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Evaluation of cortical neuroexcitation in urinary urgency using simultaneous near infrared spectroscopy of the bladder and brain with quantification of sensation

JUN
23
2019
23. JUN 2019

Lecture Hall ICM - Internationales Congress Center München European Conferences on Biomedical Optics (ECBO) > Preclinical and Clinical Optical Diagnostics > Clinical Applications: Spectroscopy

09:00-09:15 h | ICM - Internationales Congress Center München ICM Room 2

Subjects: Biophotonics and Medical Engineering

Chairman: J. Quincy Brown (, Tulane Univ.)

Type: Lecture

Speech: English

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Background: Overactivity of the bladder (OAB) affects 20% of people globally causing urgency to void and incontinence of urine (UI)). OAB has a multi-factorial causation. Problematically current tests are invasive and provide limited information. Recent advances in NIRS technology now offer non-invasive evaluation of bladder haemodynamics/oxygenation and brain neuroexcitation related to micturition. We tested the hypothesis that bladder and brain parameters can be monitored simultaneously with patient-controlled quantification of bladder sensation, and that brain-mediated control impacts UI in OAB. Methods: A symptomatic patient (OAB) and asymptomatic control were monitored during spontaneous bladder filling to capacity with continuous wave NIRS of the bladder and fNIRS of the anterior cortex while using a validated patient-controlled sensory meter. Changes in oxygenated, de-oxygenated and total haemoglobin and cortical oxyhaemoglobin concentration were recorded at 10Hz, and sensory events (bladder fullness/urgency to void) documented. Results: In the asymptomatic control fNIRS-derived neuroexcitation was evident when the bladder filled to capacity, increased at decision to void, was most intense during voiding, and waned thereafter. The OAB subject showed progressive increase in neuroexcitation from documenting a desire to void, to recording sensing urgency (imminent UI). At this point a distractor stimulus occurred (unexpected phone call), the sensation of urgency waned and an abrupt decrease in cortical oxyhaemoglobin concentration was evident. Conclusion: Simultaneous bladder NIRS, brain fNIRS, and sensation quantification is feasible and adds novel data. fNIRS-derived neuroexcitation occurs in association with sensed voiding events. The attenuation of urgency/UI by a distractor stimulus implies brain-mediated mechanisms are integral to OAB.

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Andrew Macnab

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