Several studies have used a variety of neuroimaging techniques to measure brain activity during the voiding phase of micturition. However, there is a lack of consensus on which regions of the brain are activated during voiding. The aim of this meta-analysis is to identify the brain regions that are consistently activated during voiding in healthy adults across different studies.
We searched the literature for neuroimaging studies that reported brain coordinates that were activated during voiding. We excluded studies that reported coordinates only for bladder filling, during pelvic floor contraction only, and studies that focused on abnormal bladder states such as neurogenic bladder. We used the activation likelihood estimation (ALE) approach to create a statistical map of the brain and identify the brain coordinates that were activated across different studies.
We identified 9 studies that reported brain activation during the task of voiding in 91 healthy subjects. Together, these studies reported 117 foci for ALE analysis. Our activation likelihood estimation map yielded six clusters of activation in the pons, cerebellum, insula, anterior cingulate cortex, thalamus, and the inferior frontal gyrus.
Regions of the brain involved in executive control (frontal cortex), interoception (anterior cingulate cortex, insula), motor control (cerebellum, thalamus), and brainstem (pons) are involved in micturition. This analysis provides insight into the supraspinal control of voiding in healthy adults and provides a framework to understand dysfunctional voiding. This article is protected by copyright. All rights reserved.
Clinical anatomy (New York, N.Y.). 2018 Aug 01 [Epub ahead of print]
Camryn Harvie, Steven J Weissbart, Priyanka Kadam-Halani, Hengyi Rao, Lily A Arya
Division of Urogynecology, Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, Philadelphia, PA., Department of Urology, Stony Brook School of Medicine, Stony Brook, NY, USA., Center for Functional Neuroimaging, University of Pennsylvania, Philadelphia, PA.