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Clin Anat. 2019 Jan;32(1):13-19. doi: 10.1002/ca.23244. Epub 2018 Nov 8.

Brain activation during the voiding phase of micturition in healthy adults: A meta-analysis of neuroimaging studies.

Author information

1
Division of Urogynecology, Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania.
2
Department of Urology, Stony Brook School of Medicine, Stony Brook, New York.
3
Center for Functional Neuroimaging, University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

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 co-ordinates that were activated during voiding. We excluded studies that reported co-ordinates only for bladder filling, during pelvic floor contraction only, and studies that focused on abnormal bladder states such as the neurogenic bladder. We used the activation-likelihood estimation (ALE) approach to create a statistical map of the brain and identify the brain co-ordinates that were activated across different studies. We identified nine studies that reported brain activation during the task of voiding in 91 healthy subjects. Together, these studies reported 117 foci for ALE analysis. Our ALE map yielded six clusters of activation in the pons, cerebellum, insula, anterior cingulate cortex (ACC), thalamus, and the inferior frontal gyrus. Regions of the brain involved in executive control (frontal cortex), interoception (ACC, 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. Clin. Anat., 2018.

KEYWORDS:

brain, functional neuroimaging; meta-analysis; neurogenic bladder; urinary bladder; urination

PMID:
30069958
PMCID:
PMC6309926
[Available on 2020-01-01]
DOI:
10.1002/ca.23244

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