Michael Shy1, Steve Fung2, Timothy B Boone3, Christof Karmonik2, Sophie G Fletcher3, Rose Khavari4. 1. Scott Department of Urology, Baylor College of Medicine, Houston, Texas. 2. Radiology Department, Houston Methodist Research Institute, Houston, Texas. 3. Department of Urology, Houston Methodist Hospital, Houston, Texas. 4. Department of Urology, Houston Methodist Hospital, Houston, Texas. Electronic address: rkhavari@houstonmethodist.org.
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.
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.
Authors: J P Kuhtz-Buschbeck; C van der Horst; S Wolff; N Filippow; A Nabavi; O Jansen; P M Braun Journal: Neuroimage Date: 2007-01-09 Impact factor: 6.556
Authors: Rose Khavari; Saba N Elias; Rashmi Pande; Katherine M Wu; Timothy B Boone; Christof Karmonik Journal: J Urol Date: 2019-01 Impact factor: 7.450
Authors: Anna S Nagle; John E Speich; Stefan G De Wachter; Peter P Ghamarian; David M Le; Andrew F Colhoun; Paul H Ratz; Robert W Barbee; Adam P Klausner Journal: Neurourol Urodyn Date: 2016-09-21 Impact factor: 2.696