Ha Nhi T, Abedi Aidin, Ojeda Luis Alejandro Morales, Montero Stefania, Kohli Priya, Chapman David, Abedi Armita, Gaburak Petr, Ginsberg David, Harvey Richard L, Liu Charles Y, Jann Kay, Kreydin Evgeniy
Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Department of Neurological Surgery, USC Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Neurourol Urodyn. 2025 Feb;44(2):374-381. doi: 10.1002/nau.25655. Epub 2024 Dec 29.
Detrusor contractions can be classified as either volitional or involuntary. The latter are a hallmark of urge urinary incontinence. Understanding differences in neuroactivation associated with both types of contractions can help elucidate pathophysiology and therapeutic targets. In this study we aim to compare brain activity associated with voluntary and involuntary detrusor contractions.
Twenty seven stroke survivors with secondary storage lower urinary tract symptoms underwent four filling cycles of simultaneous urodynamics and BOLD-signal fMRI. After each fill, participants were instructed to void. Voids inside the designated 10-s period were considered voluntary contractions. All others were considered involuntary. Each contraction was then segmented into phases: Early (10 s before start of contraction), Rise (start of contraction to peak vesical pressure), Plateau, and Fall (from peak pressure to resolution of the contraction). BOLD-effect was compared between the two contraction types, employing a minimum cluster size of 25 voxels and significance threshold at p < 0.005.
Compared to volitional contractions, involuntary contractions were associated with diminished brain activity in each contraction phase. During the Early phase, this difference was most prominent in areas implicated with sensory and autonomic function, shifting to regions tasked with motor control as the contraction continued and eventually attenuating as the contraction resolved.
This study uniquely contrasts brain activation associated with volitional and involuntary contractions. Relative to involuntary contractions, volitional contractions revealed increased activity in motor, sensory, and executive functioning regions. These findings reflect both the physiological mechanism of volitional contractions and suggest the displacement of this mechanism by a subcortical reflex in involuntary contractions.
NCT05301335.
逼尿肌收缩可分为自主性收缩和非自主性收缩。后者是急迫性尿失禁的一个标志。了解与这两种类型收缩相关的神经激活差异有助于阐明病理生理学和治疗靶点。在本研究中，我们旨在比较与自主性和非自主性逼尿肌收缩相关的脑活动。
27名患有继发性储尿期下尿路症状的中风幸存者接受了四个同步进行尿动力学和血氧水平依赖性功能磁共振成像（BOLD信号fMRI）的充盈周期。每次充盈后，指示参与者排尿。在指定的10秒时间段内的排尿被视为自主性收缩。所有其他情况则被视为非自主性收缩。然后将每次收缩分为几个阶段：早期（收缩开始前10秒）、上升期（收缩开始至膀胱压力峰值）、平台期和下降期（从压力峰值至收缩结束）。采用最小聚类大小为25体素且显著性阈值为p < 0.005，比较两种收缩类型之间的BOLD效应。
与自主性收缩相比，非自主性收缩在每个收缩阶段的脑活动均减弱。在早期阶段，这种差异在与感觉和自主功能相关的区域最为明显，随着收缩的持续，差异转移到负责运动控制的区域，并在收缩结束时最终减弱。
本研究独特地对比了与自主性和非自主性收缩相关的脑激活情况。相对于非自主性收缩，自主性收缩在运动、感觉和执行功能区域显示出增强的活动。这些发现既反映了自主性收缩的生理机制，也表明在非自主性收缩中该机制被皮质下反射所取代。
NCT05301335。
