Functional MRI in patients with detrusor sphincter dyssynergia: Is the neural circuit affected?

Abstract

Aims In recent years, the human brain‐bladder control network has been visualized in different functional magnetic resonance imaging (fMRI) studies. The role of the brainstem and suprapontine regions has been elucidated. Especially the pontine region and the periaqueductal gray, as the central structures of the micturition circuit, were demonstrated. Detrusor sphincter dyssynergia (DSD) is a common problem in patients with neurological diseases. Residual urine and consecutive urinary tract infections with the risk of kidney damage remain a problem. In the present study, we used fMRI of the brain to compare the activation sites of patients with DSD with those of our previously published healthy controls with special emphasis on the brainstem region. Methods fMRI was performed in 11 patients with DSD who had an urge to void due to a filled bladder. In a nonvoiding model, they were instructed to contract or to relax the pelvic floor muscles repetitively. Results In patients with DSD, we could reproduce the activation sites found in healthy subjects, showing the regions in the brainstem as well as the other micturition‐related areas. The activation of the pontine region was more rostral/dorsal compared with the healthy volunteers. Conclusion Interestingly, we detected the well‐known activation in the pontine region in the patients in the dorsal/rostral part compared with the more ventral activation in the healthy volunteers, suggesting that the L‐region of the pontine micturition center is more prominent in cases of DSD.

A systematic review and activation likelihood estimation meta-analysis of the central innervation of the lower urinary tract: Pelvic floor motor control and micturition

“…Although the current meta-analysis did not specifically focus on sex related differences, data of both men and women were included. Tables 2 and 3 demonstrate that only three studies (2 PFMC and 1 micturition) in this review studied both men and women [4,7,45]. The amount of data in the current systematic review was not sufficient to repeat the ALE analysis separately for men and women to study differences.…”

“…PFMC can be studied during different bladder states (empty vs full), sometimes used to interrupt micturition or suppress the urge to void. In the PFMC ALE, 5 studies investigated PFMC with a full bladder [10,22,23,25,45]. Among those, Zhang et al, compared activation between PFMC with empty vs full bladder and demonstrated differences in SMA, basal ganglia and cerebellum.…”

Preliminary Analysis of Brain Footprints in Multiple Sclerosis Females With Detrusor Sphincter Dyssynergia: A Concurrent Urodynamic and Functional Magnetic Resonance Imaging Study

“…They were able to elucidate differences in brain activation patterns between the two groups as seen in the brainstem, along with stronger activation of the L-region in the pons indicative of patients inability to voluntarily relax the urethral sphincter. [28] With regards to white matter, FA and MD were generated from subjects' DTI scans to evaluate the integrity of the two white matter tracts of interest. FA is proportional to the spatial in-homogeneity of water diffusion and therefore a measure for the coherence of a white matter tract bundle.…”

Interplay Between Cognitive and Bowel/Bladder Function in Multiple Sclerosis

“…Patients affected by impaired cognitive functions caused by neurological conditions such as vascular dementia and Parkinson's disease also display issues in controlling bowel and bladder function [9,10]. The association between cognitive performances and bowel/bladder control may depend upon the strong overlap of brain structures activated by both functions, namely, the prefrontal cortex, the thalamus, the cerebellum and the brainstem [11,12]. As cognitive impairment can be detected in up to 75%…”