AUA 2015 Meeting: CNS alterations in UCPPS

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From the May 2015 AUA Meeting:

Alterations in connectivity on fMRI with provocation of lower urinary tract symptoms in UCPPS
Natalia Kleinhans, Claire Yang*, Eric Strachan, Dedra Buchwald, Kenneth Maravilla, Seattle, WA

Introduction and Objectives: Urologic chronic pelvic pain syndromes (UCPPS) have refractory bladder or pelvic pain as their dominant symptom, which has been attributed to changes in the central nervous system caused by a chronic barrage of noxious stimuli. To ascertain whether altered brain function is associated with UCPPS, we developed a novel challenge protocol that induces bladder distention in study participants to reproduce pain symptoms.

Methods: We recruited 10 female twin pairs who were discordant for UCPPS-like symptoms. Before scanning, each twin urinated to completion, then consumed 500 cc of water. Each twin was scanned with our resting state fMRI protocol immediately, and approximately 50 minutes after consumption. Time series were extracted from the right and left periaqueductal gray (PAG) and right and left amygdala subregions. We conducted a repeated-measures, two-sample t-test to assess differences in connectivity between symptomatic and asymptomatic twins before and after bladder distention.

Results: Group-by-condition interaction effects were found from the PAG to the right cerebellum VIIIa, amygdala, right premotor cortex, and insular cortex and between the amygdala and the medial orbital frontal cortex, hypothalamus, insular cortex, thalamus, and anterior cingulate cortex.

Conclusions: These findings demonstrate that our non-invasive bladder distention protocol can detect differences in the processing of urinary sensation between twins discordant for lower urinary tract pain. Specifically, women with UCPPS symptoms appear to have chronically enhanced connectivity that may indicate the presence of central nervous system alterations.

Sources of Funding: National Institutes of Health 5 U01 DK082325