Bladder Dysfunction in the Context of the Bladder-Brain Connection

The aim of the thesis "Bladder dysfunction in the context of the bladder-brain connection" written by Ilse Groenendijk, was to investigate potential diagnostic tools in the field of functional urology. The first aim was to define the brain areas involved in LUT control in healthy individuals and to investigate the clinical applicability of dynamic brain imaging as a diagnostic tool of functional bladder disorders in individuals. The second aim was to evaluate and improve traditional and patient reported outcome measurements in the field of functional urology

Recent advances in neuroimaging of bladder, bowel and sexual function

PURPOSE OF REVIEW: In this review, we summarize recent advances in the understanding of the neural control of the bladder, bowel and sexual function, in both men and women. RECENT FINDINGS: Evidence of supraspinal areas controlling the storage of urine and micturition in animals, such as the pontine micturition centre, emerged in the early 20th century. Neurological stimulation and lesion studies in humans provided additional indirect evidence for additional bladder-related brain areas. Thereafter, functional neuroimaging in humans with PET and fMRI provided more direct evidence of the involvement of these brain areas. The areas involved in the storage and expulsion of urine also seem to be involved in the central control of storage and expulsion of feces. Furthermore, most knowledge on the brain control of sexual function is obtained from dynamic imaging in human volunteers. Relatively little is known about the dysfunctional central circuits in patients with pelvic organ dysfunction. SUMMARY: fMRI has been the most widely used functional neuroimaging technique in the last decade to study the central control of bladder function, anorectal function and sexual function. The studies described in this review show which sensory and motor areas are involved, including cortical and subcortical areas. We propose the existence of a switch-like phenomenon located in the pons controlling micturition, defecation and orgasm

Measurement and interpretation of skin prick test results

Background: There are several methods to read skin prick test results in type-I allergy testing. A commonly used method is to characterize the wheal size by its 'average diameter'. A more accurate method is to scan the area of the wheal to calculate the actual size. In both methods, skin prick test (SPT) results can be corrected for histamine-sensitivity of the skin by dividing the results of the allergic reaction by the histamine control. The objectives of this study are to compare different techniques of quantifying SPT results, to determine a cut-off value for a positive SPT for histamine equivalent prick -index (HEP) area, and to study the accuracy of predicting cashew nut reactions in double-blind placebo-controlled food challenge (DBPCFC) tests with the different SPT methods. Methods: Data of 172 children with cashew nut sensitisation were used for the analysis. All patients underwent a DBPCFC with cashew nut. Per patient, the average diameter and scanned area of the wheal size were recorded. In addition, the same data for the histamine-induced wheal were collected for each patient. The accuracy in predicting the outcome of the DBPCFC using four different SPT readings (i.e. average diameter, area, HEP-index diameter, HEP-index area) were compared in a Receiver-Operating Characteristic (ROC) plot. Results: Characterizing the wheal size by the average diameter method is inaccurate compared to scanning method. A wheal average diameter of 3 mm is generally considered as a positive SPT cut-off value and an equivalent HEP-index area cut-off value of 0.4 was calculated. The four SPT methods yielded a comparable area under the curve (AUC) of 0.84, 0.85, 0.83 and 0.83, respectively. The four methods showed comparable accuracy in predicting cashew nut reactions in a DBPCFC. Conclusions: The 'scanned area method' is theoretically more accurate in determining the wheal area than the 'average diameter method' and is recommended in academic research. A HEP-index area of 0.4 is determined as cut-off value for a positive SPT. However, in clinical practice, the 'average diameter method' is also useful, because this method provides similar accuracy in predicting cashew nut allergic reactions in the DBPCFC

Acute effect of sacral neuromodulation for treatment of detrusor overactivity on urodynamic parameters

Aim: The aim of this study is to evaluate the acute effects of sacral neuromodulation (SNM) on various urodynamic parameters. Methods: Patients with overactive bladder and detrusor overactivity (DO) who were planned for percutaneous nerve evaluation (PNE) were included. Directly after the PNE, a urodynamic study (UDS) was performed. The stimulation was turned off during the first UDS (UDS 1), and during the second filling cycle, stimulation was turned on (UDS 2). The UDS was followed by a test phase of 1 week and the bladder diaries were evaluated during an outpatient clinic visit. Primary outcome measures were the differences in UDS parameter values with SNM off and on. Results: Ten female patients were included in the study and completed the study protocol. Eight patients showed ≥50% improvement of symptoms following a test phase. There were no differences between UDS 1 and UDS 2 in the UDS parameters; bladder volume at first sensation, bladder volume at first DO, highest DO pressure, bladder capacity, maximum flow rate, and pressure at maximum flow rate. Discussion: None of the aforementioned urodynamic parameters was influenced by acute SNM in patients who responded to SNM. To the best of our knowledge, this is the first study investigating the ac

The validation of the Dutch OAB-q SF: An overactive bladder symptom bother and health-related quality of life short-form questionnaire

Aims: The overactive bladder quality of life short-form questionnaire (OAB-q SF) evaluates both symptom bother and health-related quality of life in patients with OAB, a highly prevalent disease. The objective of this study was to translate and validate a Dutch version of the OAB-q SF. Methods: The translation into Dutch and validation process of the OAB-q SF was performed according to standardized guidelines. Patients with OAB who visited the department of Urology outpatient clinic completed the questionnaires OAB-q SF, European Quality of life 5-Dimension 5-Level questionnaire (EQ-5D-5L), Urogenital Distress Inventory 6 (UDI-6), and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) at baseline (test) and 2 weeks later (retest). A reference group from the department of Allergology outpatient clinic completed the same questionnaires once. The evaluated measurement properties included content validity, internal consistency, reproducibility, criterion validity, and construct validity. Results: Fifty-two patients were included in the study group and 51 references were included. The content validity was adequate and the internal consistency was excellent (Cronbach's α > 0.80). The reproducibility was good with intraclass correlation coefficients higher than 0.70. Patient'

Single subject and group whole-brain fMRI mapping of male genital sensation at 7 Tesla

Processing of genital sensations in the central nervous system of humans is still poorly understood. Current knowledge is mainly based on neuroimaging studies using electroencephalography (EEG), magneto-encephalography (MEG), and 1.5- or 3- Tesla (T) functional magnetic resonance imaging (fMRI), all of which suffer from limited spatial resolution and sensitivity, thereby relying on group analyses to reveal significant data. Here, we studied the impact of passive, yet non-arousing, tactile stimulation o

Langetermijnresultaten van continent katheteriseerbare urostoma’s bij volwassenen met niet-neurogene of neurogene blaasontledigingsstoornissen

The objective was to evaluate the long-term results after the construction of a continent catheterizable urinary conduit in adults. We retrospectively reviewed the charts of 41 adults who received a continent catheterizable urinary conduit and extracted indications and complications (29/41 women, average age 32, median follow-up durations 52 months, 48% ≥1 reoperation). Patients who were still using the conduit during this research (n = 32) were sent a questionnaire about their impression of improvement, continence and catheterization problems. 24 patients completed the questionnaire and on average reported a ‘much better’ situation. In conclusion, the construction of a continent catheterizable urinary conduit in adults is associated with a high complication and reoperation rate. Nevertheless, patients perceive improvement compared to before the construction of the stoma

A systematic review and activation likelihood estimation meta-Analysis of the central innervation of the lower urinary tract: Pelvic floor motor control and micturition

Purpose Functional neuroimaging is a powerful and versatile tool to investigate central lower urinary tract (LUT) control. Despite the increasing body of literature there is a lack of comprehensive overviews on LUT control. Thus, we aimed to execute a coordinate based meta-Analysis of all PET and fMRI evidence on descending central LUT control, i.e. pelvic floor muscle contraction (PFMC) and micturition. Materials and methods A systematic literature search of all relevant libraries was performed in August 2020. Coordinates of activity were extracted from eligible studies to perform an activation likelihood estimation (ALE) using a threshold of uncorrected p 0.001. Results 20 of 6858 identified studies, published between 1997 and 2020, were included. Twelve studies investigated PFMC (1xPET, 11xfMRI) and eight micturition (3xPET, 5xfMRI). The PFMC ALE analysis (n = 181, 133 foci) showed clusters in the primary motor cortex, supplementary motor cortex, cingulate gyrus, frontal gyrus, thalamus, supramarginal gyrus, and cerebellum. The micturition ALE analysis (n = 107, 98 foci) showed active clusters in the dorsal pons, including the pontine micturition center, the periaqueductal gray, cingulate gyrus, frontal gyrus, insula and ventral pons. Overlap of PFMC and micturition was found in the cingulate gyrus and thalamus. Conclusions For the first time the involved core brain areas of LUT motor control were determined using ALE. Furthermore, the involved brain areas for PFMC and micturition are partially distinct. Further neuroimaging studies are required to extend this ALE analysis and determine the differences between a healthy and a dysfunctional LUT. This requires standardization of protocols and task-execution

Whole brain 7T-fMRI during pelvic floor muscle contraction in male subjects

Aim: The primary aim of this study is to demonstrate that 7-tesla functional magnetic resonance imaging (7T-fMRI) can visualize the neural representations of the male pelvic floor in the whole brain of a single subject. Methods: In total, 17 healthy male volunteers (age 20-47) were scanned in a 7T-MRI scanner (Philips Achieva). The scanning protocol consisted of two functional runs using a multiband echo planar imaging sequence and a T1-weighted scan. The subjects executed two motor tasks, one involving consecutive pelvic floor muscle contractions (PFMC) and a control task with tongue movements. Results: In single subjects, results of both tasks were visualized in the cortex, putamen, thalamus, and the cerebellum. Activation was seen during PFMC in the superomedial and inferolateral primary motor cortex (M1), supplementary motor area (SMA), insula, midcingulate gyrus (MCG), putamen, thalamus, and in the anterior and posterior lobes of the cerebellum. During tongue movement, activation was seen in the inferolateral M1, SMA, MCG, putamen, thalamus, and anterior and posterior lobes of the cerebellum. Tongue activation was found in the proximity of, but not overlapping with, the PFMC activation. Connectivity analysis demonstrated differences in neural networks involved in PFMC and tongue movement. Conclusion: This study demonstrated that 7T-fMRI can be used to visualize brain areas involved in pelvic floor control in the whole brain of single subjects and defined the specific brain areas involved in PFMC. Distinct differences between brain mechanisms controlling the pelvic floor and tongue movements were demonstrated using connectivity analysis

Case report. Removing a penoscrotal ring after scrotal infusion Case report. Het verwijderen van een penoscrotale ring na scrotuminfusie

A patient visited our emergency room with a red, swollen scrotum and a penoscrotal ring after scrotal infusion with saline. Scrotum inflation or scrotum infusion is an unusual sexual activity in which one injects the scrotum with physiological saline solution, air, or other kind of gas. Because of the edematous scrotum this ring was, even after a few days not removable by the patient himself. This industrial penoscrotal ring was removed with hydraulic tools of the fire department without any damage to the skin