Abstract
Bladder problems are frequently disorders of control, which is exercised from the brain. In such disorders, brain responses to bladder events are abnormal; therapy is accompanied by regional changes that may be measured by functional imaging and used to monitor the effect of treatment. The regional responses may be understood in terms of a tentative model of the bladder control system. The model helps also to interpret alterations in brain behavior (as imaged by functional scanning) that occur when afferent signals from bladder or urethra are changed experimentally or by an underlying disorder or treatment, for example, overactive bladder (urge/urgency incontinence). Successful treatment may either increase the ability to cope with the problem or may be curative. The direction of treatment-induced change of abnormal brain responses can distinguish these two possibilities and shed light on the therapeutic mechanism. In addition, brain activity in regions such as insula or dorsal anterior cingulate cortex may be regarded as a proxy for sensations such as desire to void or urgency, which are otherwise difficult to define or measure. Monitoring of brain responses in these regions offers an obvious way to test the effect of drugs.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Abrams P, Blaivas JG, Stanton S, Andersen JT (1988) The standardisation of terminology of lower urinary tract function. Neurourol Urodyn 7:403–426
Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21:167–178
Abrams P, Cardozo L, Khoury S, Wein A (2009) Incontinence: 4th international consultation on incontinence, Editions 21. Health, Paris, France
Andrew J, Nathan PW (1964) Lesions of the anterior frontal lobes and disturbances of micturition and defaecation. Brain 87:233–262
Blaivas JG, Panagopoulos G, Weiss JP, Somaroo C (2009) Two types of urgency. Neurourol Urodyn 28:188–190
Blok BF (2002) Central pathways controlling micturition and urinary continence. Urology 59:13–17
Blok BF, Holstege G (1998) The central nervous system control of micturition in cats and humans. Behav Brain Res 92:119–125
Blok BFM, Groen J, Bosch JLHR, Veltman DJ, Lammersma AA (2006) Different brain effects during chronic and acute sacral modulation in urge incontinent patients with implanted neurostimulators. BJU Int 08:1238–1243
Craig AD (2002) How do you feel? Interoception: the sense of the physiological condition of the body. Nat Rev Neurosci 3:655–666
Critchley HD, Mathias CJ, Josephs O, O’Doherty J, Zanini S, Dewar BK, Cipolotti L, Shallice T, Dolan RJ (2003) Human cingulate cortex and autonomic control: converging neuroimaging and clinical evidence. Brain 126:2139–2152
Damasio AR (2003) Looking for Spinoza: joy, sorrow, and the feeling brain. Harcourt, Orlando, FL
DasGupta R, Fowler CJ (2004) Urodynamic study of women in urinary retention treated with sacral neuromodulation. J Urol 171:1161–1164
DasGupta R, Critchley HD, Dolan RJ, Fowler CJ (2005) Changes in brain activity following sacral neuromodulation for urinary retention. J Urol 174:2268–2272
Fowler CJ, Griffiths D, De Groat WC (2008) The neural control of micturition. Nat Rev Neurosci 9:453–466
Geirsson G, Fall M, Lindstrom S (1993) The ice-water test–a simple and valuable supplement to routine cystometry. BJU 71:681–685
Griffiths D, Tadic SD (2008) Bladder control, urgency, and urge incontinence: evidence from functional brain imaging. Neurourol Urodyn 27:466–474
Griffiths D, Derbyshire S, Stenger A, Resnick N (2005) Brain control of normal and overactive bladder. J Urol 174:1862–1867
Griffiths D, Tadic SD, Schaefer W, Resnick NM (2007) Cerebral control of the bladder in normal and urge-incontinent women. Neuroimage 37:1–7
Griffiths DJ, Tadic SD, Schaefer W, Resnick NM (2009) Cerebral control of the lower urinary tract: how age-related changes might predispose to urge incontinence. Neuroimage 47:981–986
Kavia RB, Dasgupta R, Fowler CJ (2005) Functional imaging and the central control of the bladder. J Comp Neurol 493:27–32
Kavia RB, DasGupta R, Critchley HD, Fowler CJ, Griffiths D (2010) An fMRI study of the effect of sacral neuromodulation on brain responses in women with Fowler’s Syndrome. BJU Int 105:366–372
Kuhtz-Buschbeck JP, van der Horst C, Pott C, Wolff S, Nabavi A, Jansen O, Junemann KP (2005) Cortical representation of the urge to void: a functional magnetic resonance imaging study. J Urol 174:1477–1481
Lowenstein L, FitzGerald MP, Kenton K, Hatchett L, Durazo-Arvisu R, Mueller ER, Goldman K, Brubaker L (2008) Evaluation of urgency in women, with a validated urgency, severity and impact questionnaire (USIQ). Int Urogynecol J 20:301–307
Matsuura S, Kakizaki H, Mitsui T, Shiga T, Tamaki N, Koyanagi T (2002) Human brain region response to distention or cold stimulation of the bladder: a positron emission tomography study. J Urol 168:2035–2039
Mayer EA, Naliboff BD, Craig AD (2006) Neuroimaging of the brain-gut axis: from basic understanding to treatment of functional GI disorders. Gastroenterology 131:1925–1942
McLennan MT, Melick C, Bent AE (2001) Urethral instability: clinical and urodynamic characteristics. Neurourol Urodyn 20:653–660
Mehnert U, Boy S, Svensson J, Michels L, Reitz A, Candia V, Kleiser R, Kollias S, Schurch B (2008) Brain activation in response to bladder filling and simultaneous stimulation of the dorsal clitoral nerve – an fMRI study in healthy women. Neuroimage 41:682–689
Pfisterer M, Griffiths D, Schaefer W, Resnick N (2006) The effect of age on lower urinary tract function: a study in women. J Am Geriatr Soc 54:405–412
Shih YI, Chen CV, Shyu B, Lin Z, Chiang Y, Jaw F, Chen Y, Chang C (2009) A new scenario for negative functional magnetic resonance signals: endogenous neurotransmission. J Neurosci 29:3036–3044
Tadic SD, Griffiths D, Schaefer W, Resnick NM (2008) Abnormal connections in the supraspinal bladder control network in women with urge urinary incontinence. Neuroimage 39:1647–1653
Tadic SD, Griffiths D, Schaefer W, Cheng CI, Resnick NM (2010) Brain activity as measured by functional magnetic resonance imaging (fMRI) is related to patient reported severity of urge urinary incontinence. J Urol 183:221–228
Torrens M, Feneley RCL (1982) Rehabilitation and management of the neuropathic bladder. In: Illis LS, Sedgwick EM, Glanville HJ (eds) Rehabilitation of the neurological patient. Blackwell Scientific, Oxford
Wager TD, van Ast VA, Hughes BL, Davidson ML, Lindquist MA, Ochsner KN (2009) Brain mediators of cardiovascular responses to social threat, part II: Prefrontal-subcortical pathways and relationship with anxiety. Neuroimage 47:836–851
Acknowledgments
I am greatly indebted to Dr Stasa Tadic and Professor Clare Fowler for stimulating discussions that led to many of the ideas expressed here. Without their help and the help of many other colleagues and coworkers in Pittsburgh and London, none of these ideas would have been developed. I gratefully acknowledge the constant support and encouragement provided by Dr Neil Resnick as well as financial support from the University of Pittsburgh Competitive Medical Research Fund and from the US Public Health Service, grants R03AG25166 and R01AG020629.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Griffiths, D.J. (2011). Use of Functional Imaging to Monitor Central Control of Voiding in Humans. In: Andersson, KE., Michel, M. (eds) Urinary Tract. Handbook of Experimental Pharmacology, vol 2011. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-16499-6_5
Download citation
DOI: https://doi.org/10.1007/978-3-642-16499-6_5
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-16498-9
Online ISBN: 978-3-642-16499-6
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)