Examining Bladder Control Using Magnetic Resonance Imaging (MRI) and Diffusion Tensor Imaging (DTI)
Condition: Urinary Incontinence, Urge
MeSH terms: Urinary Incontinence; Enuresis; Urinary Incontinence, Urge
Study type: Observational

Summary: 
      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.
    

Detailed description: 
      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.
    

Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Women seeking care at Oregon Health and Science University in Portland, Oregon.
      
Keywords: Urge Urinary Incontinence; Magnetic Resonance Imaging; Diffusion Tensor Imaging; Brain Connectivity; Bladder Control; fMRI