By Nancy Lapid
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Brain-imaging studies are giving researchers a better understanding of the cause of incontinence after a stroke that could lead to therapies for restoring bladder control in these patients, according to a report published on Thursday.
Urinary incontinence affects up to 79% of patients in the immediate aftermath of a stroke and persists in nearly 40% of survivors one year later, the researchers wrote in the journal Stroke.
“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,” study leader Dr. Evgeniy Kreydin of the Keck School of Medicine at USC said in a statement.
“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 (nerve) pathways that govern bladder control,” he explained.
His team recruited stroke patients with incontinence and healthy volunteers and obtained MRI scans of their brain functions during repeated bladder filling and voiding.
When participants consciously decided when to empty their bladder, both healthy individuals and stroke survivors showed significant activation in brain regions associated with sensorimotor control and executive decision-making.
In contrast, during involuntary or incontinent bladder emptying in stroke survivors, researchers saw minimal cortical activation, suggesting a failure to engage key brain networks necessary for urinary control.
This finding opens doors for potential therapeutic interventions, the researchers said.
These might include non-invasive brain stimulation techniques, such as transcranial magnetic stimulation or direct current stimulation, to target the necessary network, or the development of medications that enhance activation in critical continence control regions in the brain.
USUAL ESOPHAGUS MONITORING PROTOCOL FOR CANCER PROVIDES LITTLE BENEFIT
People with an esophagus condition that can be a precursor to cancer do not generally benefit from the periodic endoscopic screening that is the current standard of care, a new study shows.
In the first-ever randomized trial to test the routine monitoring protocol employed for patients with Barrett’s esophagus, nearly 3,500 participants were assigned to undergo surveillance endoscopy at regular intervals or ‘at need’ endoscopy upon development of symptoms suggestive of cancer.
In the surveillance group, the average interval between endoscopy was three years. In the ‘at need’ group, roughly 60% of patients had at least one endoscopy.
With half the patients followed for more than 13 years, there were no differences in overall survival, cancer-specific survival, time to diagnosis of esophageal cancer, or cancer stage at diagnosis, researchers reported in Gastroenterology.
Overall in the study, the risk of developing esophageal adenocarcinoma was 0.23% per patient per year.
“Guidelines suggest that all patients with Barrett’s esophagus should have surveillance every 3-5 years,” the authors wrote. “Our data indicate this may be too aggressive as any benefit is likely to be modest for (certain) low-risk patients.”
(Reporting by Nancy Lapid; editing by Bill Berkrot)
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