Advertisement

Supraspinal Neural Changes in Men With Benign Prostatic Hyperplasia Undergoing Bladder Outlet Procedures: A Pilot Functional MRI Study

      Abstract

      Objective

      To explore brain activation patterns on functional MRI (fMRI) in men with BPH and BOO before and after outlet obstruction procedures.

      Methods

      Men age ≥45 who failed conservative BPH therapy planning to undergo BOO procedures were recruited. Eligible men underwent a concurrent fMRI/urodynamics testing before and 6 months after BOO procedure. fMRI images were obtained via 3 Tesla MRI. Significant blood-oxygen-level-dependent (BOLD) signal activated voxels (P <.05) were identified at strong desire to void and (attempt at) voiding initiation pre- and post-BOO procedure.

      Results

      Eleven men were enrolled, of which 7 men completed the baseline scan, and 4 men completed the 6-month follow-up scan. Baseline decreased BOLD activity was observed in right inferior frontal gyrus (IFG), bilateral insula, inferior frontal gyrus (IFG) and thalamus. Significant changes in BOLD signal activity following BOO procedures were observed in the insula, IFG, and cingulate cortices.

      Conclusions

      This represents a pilot study evaluating cortical activity in men with BPH and BOO. Despite limitations we found important changes in supraspinal activity in men with BPH and BOO during filling and emptying phases at baseline and following BOO procedure, with the potential to improve our understanding of neuroplasticity secondary to BPH and BOO. This preliminary data may serve as the foundation for larger future trials.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • McVary KT.
        BPH: epidemiology and comorbidities.
        Am J Manag Care. Apr 2006; 12: S122-S128
        • Saigal CS
        • Joyce G.
        Economic costs of benign prostatic hyperplasia in the private sector.
        J Urol. Apr 2005; 173: 1309-1313https://doi.org/10.1097/01.ju.0000152318.79184.6f
        • Andersson KE.
        Storage and voiding symptoms: pathophysiologic aspects.
        Urology. Nov 2003; 62: 3-10https://doi.org/10.1016/j.urology.2003.09.030
        • Abrams PH
        • Farrar DJ
        • Turner-Warwick RT
        • Whiteside CG
        • Feneley RC
        The results of prostatectomy: a symptomatic and urodynamic analysis of 152 patients.
        J Urol. May 1979; 121: 640-642https://doi.org/10.1016/s0022-5347(17)56918-9
        • Abrams P.
        Nocturia: escaping the “prostate-centric” approach.
        J Urol. 2011; 3: 781-782
        • Steers WD
        • De Groat WC.
        Effect of bladder outlet obstruction on micturition reflex pathways in the rat.
        J Urol. Oct 1988; 140: 864-871https://doi.org/10.1016/s0022-5347(17)41846-5
        • Chai TC
        • Gemalmaz H
        • Andersson K-E
        • Tuttle JB
        • Steers WD
        Persistently increased voiding frequency despite relief of bladder outlet obstruction.
        J Urol. 1999; 161: 1689-1693
        • Blok BF
        • Willemsen AT
        • Holstege G.
        A PET study on brain control of micturition in humans.
        Brain. 1997; 120: 111-121
        • Khavari R
        • Karmonik C
        • Elias S
        • Boone T.
        PD04-01 Changes in brain activity following intradetrusor injection of onabotulinumtoxina in patients with multiple sclerosis: an fMRI study.
        J Urol. 2018; 199: e77
        • Khavari R
        • Karmonik C
        • Boone T.
        PD04-02 Supraspinal control variaitons in multiple sclerosis patients who void spontanously verus patients with voiding dysfunction.
        J Urol. 2018; 199: e77-e78
        • Khavari R
        • Hernandez N
        • Karmonik C
        • Shi Z
        • Miles B
        • Gonzalez RR.
        Higher neural contribution underlying persistent lower urinary tract symptoms in men with Benign Prostatic Hyperplasia undergoing bladder outlet procedures.
        Contemp Clin Trials Commun. Mar 2020; 17100498https://doi.org/10.1016/j.conctc.2019.100498
        • Shy M
        • Fung S
        • Boone TB
        • Karmonik C
        • Fletcher SG
        • Khavari R.
        Functional magnetic resonance imaging during urodynamic testing identifies brain structures initiating micturition.
        J Urol. Oct 2014; 192: 1149-1154https://doi.org/10.1016/j.juro.2014.04.090
        • Khavari R
        • Karmonik C
        • Shy M
        • Fletcher S
        • Boone T.
        Functional magnetic resonance imaging with concurrent urodynamic testing identifies brain structures involved in micturition cycle in patients with multiple sclerosis.
        J Urol. 02 2017; 197: 438-444https://doi.org/10.1016/j.juro.2016.09.077
        • Motswin J.
        Clinical physiology of micturition.
        1st edn. Textbook of Female Urology and Urogynecology. 12. 1999: 125-138 (Chapt)
        • Elbadawi A
        • Meyer S
        • Malkowicz SB
        • Wein AJ
        • Levin RM
        • Atta MA.
        Effects of short-term partial bladder outlet obstruction on the rabbit detrusor: an ultrastructural study.
        Neurourol Urodyn. 1989; 8: 89-116
        • Seseke S
        • Baudewig J
        • Kallenberg K
        • Ringert RH
        • Seseke F
        • Dechent P.
        Gender differences in voluntary micturition control: an fMRI study.
        Neuroimage. 2008; 43: 183-191https://doi.org/10.1016/j.neuroimage.2008.07.044
        • Arya NG
        • Weissbart SJ
        • Xu S
        • Rao H.
        Brain activation in response to bladder filling in healthy adults: An activation likelihood estimation meta-analysis of neuroimaging studies.
        Neurourol Urodyn. 2017; 36: 960-965https://doi.org/10.1002/nau.23058
        • Fowler CJ
        • Griffiths DJ.
        A decade of functional brain imaging applied to bladder control.
        Neurourol Urodyn. 2010; 29: 49-55https://doi.org/10.1002/nau.20740
        • Harvie C
        • Weissbart SJ
        • Kadam-Halani P
        • Rao H
        • Arya LA.
        Brain activation during the voiding phase of micturition in healthy adults: a meta-analysis of neuroimaging studies.
        Clin Anat. 2019; 32: 13-19https://doi.org/10.1002/ca.23244
        • Michels L
        • Blok BF
        • Gregorini F
        • et al.
        Supraspinal control of urine storage and micturition in men–an fMRI study.
        Cereb Cortex. Oct 2015; 25: 3369-3380https://doi.org/10.1093/cercor/bhu140
        • Nour S
        • Svarer C
        • Kristensen JK
        • Paulson OB
        • Law I.
        Cerebral activation during micturition in normal men.
        Brain. 2000; 123: 781-789https://doi.org/10.1093/brain/123.4.781
        • Critchley HD
        • Wiens S
        • Rotshtein P
        • Ohman A
        • Dolan RJ.
        Neural systems supporting interoceptive awareness.
        Nat Neurosci. 2004; 7: 189-195https://doi.org/10.1038/nn1176
        • Torta DM
        • Cauda F.
        Different functions in the cingulate cortex, a meta-analytic connectivity modeling study.
        Neuroimage. 2011; 56: 2157-2172https://doi.org/10.1016/j.neuroimage.2011.03.066
        • Tadic SD
        • Griffiths D
        • Schaefer W
        • Cheng CI
        • Resnick NM.
        Brain activity measured by functional magnetic resonance imaging is related to patient reported urgency urinary incontinence severity.
        J Urol. Jan 2010; 183: 221-228https://doi.org/10.1016/j.juro.2009.08.155
        • Malykhina AP.
        Neural mechanisms of pelvic organ cross-sensitization.
        Neuroscience. 2007; 149: 660-672https://doi.org/10.1016/j.neuroscience.2007.07.053
        • Desmond JE
        • Glover GH.
        Estimating sample size in functional MRI (fMRI) neuroimaging studies: statistical power analyses.
        J Neurosci Methods. 2002; 118: 115-128https://doi.org/10.1016/s0165-0270(02)00121-8
        • Haylen B
        • Ashby D
        • Sutherst J
        • Frazer M
        • West C.
        Maximum and average urine flow rates in normal male and female populations—the Liverposl nomograms.
        Br J Urol. 1989; 64: 30-38