Examining Bladder Control Using Magnetic Resonance Imaging (MRI) and Diffusion Tensor Imaging (DTI)
Urgency incontinence (where the bladder muscles contract suddenly, causing an immediate urge to urinate that is difficult to prevent) is commonly experienced in patients with overactive bladder. New findings have discovered that urgency incontinence may be connected to the interactions of certain regions of the brain and the bladder. Although this is a common problem, researchers still do not know how these interactions impact the process of urgency incontinence. The purpose of this study is to better understand how the brain functions, by using Magnetic Resonance Imaging (MRI) machine and Diffusion Tensor Imaging (DTI) to create images of the brain during different bladder states.
Urinary Incontinence, Urge
|Study Design:||Observational Model: Case Control
Time Perspective: Cross-Sectional
|Official Title:||Examining the Brain's Control Systems in Normal and Overactive Bladder Using DTI and Functional MRI|
- Determine differences in fluctuations in brain activity between different regions of the brain associated with control functions. [ Time Frame: Once during up to 3 months ] [ Designated as safety issue: No ]We will look at the overall group differences to see if there are differences between the case group participants and control group participants in control brain regions related to normal bladder function.
- Scores on the Pelvic Floor Distress Inventory [ Time Frame: Once during up to 3 months ] [ Designated as safety issue: No ]This Questionnaire is a condition-specific quality of life questionnaire to assess pelvic floor disorders including urinary incontinence, pelvic organ prolapse and fecal incontinence.
- 3 Day Bladder Diary to Assess Participant Symptom Severity [ Time Frame: Once during up to 3 months ] [ Designated as safety issue: No ]Subjects will be given three questionnaires and will also be asked to keep a diary that tracks their bladder and urinary habits for 3 days.
- Determine any difference in brain response to bladder filling in subjects with and without overactive bladder. [ Time Frame: Once during up to 3 months ] [ Designated as safety issue: No ]
- Determine functional brain connectivity with bladder. [ Time Frame: Once during up to 3 months ] [ Designated as safety issue: No ]In order to asses functional connectivity (measurement of the strength of integration between brain regions), direct statistical comparison of connectivity maps derived from urge incontinence versus control groups will be done.
- Scores on the Pelvic Floor Impact Questionnaire [ Time Frame: Once during up to 3 months ] [ Designated as safety issue: No ]This is another validated brief quality of life questionnaire to assess how various pelvic floor disorders affect specific daily activities.
- Scores on the International Consultation on Incontinence Questionnaire [ Time Frame: Once during up to 3 months. ] [ Designated as safety issue: No ]This questionnaire allows assessment of the prevalence, frequency and perceived cause of urinary incontinence as well as its impact on life.
|Study Start Date:||May 2010|
|Estimated Study Completion Date:||January 2012|
|Estimated Primary Completion Date:||March 2011 (Final data collection date for primary outcome measure)|
Urge Incontinent Women
Women with documented urge/urgency incontinence with established care at the Oregon Health and Science University.
Women with no urge/urgency incontinence with established care at the Oregon Health and Science University.
One devastating manifestation of overactive bladder is urgency incontinence. Although urgency incontinence is a common problem with profound clinical, social and psychological consequences, little is understood about its underlying cause. The involuntary detrusor overactivity (DO) often associated with the disease points to a possible abnormality in voluntary control of the spinobulbospinal voiding reflex by a higher order neuronal network. Recent functional MRI (fMRI) and PET studies have identified increased brain activity during bladder filling and voiding in normal subjects from higher order cognitive control centers. In addition, there are now data to suggest that interactions between these brain areas, which include the pontine micturition center (PMC), periaqueductal gray (PAG), thalamus, insula, dorsal anterior cingulate and prefrontal cortex, may be abnormal in patients with urgency incontinence. Despite these encouraging findings, we do not yet know how these regions are interacting with each other, or to other, unknown but important, regions in the brain. Nor do we know how this interaction might play a role in this disease process. Expanding our knowledge of how these regions are integrated to achieve continence and, importantly, what aspects of this complex circuitry are atypical in patients with urge incontinence is key to our future therapeutic endeavors. With this in mind, the goal of this study is to better characterize the functional integration (i.e. functional connectivity) of the brain's control networks in relation to typical and atypical bladder function. We aim to identify distinct differences in the brain's functional and anatomic topography in women with and without urgency incontinence. Our approach not only has the potential to advance our understanding of the higher level pathophysiology of this disease process, but could also lead to novel more centrally acting therapeutic approaches for treatment of urgency incontinence.
|United States, Oregon|
|Oregon Health & Science University|
|Portland, Oregon, United States, 97239|
|Principal Investigator:||Rahel Nardos, M.D.||Oregon Health and Science University|