Presentation Authors: wanhua wu*, Hai huang, Guangzhou, China, People's Republic of
Introduction: The ileal orthotopic neobladder is becoming a more desirable method of urinary diversion. This transition has been due to the increasing importance of providing patients with a favourable cosmetic outcome and the best quality of life after cystectomy. neural control of bladder and micturition reflex change after surgery due to the neobladder replacement and the injury of the peripheral nerve during the operation. In this study, we determine brain responses to micturition, bladder filling and voluntary voiding control using functional magnetic resonance imaging in subjects with ileal orthotopic neobladder.
Methods: We performed BOLD-fMRI imaging in seven men undergoing radical cystoprostatectomy and ileal orthotopic bladder substitution, aged 46 to 74 years, postoperative time 10-36 months. Meaningful data were obtained on 5 of these subjects. Brain activity was recorded during micturition, bladder filling and voluntary voiding control.
Results: During micturition, we identified clusters of brain activity in the inferior temporal gyrus, inferior parietal lobule, parahippocampal gyrus, anterior cingulate gyrus, and basal ganglia. During bladder filling, we identified clusters of brain activity in frontal lobe, parietal/occipital region, insula, vermis, thalamus, parahippocampal gyrus, anterior cingulate gyrus, sensory/motor region. During voiding control, we identified clusters of brain activity in precentral gyrus, postcentral gyrus, supplementary motor cortex, inferior frontal gyrus, insula, vermis, thalamus, and cingulate cortex.There was no activation in the pons region, which was identified in healthy men during urination, probably due to changes of the micturition reflex after surgery. During bladder filling, activation area is basically the same as that of the normal intestine capacity sensory activation area, and there is a crossover with normal bladder capacity perception, which may mainly reflect activation of the visceral sensory control area of the ileal neobladder. During voiding control activation was basically the same as that of healthy subject, mainly reflecting the feeling of neocapsule filling and the urinary activation area of pelvic floor contraction.
Conclusions: In men undergoing radical cystoprostatectomy and ileal orthotopic bladder substitution, no clusters of brain activity of the pontine micturition centre was found during micturition. The clusters of brain activity during bladder filling is conform to normal intestine capacity sensory.
Source of Funding: Guangzhou International Science and Technology Cooperation Programï¼ˆNO.201807010087ï¼‰; Guangdong Province Science and Technology for Social Development Project (No.2017A020215018);National Natural Science Foundation of China (No. 81472382, No. 81672550)