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11–14 APRIL, 2018, HELSINKI, FINLAND
S20: FUNCTIONAL VOIDING
DISORDERS
Moderators: Marcel Drlik (Czech Republic), Guy Bogaert (Belgium)
ESPU Meeting on Friday 13, April 2018, 16:44–17:20
16:44–16:49
S20-1 (LO)
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MAPPING OF BRAIN ACTIVITY FOLLOWING
TRANSCUTANEOUS POSTER TIBIAL NERVE STIMULATION
FOR LOWER URINARY TRACT SYMPTOMS IN PEDIATRIC
PATIENTS: A PET STUDY
M S ANSARI
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Pediatric Urology, Department of Urology and renal
transplantation, Lucknow, INDIA
PURPOSE
Peripheral nerve stimulation via lumbosacral route has shown to modulate cortical and subcortical
brain areas which seem to control the complex process of micturion, i.e. sensation of bladder filling
and the timing of micturition. The present study was conducted to investigate the changes in brain
activity during modulation of various brain areas after transcutaneous posterior tibial nerve stimula-
tion (TcPTNS) for lower urinary tract symptoms (LUTS) in pediatric patients.
MATERIAL AND METHODS
We used 18 FDG PET to investigate the effects of PTNS on brain activity in pediatric patients
with urodynamically proven detrusor overactivity (DO) or underactive detrusor (UD). All the patient
underwent weekly session for 30 minutes for 12 weeks followed by 3 weekly maintenance therapy.
PET CT brain was done before the start of TcPTNS and at the end of induction therapy i.e. 3 months.
RESULTS
The study included 21 pediatric patients with a mean age of 5.6Yrs (range 4–16 yrs).
Of the 21 patients, 12 had overactive bladder with urodynamically proven DO and 9 had under
active detrusor.
In cases overactive bladder TcPTNS decreased the activity in the cerebellum, midbrain and adja-
cent midline thalamus and limbic cortical areas, i.e. the cingulate gyrus, ventromedial orbitofrontal
gyrus and prefrontal cortex. These are the areas involved in the sense of bladder filling. While, FDG
uptake was more avid in these areas before the start of TcPTNS. On contrary the avid uptake was
noted in hypothalamus and prefrontal area in cases of underactive detrusor. These are the areas
involved sensorimotor learning and the initiation of voiding.
CONCLUSIONS
Our findings suggest that after therapy by TcPTNS the focus of brain activation changes from areas
involved in sensorimotor learning to areas involved in the sense of bladder filling (as to overcome
urge in DO) and the initiation of voiding (in cases of underactive detrusor).