443 EFFECTIVE CONNECTIVITY AND CORTICAL REGIONS INVOLVED IN TASK-RELATED BLADDER CONTROL

Abstract

You have accessJournal of UrologyBladder and Urethra: Anatomy, Physiology and Pharmacology II1 Apr 2010443 EFFECTIVE CONNECTIVITY AND CORTICAL REGIONS INVOLVED IN TASK-RELATED BLADDER CONTROL Moritz Hamann, Christoph Van der Horst, Stephan Wolff, Olaf Jansen, Klaus-Peter Juenemann, and Johann Kuhtz-Buschbeck Moritz HamannMoritz Hamann More articles by this author , Christoph Van der HorstChristoph Van der Horst More articles by this author , Stephan WolffStephan Wolff More articles by this author , Olaf JansenOlaf Jansen More articles by this author , Klaus-Peter JuenemannKlaus-Peter Juenemann More articles by this author , and Johann Kuhtz-BuschbeckJohann Kuhtz-Buschbeck More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.514AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder sensations are influenced by individual and situational factors. This study aims to localise brain regions that are active when micturition is brought forward, to analyse effects of bladder volume and to explore the effective connectivity of cortical regions involved in task-related bladder control. METHODS Brain activity during intentional modulations of bladder sensations was studied by fMRI in 33 healthy volunteers. During the imaging the subjects alternately repressed the desire to void (“B task”), or concentrated on bladder sensations and called forth the urge to void as if initiating micturition (“U-task”). Two imaging runs, including five repetitions of the B- and U-task, were performed with high- as well as low bladder volume. The images were analysed with SPM2 software. Brain activations associated with “attempted micturition” were identified by subtracting the U- and B-tasks. A reverse subtraction detected deactivations. The contrast images of all subjects were entered into a second-level random-effects analysis. Psychophysiological interaction analyses (PPI) were performed to assess changes in effective connectivity during the U-task and were first conducted for each subject. The resulting contrast images underwent a second-level group analysis. Significant target regions were determined by one sample t-tests. RESULTS The supplementary motor area, midcingulate cortex, insula, frontal operculum, and right prefrontal cortex were more active during the U-task than during the B-task. The right anterior insula and midbrain periaquaeductal grey (PAG) were more active at higher than at lower bladder volumes. Responses of the right thalamus and several other right hemispherical regions were stronger in women. Using the PPI, we found that the midcingulate cortex had stronger connectivity (indicated by parallel co-variations of the activation time series) with the PAG and medial motor areas during the U-task than during the B-task. During the U-task the left and right insulae showed decreased connectivity with many other brain regions, incl. bilateral middle frontal, posterior parietal and temporal cortices which signal decreased when the source (insular) signal increased. CONCLUSIONS In both sexes, a set of frontoparietal brain regions are involved in voluntary bladder control. Intentional modulations of the desire to void change the effective connectivity of these supraspinal regions. Activation patterns during the B- and U-task possibly reflect processing of bladder afferent input as well as central monitoring of urethral sphincter control. Kiel, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e175 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Moritz Hamann More articles by this author Christoph Van der Horst More articles by this author Stephan Wolff More articles by this author Olaf Jansen More articles by this author Klaus-Peter Juenemann More articles by this author Johann Kuhtz-Buschbeck More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...