Functional imaging of stress urinary incontinence

Herms, Achim; Veit, Ralf; Reisenauer, Christl; Grodd, Wolfgang; Enck, Paul; Stenzl, Arnulf; Birbaumer, Niels

doi:10.1016/j.neuroimage.2005.07.018

Cited by 60 publications

(42 citation statements)

References 31 publications

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“…Activity in regions of this alternative complex is related in healthy volunteers to voluntary control of voiding by pelvic floor contraction (Zhang et al, 2005); to suppression of the voluntary urge to void (Kuhtz-Buschbeck et al, 2005); to withholding of urine (Yin et al, 2006); and to use of pelvic floor muscles (Di Gangi Herms et al, 2006;KuhtzBuschbeck et al, 2005;Seseke et al, 2006). This regional and functional pattern, along with the changed sign of connectivity, suggests that activity in the alternative complex represents excitation (recruitment) of accessory pathways in an attempt to control urgency and the voiding reflex when loss of bladder control threatens.…”

Section: Discussionmentioning

confidence: 99%

“…Bladder control depends on an extensive supraspinal neuronal network. The anatomic locations of its main regions, and their responses during urine storage and voiding, have been identified in normal subjects by functional imaging using PET or fMRI (Athwal et al, 2001;Blok et al, 1997;Di Gangi Herms et al, 2006;Griffiths et al, 2005;Kuhtz-Buschbeck et al, 2005;Nour et al, 2000;Zhang et al, 2005) (see (Kavia et al, 2005) for a review). However, the function of the network as an integrated system is less well understood than its anatomy.…”

Section: Introductionmentioning

confidence: 99%

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Abnormal connections in the supraspinal bladder control network in women with urge urinary incontinence

et al. 2008

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The regions of the supraspinal network that controls urinary bladder behavior are well known, but little is known about their interconnections. We tested the feasibility of using physiophysiological interaction to explore the effective connections of the network and to seek disease-related differences in connectivity. This was a secondary analysis of fMRI data obtained from women aged 26 -85 years, 11 with urge urinary incontinence and 10 with normal bladder function. In each subject, fMRI BOLD images were obtained during a period with full bladder and strong bladder sensation (without detrusor overactivity) while repeatedly infusing and withdrawing a small amount of liquid in and out of the bladder. Regions of interest included right insula (RI) and anterior cingulate gyrus (ACG), both consistently involved in bladder control. Other regions effectively connected to them were identified by significant correlation between their fMRI signal and the interaction RIxACG. Among normal subjects, many regions involved in bladder control were effectively connected with RI/ACG, including frontotemporal and sensorimotor cortex, forebrain, midbrain and pontine regions. The sign of the correlation with RIxACG was near-uniformly positive, perhaps suggesting mainly inhibitory connections. Among urge-incontinent subjects the effective connectivity was shifted to a parietotemporal complex, while the sign of the correlation was predominantly negative, perhaps consistent with excitation (recruitment) of accessory pathways in an attempt to maintain bladder control. Thus, physiophysiological interaction yields potentially important information about the connectivity of the bladder control network and its changes in disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Abnormal connections in the supraspinal bladder control network in women with urge urinary incontinence

et al. 2008

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“…Bladder control is exercised by the brain via a long-loop spinobulbospinal reflex pathway that includes the midbrain periaqueductal gray (PAG) and the pontine micturition center (PMC), which in turn are controlled by a supratentorial network. The main network landmarks are known from animal and clinical observations, and from functional imaging by positron emission tomography (PET) (Athwal et al, 2001;Blok et al, 1997b;Kitta et al, 2006;Matsuura et al, 2002;Nour et al, 2000) or functional magnetic resonance imaging (fMRI) (Di Gangi Herms et al, 2006;Griffiths et al, 2005;KuhtzBuschbeck et al, 2005;Seseke et al, 2006;Zhang et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Cerebral control of the bladder in normal and urge-incontinent women

et al. 2007

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Aim: To identify age-related changes in the normal brain/bladder control system, and differences between urge incontinence in younger and older women, as shown by brain responses to bladder filling; and to use age, bladder volume, urge incontinence and detrusor overactivity (DO) as probes to reveal control-system function. Functional MRI was used to examine regional brain responses to bladder infusion in 21 females (26 -85 years): 11 "cases" with urge incontinence and DO (proven previously) and 10 normal "controls". Responses and their age dependence were determined at small and large bladder volumes, in whole brain and in regions of interest representing right insula and anterior cingulate (ACG). In "controls", increasing bladder volume/sensation led to increasing insular responses; with increasing age, insular responses became weaker. In younger "cases", ACG responded abnormally strongly at large bladder volumes/strong sensation. Elderly "cases" showed strong ACG responses even at small bladder volume, but more moderate responses at larger volumes; if DO occurred, pontine micturition center (PMC) activation did not increase. Conclusion:Among normal "controls", increasing age leads to decreased responses in brain regions involved in bladder control, including right insula, consistent with its role in mapping normal bladder sensations. Strong ACG activation occurs in urge-incontinent "cases" and may be a sign of urgency, indicating recruitment of alternative pathways when loss of bladder control is feared. Easier ACG provocation in older "cases" reflects lack of physiological reserve or different etiology. ACG responses seem associated with PMC inhibition: reduced ACG activity accompanies failure of inhibition (DO).

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“…Recent neuroimaging studies of repetitive pelvic floor contractions (mimicking the interruption of micturition), often showed evidence of supplementary motor area (SMA, BA 6) activation (Zhang et al 2005;Di Gangi Herms et al 2006;Seseke et al 2006;Kuhtz-Buschbeck et al 2007). Neither SMA, nor other motor cortex activity, was present at the threshold of P < 0.01 (cluster corrected, k > 106) in our study, something probably attributable to differences in the applied protocol.…”

Section: The Supraspinal Cycle Of Micturition and The Bulbospinal Micmentioning

confidence: 99%

70 Supraspinal control of urine storage and micturition in men – an fMRI study

Michels¹,

Wöllner²,

Gregorini³

et al. 2013

European Urology Supplements

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Despite the crucial role of the brain in the control of the human lower urinary tract, little is known about the supraspinal mechanisms regulating micturition. To investigate the central regulatory mechanisms activated during micturition initiation and actual micturition, we used an alternating sequence of micturition imitation/imagination, micturition initiation, and actual micturition in 22 healthy males undergoing functional magnetic resonance imaging. Subjects able to micturate (voiders) showed the most prominent supraspinal activity during the final phase of micturition initiation whereas actual micturition was associated with significantly less such activity. Initiation of micturition in voiders induced significant activity in the brainstem (periaqueductal gray, pons), insula, thalamus, prefrontal cortex, parietal operculum and cingulate cortex with significant functional connectivity between the forebrain and parietal operculum. Subjects unable to micturate (nonvoiders) showed less robust activation during initiation of micturition, with activity in the forebrain and brainstem particularly lacking. Our findings suggest that micturition is controlled by a specific supraspinal network which is essential for the voluntary initiation of micturition. Once this network triggers the bulbospinal micturition reflex via brainstem centers, micturition continues automatically without further supraspinal input. Unsuccessful micturition is characterized by a failure to activate the periaqueductal gray and pons during initiation.

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Functional imaging of stress urinary incontinence

Cited by 60 publications

References 31 publications

Abnormal connections in the supraspinal bladder control network in women with urge urinary incontinence

Abnormal connections in the supraspinal bladder control network in women with urge urinary incontinence

Cerebral control of the bladder in normal and urge-incontinent women

70 Supraspinal control of urine storage and micturition in men – an fMRI study

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