The CNS and bladder dysfunction.
Tadic SD, Holstege G, Griffiths DJ -F1000 medicine reports(2012)
fig-001:Neuroanatomy of micturition and control of voiding, showing neuroanatomically well-established regions and projectionsThe peripheral and spinal connections support the voiding reflex, together with the pontine micturition center (PMC) and midbrain periaqueductal gray (PAG). Note that several of the brain regions shown are also registered by functional magnetic resonance (Fig. 1B). They include the medial part of the prefrontal cortex and the dorsal part of the anterior cingulate gyrus, which are key areas in two cortical neural circuits postulated to control the lower urinary tract [16]. The hypothalamus and amygdala belong to a third, subcortical postulated control circuit. Brain regions that appear in Fig. 1B but not in Fig. 1A (e.g. insula) represent areas of possible disagreement that remain to be resolved.
View Article:PubMed Central - PubMed
Affiliation:Division of Geriatric Medicine and Gerontology University of Pittsburgh, Pittsburgh, PA, USA 15213.
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Bottom Line:The brain's role in the development and maintenance of bladder control is critical, although its precise role in patient-reported complaints such as urgency and urine leakage is unknown.Functional brain imaging studies have advanced our knowledge of brain activity during the micturition cycle, showing multiple neuronal circuits involved as parts of a 'brain-bladder control network.' Yet, new advances need to be made in order to incorporate this knowledge into existing models of neuroanatomy and of clinical syndromes of bladder dysfunction and related clinical practice.This short article explains why and how brain imaging methods are poised to achieve that goal and decode the role of the brain in widely prevalent clinical conditions related to bladder dysfunction.
Abstract
The brain's role in the development and maintenance of bladder control is critical, although its precise role in patient-reported complaints such as urgency and urine leakage is unknown. Functional brain imaging studies have advanced our knowledge of brain activity during the micturition cycle, showing multiple neuronal circuits involved as parts of a 'brain-bladder control network.' Yet, new advances need to be made in order to incorporate this knowledge into existing models of neuroanatomy and of clinical syndromes of bladder dysfunction and related clinical practice. This short article explains why and how brain imaging methods are poised to achieve that goal and decode the role of the brain in widely prevalent clinical conditions related to bladder dysfunction.
Mentions
Since the last decade of the 20th century, functional imaging of regional activity in the brain's gray matter has revealed characteristic changes during bladder voiding and storage and, more recently, during patient-reported urgency [8-13]. This has led to the emerging concept of a “brain-bladder control network” that adds new information to the existing knowledge of the neuroanatomy of micturition and the control of voiding (Figure 1) [14, 16]. Yet, further breakthroughs are needed to improve our current insight into brain function and define factors leading to the failure of the brain to control voiding. Given recent advances in imaging methodologies, this is now possible. Let's review potential avenues.
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