Skip to main content

Advertisement

Log in

Functional brain imaging and the bladder: New insights into cerebral control over micturition

  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Mechanisms for cerebral control over the micturition process remain poorly elucidated. The knowledge is based largely on human pathophysiology and data derived from electrophysiologic testing in animals. Recent advances in dynamic functional brain imaging technologies including positron-emission tomography, single photon emission computed tomography, and functional magnetic resonance imaging have allowed new insights into how the human brain regulates this process. This article discusses animal studies, which provided the foundation for our understanding of cerebral control over micturition, and recent human studies, implementing functional brain imaging to enhance our knowledge of this complex phenomenon.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

References and Recommended Reading

  1. Blaivas JG: The neurophysiology of micturition: a clinical study of 550 patients. J Urol 1982, 127:958–963.

    PubMed  CAS  Google Scholar 

  2. Barrington FJ: The relation of the hind-brain to micturition. Brain 1921, 44:23–53.

    Article  Google Scholar 

  3. Langworthy OR, Kolb LC: The encephalic control of tone in the musculature of the urinary bladder. Brain 1933, 56:371–382.

    Article  Google Scholar 

  4. Kuru M, Yamamoto H: Fiber connections of the pontine detrusor nucleus (Arrington). J Comp Neurol 1964, 123:161–185.

    Article  PubMed  CAS  Google Scholar 

  5. Loewy AD, Saper CB, Baker RP: Descending projections from the pontine micturition center. Brain Res 1979, 172:533–538.

    Article  PubMed  CAS  Google Scholar 

  6. Holstege G, Griffiths D, DeWall H, Dalm E: Anatomical and physiological observations on supraspinal control of bladder and urethral sphincter muscles in the cat. J Comp Neurol 1986, 250:449–461. The initial article describing the existence of two distinct regions within the PMC (M-region and L-region) involved in the differential control of the bladder and external urethral sphincter.

    Article  PubMed  CAS  Google Scholar 

  7. Griffiths D, Holstege G, Dalm E, De Wall H: Control and coordination of bladder and urethral function in the brain stem of the cat. Neurourol Urodyn 1990, 9:63–82.

    Article  Google Scholar 

  8. Blok BF, Holstege G: The central control of micturition and continence: implications for urology. BJU Int 1999, 83(suppl 2):1–6.

    Article  PubMed  Google Scholar 

  9. Blok BF, Holstege G: The two pontine micturition centers in the cat are not interconnected: implications for the central organization of micturition. J Comp Neurol 1999, 403:209–218.

    Article  PubMed  CAS  Google Scholar 

  10. Andrew J, Nathan PW: Lesions of the anterior frontal lobes and disturbances of micturition and defecation. Brain 1964, 87:233–262.

    Article  PubMed  CAS  Google Scholar 

  11. Gjone R: Excitatory and inhibitory bladder responses to stimulation of ‘limbic’, diencephalic and mesencephalic structures in the cat. Acta Physiol Scand 1966, 66:91–102.

    PubMed  CAS  Google Scholar 

  12. Blok BF, Holstege G: Direct projections from the periaqueductal gray to the pontine micturition center (M-region): an anterograde and retrograde tracing study in the cat. Neurosci Letters 1994, 166:93–96.

    Article  CAS  Google Scholar 

  13. Holstege G: Some anatomical observations on the projections from the hypothalamus to brain stem and spinal cord: an HRP and autoradiographic tracing study in the cat. J Comp Neurol 1987, 260:98–126.

    Article  PubMed  CAS  Google Scholar 

  14. Ding YQ, Wang D, Xu JQ, Ju G: Direct projections from the medial preoptic area to spinally-projecting neurons in Barrington’s nucleus: an electron microscope study in the rat. Neurosci Lett 1999, 271:175–178.

    Article  PubMed  CAS  Google Scholar 

  15. Skultety FM: Relation of periaqueductal gray matter to stomach and bladder motility. Neurology 1959, 9:190–198.

    PubMed  CAS  Google Scholar 

  16. Tang PC, Ruch TC: Localization of brain stem and diencephalic areas controlling the micturition reflex. J Comp Neurol 1956, 106:213–245.

    Article  PubMed  Google Scholar 

  17. Blok BF: Brain control of the lower urinary tract. Scand J Urol Nephrol 2002, 210(suppl):11–15.

    Article  Google Scholar 

  18. Orrison WW Jr: 3M Mayneord Memorial Lecture: functional brain imaging: an overview. Br J Radiol 1996, 69:493–501. A comprehensive and well-written review of functional brain imaging technologies.

    Article  PubMed  Google Scholar 

  19. Fukuyama H, Matsuzaki S, Ouchi Y, et al.: Neural control of micturition in man examined with single photon emission computed tomography using 99mTc-HMPAO. Neuroreport 1996, 7:3009–3012.

    Article  PubMed  CAS  Google Scholar 

  20. Andersen AR, Friberg HH, Schmidt JF, Hasselbalch SG: Quantitative measurements of cerebral blood flow using SPECT and [99mTc]-d,l-HM-PAO compared to xenon-133. J Cerebr Blood Flow Metab 1988, 8:S69-S81.

    CAS  Google Scholar 

  21. Blok BF, Willemsen AT, Holstege G: A PET study on brain control of micturition in humans. Brain 1997, 120:111–121. This was the first report of PET scanning during micturition. It is an important study that suggested the presence of the specific PMC regions (M + L) in humans. Higher cerebral centers involved in control over micturition also were identified.

    Article  PubMed  Google Scholar 

  22. Blok BF, Sturms LM, Holstege G: Brain activation during micturition in women. Brain 1998, 121:2033–2042. The companion study to the preceding article, performed in women, confirming past results found in men. It describes the potential importance of the right side of the brain in controlling micturition.

    Article  PubMed  Google Scholar 

  23. Fowler CJ: Brain activation during micturition. Brain 1998, 121:2031–2032.

    Article  PubMed  Google Scholar 

  24. Maurice-Williams RS: Micturition symptoms in frontal tumours. J Neurol Neurosurg Psychiatry 1974, 37:431–436.

    Article  PubMed  CAS  Google Scholar 

  25. Kuroiwa Y, Thgi H, Ono S, Itoh M: Frequency and urgency of micturition in hemiplegic patients: relationship to hemisphere laterality of lesions. J Neurol 1987, 234:100–102.

    Article  PubMed  CAS  Google Scholar 

  26. Griffiths D: Clinical studies of cerebral and urinary tract function in elderly people with urinary incontinence. Behav Brain Res 1998, 92:151–155.

    Article  PubMed  CAS  Google Scholar 

  27. Pardo JV, Fox PT, Raichle ME: Localization of human system for sustained attention by positron-emission tomography. Nature 1991, 349:61–64.

    Article  PubMed  CAS  Google Scholar 

  28. Jenkins IH, Brooks DJ, Nixon PD, et al.: Motor sequence learning: a study with positron-emission tomography. J Neurosci 1994, 14:3775–3790.

    PubMed  CAS  Google Scholar 

  29. Paus T, Petrides M, Evans AC, Meyer E: Role of the human anterior cingulate cortex in the control of oculomotor, manual, and speech responses: a positron-emission tomography study. J Neurophysiol 1993, 70:453–469.

    PubMed  CAS  Google Scholar 

  30. Pardo JV, Pardo PJ, Janer KW, Raichle ME: The anterior cingulate cortex mediates processing selection in the Stroop attentional conflict paradigm. Proc Natl Acad Sci U S A 1990, 87:256–259.

    Article  PubMed  CAS  Google Scholar 

  31. Aziz Q, Andersson JL, Valind S, et al.: Identification of human brain loci processing esophageal sensation using positronemission tomography. Gastroenterology 1997, 113:50–59.

    Article  PubMed  CAS  Google Scholar 

  32. Oppenheimer SM, Gelb A, Girvin JP, Hachinski VC: Cardiovascular effects of human insular cortex stimulation. Neurology 1992, 42:1727–1732.

    PubMed  CAS  Google Scholar 

  33. Nour S, Svarer C, Kristensen JK, et al.: Cerebral activation during micturition in normal men. Brain 2000, 123:781–789. In this study, PET was combined with simultaneous cystometry, confirming simultaneous bladder contractility at the time of brain activation. The potential for a more complex network of cortical and subcortical structures responsible for the control of micturition was discovered.

    Article  PubMed  Google Scholar 

  34. Athwal BS, Berkley KJ, Hussain I, et al.: Brain responses to changes in bladder volume and urge to void in healthy men. Brain 2001, 124:369–377. These authors implemented PET to look for brain regions responsible for the sensations of bladder fullness and urgency by passively filling the bladder. It was found that these two sensations occurred in individually distinct brain regions, which appear to be unrelated to the somatosensory cortex.

    Article  PubMed  CAS  Google Scholar 

  35. Matsuura S, Kakizaki H, Mitsui T, et al.: Human brain region response to distension or cold stimulation of the bladder: a positron-emission tomography study. J Urol 2002, 168:2035–2039.

    Article  PubMed  Google Scholar 

  36. Blok BF, De Weerd H, Holstege G: Ultrastructural evidence for a paucity of projections from the lumbosacral cord to the pontine micturition center or M-region in the cat: a new concept for the organization of the micturition reflex with the periaqueductal gray as central relay. J Comp Neurol 1995, 359:300–309.

    Article  PubMed  CAS  Google Scholar 

  37. Devinsky O, Morrell MJ, Vogt BA: Contributions of anterior cingulate cortex to behaviour. Brain 1995, 118:279–306.

    Article  PubMed  Google Scholar 

  38. De Ridder D, Ponette D, Soenaert S, et al.: Brain activation during sacral nerve stimulation in females: an FMRI study. SNS Currents 2002, 6.

  39. De Ridder D, Sunaert S, Ost D, et al.: Functional MRI during percutaneous sacral nerve evaluation of female patients shows central differences between fowler and non-fowler patients. J Urol 2003, 169(suppl 4):172A.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kershen, R.T., Kalisvaart, J. & Appell, R.A. Functional brain imaging and the bladder: New insights into cerebral control over micturition. Curr Urol Rep 4, 344–349 (2003). https://doi.org/10.1007/s11934-003-0004-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-003-0004-4

Keywords

Navigation