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Bladder recovery relates with increased mid-cingulate perfusion after shunt surgery in idiopathic normal-pressure hydrocephalus: a single-photon emission tomography study

  • Urology - Original Paper
  • Published:
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Abstract

Aims of study

It is reported that severe bladder disorder in idiopathic normal-pressure hydrocephalus (iNPH) is predicted by right frontal hypoperfusion. However, it is not known whether bladder recovery is predicted by brain perfusion change after shunt surgery. To address this issue, we compared bladder and brain function before and after shunt surgery in iNPH.

Methods

We enrolled 75 patients in the study. Before and 12 months after shunt surgery, we analyzed brain perfusion by SPECT and bladder disorder by a specialized grading scale. The scale consisted of grade 0, none; grade 1, urinary urgency and frequency; grade 2, urinary incontinence 1–3 times a week; grade 3, urinary incontinence >daily; and grade 4, loss of bladder control. More than one grade improvement is defined as improvement, and more than one grade decrement as worsening; otherwise no changes.

Results

Comparing before and after surgery, in the bladder-no-change group (32 cases) there was an increase in blood flow which is regarded as reversal of enlargement in the Sylvian fissure and lateral ventricles (served as control). In contrast, in the bladder-improved group (32 cases) there was an increase in bilateral mid-cingulate, parietal, and left frontal blood flow (p < 0.05). In the bladder-worsened group (11 cases) no significant blood flow change was observed.

Conclusion

The present study showed that after shunt surgery, bladder recovery is related with mid-cingulate perfusion increase in patients with iNPH. The underlying mechanism might be functional restoration of the mid-cingulate that normally inhibits the micturition reflex.

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Author contributions

Sakakibara R has a role in study concept and design, acquisition of subjects and/or data, analysis and interpretation of data, and preparation of manuscript; Uchida Y has a role in statistical analysis of the study; Ishii K has a role in: execution of the study; Kazui H has a role in: execution of the study; Hashimoto M has a role in execution of the study; Ishikawa M has a role in execution of the study; Yuasa T has a role in execution of the study; Yamamoto T has a role in execution of the study; Yamanishi T has a role in execution of the study; Uchiyama T has a role in execution of the study; Tateno F has a role in acquisition of data; Kishi M has a role in acquisition of data; Tsuyusaki Y has a role in acquisition of data; Aiba Y has a role in execution of the study; Nagao T has a role in execution of the study; Terada H has a role in execution of the study; All the members of SINPHONI have a role in acquisition of data.

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Authors and Affiliations

  1. Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura, 285-8741, Japan

    Ryuji Sakakibara, Fuyuki Tateno, Masahiko Kishi, Yohei Tsuyusaki, Yosuke Aiba & Hiromi Tateno

  2. Neurology, Chiba University, Chiba, Japan

    Ryuji Sakakibara & Tatsuya Yamamoto

  3. Radiology, Sanno Hospital, Chiba, Japan

    Yoshitaka Uchida

  4. Center for Early Diagnosis of Dementia, Kinki University, Sayama, Japan

    Kazunari Ishii

  5. Neurosurgery, Kohritsu Noto Hospital, Ishikawa, Japan

    Masaaki Hashimoto

  6. Neurosurgery, Kitano Hospital, Kyoto, Japan

    Masaaki Ishikawa

  7. Psychiatry, Osaka University, Osaka, Japan

    Hiromitsu Kazui

  8. Continence Center, Dokkyo Medical College, Tochigi, Japan

    Tomoyuki Uchiyama

  9. Neurosurgery, Sakura Medical Center, Toho University, Sakura, Japan

    Takeki Nagao

  10. Radiology, Sakura Medical Center, Toho University, Sakura, Japan

    Hitoshi Terada & Tsutomu Inaoka

Authors
  1. Ryuji Sakakibara
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  2. Yoshitaka Uchida
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  3. Kazunari Ishii
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  4. Masaaki Hashimoto
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  5. Masaaki Ishikawa
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  6. Hiromitsu Kazui
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  7. Tatsuya Yamamoto
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  8. Tomoyuki Uchiyama
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  9. Fuyuki Tateno
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  10. Masahiko Kishi
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  11. Yohei Tsuyusaki
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  14. Takeki Nagao
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  15. Hitoshi Terada
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  16. Tsutomu Inaoka
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Consortia

The Members of SINPHONI (Study of Idiopathic Normal Pressure Hydrocephalus On Neurological Improvement)

Corresponding author

Correspondence to Ryuji Sakakibara.

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None of the authors have any conflicts of interest to declare relevant to this study.

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Sakakibara, R., Uchida, Y., Ishii, K. et al. Bladder recovery relates with increased mid-cingulate perfusion after shunt surgery in idiopathic normal-pressure hydrocephalus: a single-photon emission tomography study. Int Urol Nephrol 48, 169–174 (2016). https://doi.org/10.1007/s11255-015-1162-2

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  • DOI: https://doi.org/10.1007/s11255-015-1162-2

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