emptier bladder states, interleaved with voiding. Urgency ratings (0-10) were assessed. Patterns of urgency during bladder filling were investigated using latent class trajectory models. Clusters of participants encompassing each pattern (ie, subtype) were derived from aggregated groups of OAB and CON independent of diagnosis.
Two distinct patterns of urgency trajectories were revealed: first subtype with OAB and CON who were unresponsive to bladder filling (OAB-1 and CON-1) and second highly responsive subtype predominantly containing OAB (OAB-2). OAB-2 participants scored significantly higher on urinary symptoms but not pain or psychosocial measures. Neuroimaging analyses showed change in urgency due to both bladder filling and voided volume related to multiple loci of brain network connectivity in OAB-2, and in some cases, different than OAB-1 and/or CON-1. Sensorimotor to dorsomedial/dorsolateral prefrontal connectivity mediated the relationship between stimulus (voided volume) and percept (urgency) in OAB-2.
Our results reveal different OAB subtypes with latent class trajectory models of urgency ratings during natural bladder filling. Functional MRI revealed differences in pathophysiology between subtypes, namely sensorimotor-prefrontal connectivity is a key locus in OAB patients with higher urinary symptoms.
膀胱过度活动症（OAB）可能归因于脊髓上脑回路功能障碍。参与下尿路功能障碍症状研究网络（LURN）研究的膀胱过度活动症患者在膀胱充盈范式期间报告有尿急感，同时接受脑功能磁共振成像以绘制脊髓上功能障碍图谱。
膀胱过度活动症患者和对照组（CONs）在饮用350毫升水后完成2次静息态功能磁共振成像扫描。扫描在膀胱更充盈和更排空状态下进行，与排尿交替进行。评估尿急评分（0 - 10分）。使用潜在类别轨迹模型研究膀胱充盈期间的尿急模式。包含每种模式（即亚型）的参与者聚类来自独立于诊断的膀胱过度活动症和对照组的汇总组。
揭示了两种不同的尿急轨迹模式：第一种亚型是膀胱过度活动症患者和对照组中对膀胱充盈无反应的（OAB - 1和CON - 1），第二种高度反应性亚型主要包含膀胱过度活动症患者（OAB - 2）。OAB - 2参与者在泌尿症状方面得分显著更高，但在疼痛或心理社会指标方面并非如此。神经影像学分析显示，在OAB - 2中，尿急变化与膀胱充盈和排尿量有关，涉及多个脑网络连接位点，在某些情况下，与OAB - 1和/或CON - 1不同。感觉运动与背内侧/背外侧前额叶连接介导了OAB - 2中刺激（排尿量）与感知（尿急）之间的关系。
我们的结果通过自然膀胱充盈期间尿急评分的潜在类别轨迹模型揭示了不同的膀胱过度活动症亚型。功能磁共振成像揭示了亚型之间病理生理学的差异，即感觉运动 - 前额叶连接是泌尿症状较高的膀胱过度活动症患者的关键位点。
