Brain, Vol 120, Issue 1 111-121, Copyright © 1997 by Oxford University Press
BF Blok, AT Willemsen and G Holstege
Although the brain plays a crucial role in the control of micturition,
little is known about the structures involved. Identification of these
areas is important, because their dysfunction is though to cause urge
incontinence, a major problem in the elderly. In the cat, three areas in
the brainstem and diencephalon are specifically implicated in the control
of micturition: the dorsomedial pontine tegmentum, the periaqueductal grey,
and the preoptic area of the hypothalamus. PET scans were used to test
whether these areas are also involved in human micturition. Seventeen
right-handed male volunteers were scanned during the following four
conditions: (i) 15 min prior to micturition during urine withholding: (ii)
during micturition; (iii) 15 min after micturition; (iv) 30 min after
micturition. Ten of the 17 volunteers were able to micturate during
scanning. micuturition was associated with increased blood flow in the
right dorsomedial pontine tegmentum, the periaqueductal grey, the
hypothalamus and the right inferior frontal gyrus. Decreased blood flow was
found in the right anterior cingulate gyrus when urine was withheld. The
other seven volunteers were not able to micturate during scanning, although
they had a full bladder and tried vigorously to do so. In this group,
during these unsuccessful attempts to micturate, increased blood flow was
found in the right ventral pontine tegmentum, which corresponds with the
hypothesis, formulated from results in cats, that this area controls the
motor neurons of the pelvic floor. Increased blood flow was also found in
the right inferior frontal gyrus during unsuccessful attempts at
micturition, and decreased blood flow in the right anterior cingulate gyrus
was found during the withholding of urine. The results suggest that, as
that of the cat, the human brainstem contains specific nuclei responsible
for the control of micturition, and that the cortical and pontine
micturition sites are predominantly on the right side.
ARTICLES
A PET study on brain control of micturition in humans
Department of Anatomy and Embryology, Faculty of Medical Sciences, University of Groningen, The Netherlands.
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