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Brain activity measured by functional magnetic resonance imaging (fMRI) is related to patient reports and clinical severity of urge urinary incontinence

Hypothesis / aims of study Urge urinary incontinence (UI) is diagnosed clinically using bladder diary and pads which also help grade its severity and further guide and assess the therapy outcomes. Unfortunately, the effectiveness of treatment has not greatly improved, partly due to our lack of understanding of the pathobiology of the disease. Our group has adapted functional brain imaging to study UI by adding urodynamics to fMRI. This enables simultaneous monitoring of brain and bladder activity during bladder filling so that bladder storage and continence control can be studied under experimental conditions. 1,2 Studies using this methodology in older women have shown significantly increased activity of brain regions involved in mapping body sensations (right insula/somatosensory cortex), emotional processing (anterior cingulated cortex – ACC, limbic cortex) and decision-making (various parts of frontal cortex), implying their potential role in continence control. 3 These responses are most pronounced when subjects report strong bladder sensation – probably ‘urgency’ – while in the scanner, further implying that such brain activity might represent a neural correlate of this symptom. Despite these findings, it is not yet known whether these experimental observations reflect patients’ everyday experience, as registered by standard clinical tests such as a bladder diary or a pad test. A significant association between observed brain responses and clinical data would imply that activity recorded under artificial conditions in the scanning session reflects the clinical severity of the condition in daily life. Thus, our primary hypothesis was that the brain responses to bladder filling observed in the scanner during reported sensations of ‘urgency’ would be correlated with the number of episodes of urge UI recorded in the bladder diary and with the severity of leakage measured by pads. Secondary analysis included correlation of brain responses with patients’ reports of the burden of disease using the Urge Impact Scale (URIS-24).