Functional Magnetic Resonance Imaging during Urodynamic Testing Identifies Brain Structures Initiating Micturition

Abstract

Purpose Normal voiding in neurologically intact patients is triggered by the release of tonic inhibition from suprapontine centers, allowing the pontine micturition center to trigger the voiding reflex. Supraspinal mechanisms of voluntary voiding in humans are just beginning to be described via functional neuroimaging. We further elucidated brain activity processes during voiding using functional magnetic resonance imaging in normal females to gain better understanding of normal voiding as well as changes that may occur in voiding dysfunction. Materials and Methods We screened 13 healthy premenopausal female volunteers using baseline clinic urodynamics to document normal voiding parameters. We then recorded brain activity via functional magnetic resonance imaging and simultaneous urodynamics, including the pressure flow voiding phase. After motion correction of functional magnetic resonance images we performed activation and connectivity analyses in 10 subjects. Results Group analysis revealed consistent activation areas, including regions for motor control (cerebellum, thalamus, caudate, lentiform nucleus, red nucleus, supplementary motor area and post-central gyrus), emotion (anterior/posterior cingulate gyrus and insula), executive function (left superior frontal gyrus) and a focal region in the pons. Connectivity analysis demonstrated strong interconnectivity of the pontine micturition center with many short-range and long-range cortical clusters. Conclusions Our study is one of the first reports of brain activation centers associated with micturition initiation in normal healthy females. Results show activation of a brain network consisting of regions for motor control, executive function and emotion processing. Further studies are planned to create and validate a model of brain activity during normal voiding in women.

Functional Magnetic Resonance Imaging with Concurrent Urodynamic Testing Identifies Brain Structures Involved in Micturition Cycle in Patients with Multiple Sclerosis

“…Control data were provided by records from HC female subjects reported in our previous study. 5 Men were excluded from study to avoid confounding by prostate pathology.…”

“…2 Positron emission tomography and fMRI neuro-imaging have shown activation of the right dorsal pontine tegmentum, the right inferior frontal gyrus and other regions for motor control during voiding. 3–5 Following the identification of these circuits in healthy individuals, in recent years investigators have started to study patients with LUTS and urological chronic pelvic pain syndrome to better establish a phenotype and understand these complex urological syndromes. 6,7 …”

“…We applied our previously established fMRI/UDS platform 5 to investigate the higher neural control involved during the complete micturition cycle (storage and voiding phase) in ambulatory female patients with MS and NLUTD. In addition, we explored whether patients with demonstrable NDO or DSD show a trend toward distinct supraspinal activation.…”

Que sait-on des femmes fontaines et de l’éjaculation féminine en 2015 ?

“…Plusieurs hypothè ses sont avancé es, telles que l'action mé canique avec la pression digitale sur le sphincter vé sical ou alors un mé canisme neurologique central avec la dé sactivation concomitante de la zone du « lâcher prise », né cessaire à l'orgasme, et situé e dans le cortex fronto-parié tal [34], et une de celles du contrô le de la miction [35], situé dans le lobe frontal et adjacente à la premiè re. De nouvelles é tudes sont en cours.…”

New Frontiers in Molecular and Imaging Research on Evaluation and Diagnosis of Bladder Outlet Obstruction in Women

“…Specifically, functional MRI (fMRI) studies have identified several cortical brain areas are involved in the regulation of micturition (34). Our institution performed a pilot study of brain activity evaluated by fMRI during simultaneous urodynamic testing in 10 healthy female subjects and identified activation of a brain network consisting of regions for motor control, executive function and emotion processing at “initiating of micturition” (35). These functional imaging protocols can be applied to subjects with various urologic pathologies to better elucidate differences in neural control compared to normal subjects.…”