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Is there “brain OAB” and how can we recognize it? International Consultation on Incontinence‐Research Society (ICI‐RS) 2017
Author(s) -
Apostolidis Apostolos,
Wagg Adrian,
Rahnama'i Mohammad S.,
Panicker Jalesh N.,
Vrijens Desiree,
von Gontard Alexander
Publication year - 2018
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.23506
Subject(s) - medicine , neurochemical , neuroscience , depression (economics) , disease , overactive bladder , serotonergic , pathophysiology , urinary urgency , translational research , psychology , pathology , serotonin , alternative medicine , receptor , economics , macroeconomics
Aims In light of mounting evidence supporting the association of brain regions with the control of urine storage and voiding, the high placebo effect in OAB studies as well as certain anecdotal observations from clinical practice with OAB patients, the role of the brain in OAB was explored. Methods At the ICI‐RS 2017 meeting, a panel of Functional Urologists and Basic Scientists presented literature data generating a proposal to discuss whether there is “brain OAB” and how we could recognize it. Results Existing data point toward organic brain causes of OAB, in particular concerning white matter disease (WMD) and aging, but with currently speculative mechanisms. Imaging techniques have revealed connectivity changes between brain regions which may explain brain‐peripheral interactions in OAB patients, further to acknowledged structural and functional changes in the central nervous system (CNS). Furthermore, psychological disorders like stress and depression have been identified as causes of OAB, with animal and human studies proposing a neurochemical and neuroendocrine pathophysiological basis, involving either the serotoninergic system or the hypothalamic‐pituitary‐adrenal axis. Finally, childhood data suggest that OAB could be a developmental disorder involving the CNS, although childhood OAB could be a different condition than that of adults in many children. Conclusions Future research should aim to identify the pathogenesis of WMD and the aging processes affecting the brain and the bladder, with possible benefits in prevention strategies, as well as connectivity disorders within the CNS, the pathophysiology of OAB in childhood and the neurochemical pathways connecting affective disorders with OAB.