The Effect of OnabotulinumtoxinA on the Symptoms and Quality of Life in Women with Urge Urinary Incontinence

Objectives: To determine the effect of OnabotulinumtoxinA intradetrusor injection on quality of life (QOL) and symptoms of women with urge urinary incontinence. Methods: Twenty five postmenopausal patients with urge urinary incontinence, underwent cystoscopy and 200 U OnabotulinumtoxinA intradetrusor injections (0.5 cc at each injection). The effects of botox have been evaluated on urge urinary incontinence and quality of life. Results: The mean urge urinary incontinence per day was 7.25 which decreased to 2.87 (month 1) and 3.12 (month 6); P value = 0.019. The mean of nocturnal episodes was 3 which decreased to 0 and 1in the first and sixth months, respectively (P = 0.007). Baseline mean I-QOL total score was 43.37 which reached 82.12 (month 1) and 78.87 (month 6); P < 0.001. Conclusions: OnabotulinumtoxinA significantly decreased urinary urge incontinence and nocturia at month 1 and 6. The quality of life of patients has improved.

Natural bladder filling alters resting brain function at multiple spatial scales: a proof-of-concept MAPP Network Neuroimaging Study

Neural circuitry regulating urine storage in humans has been largely inferred from fMRI during urodynamic studies driven by catheter infusion of fluid into the bladder. However, urodynamic testing may be confounded by artificially filling the bladder repeatedly at a high rate and examining associated time-locked changes in fMRI signals. Here we describe and test a more ecologically-valid paradigm to study the brain response to bladder filling by (1) filling the bladder naturally with oral water ingestion, (2) examining resting state fMRI (rs-fMRI) which is more natural since it is not linked with a specific stimulus, and (3) relating rs-fMRI measures to self-report (urinary urge) and physiologic measures (voided volume). To establish appropriate controls and analyses for future clinical studies, here we analyze data collected from healthy individuals (N = 62) as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. Participants orally ingested approximately 350 mL of water, and had a 10 min “fuller bladder” rs-fMRI scan approximately 1 h later. A second 10 min “empty bladder” rs-fMRI scan was conducted immediately following micturition. We examined multiple spatial scales of brain function, including local activity, circuits, and networks. We found changes in brain function distributed across micturition loci (e.g., subregions of the salience, sensorimotor, and default networks) that were significantly related to the stimulus (volume) and response (urinary urge). Based on our results, this paradigm can be applied in the future to study the neurobiological underpinnings of urologic conditions.