Page 13 - CUA 2020_Sexual Dysfunction and Transplant

2020 CUA Abstracts

MP-11.5 experiment. All MRI scans were performed on a 3T Philips Elition scan-
Increased risk of dementia among overactive bladder patients ner. Diffusion tensor imaging and myelin water fraction (MWF) were also
treated with an anticholinergic medication compared to a beta-3 acquired for tractography purposes. Connectivity between cortical and
agonist PAG were computed with a novel partial least squares (PLS) approach. 1
1,2
Blayne K. Welk , Eric McArthur 2 Results: Ten subject were consented; cases-UUI and key in the door
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1 Surgery, Western University, London, ON, Canada; ICES, London, ON, or visual trigger history; controls-IPSS=0 or genitourinary distress inven-
Canada tory=0. Debriefing of participants suggested that this fMRI paradigm
Introduction: Research has suggested that anticholinergic medications effectively elicited the desired response during the “trigger” blocks.
are associated with an increased risk of dementia, however, this has not Tractography demonstrated robust structural connectivity between the
been well-studied in the overactive bladder population. Our objective was anterior cingulate cortex and the PAG.
to determine if there is an increased risk of dementia among overactive Conclusions: While preliminary, the aforementioned paradigm may pro-
bladder patients starting anticholinergic medication compared to those vide a powerful method to evaluate cortical-PAG connectivity and dynam-
starting a beta-3 agonist. ics in subjects with VE-UUI.
Methods: This was a population-based, retrospective, matched cohort Reference
study using linked administrative data from Ontario, Canada. We matched 1. Cai J, Lee S, Ba Fet al. Galvanic vestibular stimulation (GVS) aug-
47 324 new users of anticholinergics to 23 662 new users of a beta-3 ments deficient pedunculopontine nucleus (PPN) connectivity in
agonists; all the included medications are only indicated for the treat- mild Parkinson’s disease: fMRI effects of different stimuli. Front
ment of overactive bladder. We measured 75 baseline variables (including Neurosci 2018;12:101. https://doi.org/10.3389/fnins.2018.00101
comorbid conditions, recent medications, and prior healthcare use) and
used these to create a propensity score, which was used in the matching. MP-11.7
The primary exposure was the class of overactive bladder medication Monitoring cortical activity in outpatients to evaluate brain
(anticholinergic or beta-3 agonist). The primary outcome was the new mediated voiding mechanisms
diagnosis of dementia. Lynn Stothers , Andrew Macnab , Jennifer A. Locke , A Klausner , J Speich 2
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Results: The most common anticholinergics used were tolterodine (40%), 1 Urologic Sciences, University of British Columbia, Vancouver, BC,
oxybutynin (29%), and solifenancin (26%). The median duration of use Canada; Urology, Virginia Commonwealth University, Richmond, VA,
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among anticholinergics was 30 (interquartile range [IQR] 30–170) days. United States.
The median duration of use of a beta-3 agonist (mirabegron) was 64 (IQR Introduction: Functional magnetic resonance imaging (fMRI) studies have
30–317) days. There was an increased risk of dementia among anticho- identified a network of brain regions integral to bladder sensation and
linergic users compared to beta-3 agonist users (hazard raio [HR] 1.23; voiding control, where dysfunction may contribute to phenotypes of urge
95% confidence interval [CI] 1.12–1.35). There was significant effect incontinence (UI). The term “brain overactive bladder (OAB)” has been
modification with gender and age; men and those ≤75 years of age on coined for a subgroup of patients identified to require non-conventional
anticholinergics had the highest risk of dementia relative to similar beta-3 treatment. Problematically, urologists currently lack a practical means
agonist users. An exploratory analysis did not show significant differences to evaluate brain-mediated voiding mechanisms in an everyday clinical
in dementia risk between specific anticholinergics. context. However, since the optical technique functional near-infrared
Conclusions: The use of anticholinergic medications among overactive spectroscopy (fNIRS) was shown to identify brain activity in the frontal
bladder patients was associated with an increased risk of new onset micturition area originally identified using fMRI during natural voiding,
dementia compared to beta-3 agonist users. This may have implications we hypothesized that a newly available wireless multichannel brain fNIRS
during the selection of initial medical therapy for patients with overac- system could provide urologists with simultaneous anterior cortical data
tive bladder. during voiding studies.
Methods: Subjects (controls IPSS or UGDI=0 and cases with OAB) were
MP-11.6 monitored using a commercially available, 23-channel, portable fNIRS
Multimodal magnetic resonance imaging assessment of brain system with dual wavelength (750 and 860 nm) emitters and photodiode
networks associated with visually evoked urgency urinary detectors worn over the anterior cortex in a neoprene headcap. Changes
incontinence (VE-UUI) in oxy, deoxy, and total hemoglobin concentration were measured at 50
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Jennifer A. Locke , Andrew Macnab , Mark K. Nigro , Saurabh Garg , Hz during natural bladder-filling and spontaneous emptying.
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Sepideh Allahdadian , Martin McKeown , Lynn Stothers 1 Results: Six subjects (ages 24–76, two female, four male) were studied.
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1 Urologic Sciences, University of British Columbia, Vancouver, BC, Increases in oxyhemoglobin concentration occurred in localized geo-
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Canada; Neurology, University of British Columbia, Vancouver, BC, graphic areas of the cortex associated with specific phases of the filling
Canada voiding cycle. The prefrontal cortex showed strong localized oxyhemo-
Support: Canadian Urological Association – Pfizer Resident Grant Program globin concentration signals when bladder-filling reached a sensation
has graciously funded this project of urgency. These increases occurred in locations previously linked to
Introduction: Patients with urgency urinary incontinence (UUI) often voiding through fMRI by use of the Polhemus system, which linked NIRS
describe visual, somatic, and tactile triggers that initiate symptoms. The
periaqueductal gray (PAG) region provides innervation to the bladder and
urethra but the structure and dynamics of the upstream brain networks
modulating the PAG, especially in people with visually evoked (VE)-UUI,
are unknown.
Methods: VE-UUI subjects were identified within a subspecialty urology
practice. Controls were community dwelling men and women without
a history of lower urinary tract symptoms (LUTS). We developed a novel
functional magnetic resonance imaging (fMRI) protocol to evaluate corti-
cal pathways associated with VE-UUI. We first asked subjects to provide
a picture of their “trigger” stimulus (typically a part of their bathroom).
We then randomly sampled smaller regions of the trigger picture to pro-
vide unique “trigger stimuli.” To create “neutral” stimuli, we also created
images of different parts of their house. We then incorporated an indi-
vidualized visual display stream consisting of alternate 30-second blocks MP-11.7. Fig. 1. fNIRS activity in the brain during urgency.
of five trigger stimuli and five neutral stimuli into a block-design fMRI
S144 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)