title: Supraspinal Control of Urine Storage and Micturition in Men--An fMRI Study.
abstract: 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.
authors: Institute of Neuroradiology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors: Lars
authors: L
authors: Michels
authors: Department of Urology, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands.
authors: Bertil F M
authors: BF
authors: Blok
authors: Neuro-Urology, Spinal Cord Injury Center & Research, University of Zurich, Balgrist University Hospital, 8008 Zurich, Switzerland.
authors: Flavia
authors: F
authors: Gregorini
authors: Department of Urology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors: Michael
authors: M
authors: Kurz
authors: Neuro-Urology, Department of Clinical Neurosciences, University Hospital Centre (CHUV), University of Lausanne, 1011 Lausanne, Switzerland.
authors: Brigitte
authors: B
authors: Schurch
authors: Neuro-Urology, Spinal Cord Injury Center & Research, University of Zurich, Balgrist University Hospital, 8008 Zurich, Switzerland.
authors: Thomas M
authors: TM
authors: Kessler
authors: Institute of Neuroradiology, University Hospital Zurich, 8091 Zurich, Switzerland.
authors: Spyros
authors: S
authors: Kollias
authors: Neuro-Urology, Spinal Cord Injury Center & Research, University of Zurich, Balgrist University Hospital, 8008 Zurich, Switzerland.
authors: Ulrich
authors: U
authors: Mehnert
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000502:physiology*; D001931:Brain Mapping; D006801:Humans; D007092:Imagination / Q000502:physiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000502:physiology; D011597:Psychomotor Performance / Q000502:physiology; D014554:Urination / Q000502:physiology*; D014556:Urine / Q000502:physiology; D055815:Young Adult
keywords: functional magnetic resonance imaging; lower urinary tract; micturition; pontine micturition center; supraspinal control