On the appropriate is a visualization of a wholesome mind with intact cortical neuronal connections between the cortex and spinal wire, with mind areas energetic throughout volitional voiding of the bladder. The mind of a stroke affected person with broken connections and mind areas which can be hypoactive is on the left. Credit score: USC Stevens INI
A brand new USC-led examine utilizing practical magnetic resonance imaging (fMRI) reveals the neural mechanisms that contribute to urinary incontinence, a standard situation affecting stroke survivors that has a major impression on their high quality of life.
The analysis, printed in Stroke, was carried out by a multidisciplinary staff of urologists, neurosurgeons, and imaging specialists from the Keck Faculty of Medication of USC, Keck Medication of USC, the Rancho Los Amigos Nationwide Rehabilitation Heart, and the Shirley Ryan Means Lab.
The staff found vital variations in mind exercise throughout voluntary versus involuntary bladder contractions, presenting potential pathways for focused therapies.
Urinary incontinence impacts as much as 79% of sufferers within the speedy aftermath and persists in almost 40% of survivors one yr later. It sometimes arises from uncontrolled bladder contractions and involuntary urine expulsion, leaving sufferers with debilitating signs comparable to urinary urgency, frequency, and leakage. Though widespread, it’s usually undertreated. This situation additionally predicts poorer long-term outcomes, together with larger mortality charges and elevated incapacity.
“The brain plays a crucial role in regulating the bladder, allowing people to sense bladder fullness and giving them the ability to delay urination until it is socially appropriate or initiate it at will,” mentioned Evgeniy Kreydin, MD, adjunct assistant professor of medical urology and lead creator of the examine.
“In contrast, stroke survivors often struggle to suppress unwanted bladder contractions and may even lose bladder sensation and awareness entirely. Since a stroke impacts the brain, it disrupts the normal pathways that govern bladder control. Nevertheless, the precise neurological foundations of this dysfunction have remained poorly understood until recently.”
This analysis performed a key position in Kreydin receiving the McGuire-Zimskind Award from the Society of Urodynamics, Feminine Pelvic Medication, and Urogenital Reconstruction (SUFU).
The examine utilized an revolutionary methodology of repeated bladder filling and voiding whereas contributors had been contained in the MRI, throughout which their mind operate was measured.
“In distinction to earlier research the place contributors utilizing a catheter entered the scanner with a full bladder and voided on command, our examine enabled us to watch filling and voiding repeatedly. The simultaneous recording of bladder stress allowed us to establish each voluntary and involuntary bladder emptying.
This allowed us to detect variations in mind exercise throughout involuntary emptying for the primary time,” mentioned Kay Jann, Ph.D., of the USC Mark and Mary Stevens Neuroimaging and Informatics Institute on the Keck Faculty of Medication. Jann develops analytical instruments and medical translations of practical MRI expertise and served because the imaging knowledgeable for the examine.
Throughout voluntary bladder emptying, when contributors consciously determined when to empty the bladder, each wholesome people and stroke survivors confirmed vital activation in mind areas related to sensorimotor management and govt decision-making.
In distinction, involuntary or incontinent bladder emptying in stroke survivors was marked by minimal cortical activation, suggesting a failure to have interaction key mind networks obligatory for urinary management.
In each wholesome people and stroke survivors, bladder filling earlier than voluntary urination triggered exercise in a set of mind areas referred to as the salience community. These mind areas work collectively to guage the significance of inner or exterior stimuli and coordinate the mind’s response to these stimuli.
Nevertheless, throughout bladder filling that preceded involuntary urination, this community remained inactive for stroke survivors with incontinence. These findings recommend the shortcoming to have interaction the salience community could also be a core mechanism underlying post-stroke urinary incontinence.
These findings open doorways for novel interventions aimed toward restoring bladder management in stroke sufferers. Potential therapeutic approaches may embrace:
Utilizing non-invasive mind stimulation strategies, comparable to transcranial magnetic stimulation (TMS) or direct present stimulation (tDCS), to focus on the salience community
Creating drugs that improve neural activation in vital continence management areas
Cognitive coaching and biofeedback therapies designed to enhance bladder consciousness and voluntary management
Whereas the examine represents a major development in understanding post-stroke incontinence, the researchers emphasize the necessity for additional investigation. Future research may discover how several types of strokes have an effect on urinary management and whether or not early intervention focusing on the salience community may assist stop power incontinence in stroke survivors.
Charles Liu, Ph.D., MD, director of the USC Neurorestoration Heart, senior creator of the examine, and coordinator of all of the collaborators, is looking forward to additional discovery as this essential analysis is constructed upon.
“The neurological basis of urination is still poorly understood, and additional research will be crucial for the neurorestoration of the urinary and reproductive systems,” mentioned Liu, who can be a professor of medical neurological surgical procedure, surgical procedure, psychiatry and the behavioral sciences, and biomedical engineering on the Keck Faculty of Medication.
“This work not only deepens our understanding of a common post-stroke complication but also provides hope for a better quality of life for millions of stroke survivors globally.”
Extra data:
Evgeniy I. Kreydin, et al. Neural Mechanisms of Publish-stroke Urinary Incontinence: Outcomes from a fMRI Research, Stroke (2025). DOI: 10.1161/STROKEAHA.124.048057
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New examine identifies key mind networks behind post-stroke urinary incontinence (2025, April 10)
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