Nour S, Svarer C, Kristensen J K, Paulson O B, Law I
The Neurobiology Research Unit, N9201, KF3982, The National University Hospital, Rigshospitalet, Copenhagen, Denmark.
Brain. 2000 Apr;123 ( Pt 4):781-9. doi: 10.1093/brain/123.4.781.
Specific cerebral lesions have shown the crucial role of the brain in the control of micturition. The precise identification of the anatomical cerebral structures involved in micturition can contribute to a better understanding of the control of micturition and the development of therapeutic models. Various neuropathological and animal studies have referred to the medulla oblongata, pons, limbic system, superior frontal lobe and premotor cortical regions as areas implicated in micturition control. The aim of this study was to investigate whether the activity of these areas during micturition can be confirmed by PET in normal men. The distribution of the regional cerebral blood flow after bolus injection of (15)O water was used as an indirect measure of cerebral activation. PET scans were performed during the following three conditions: (i) at rest with the bladder empty; (ii) during simulated micturition after instillation of isotonic saline into the urinary bladder; and (iii) the withholding of urine (saline). Normal micturition using this model was achieved in eight out of 12 right-handed normal subjects. The changes in bladder contraction, bladder pressure and intra-abdominal pressure were monitored on-line during the whole scanning session by a cystometry device. The images were analysed using statistical parametric mapping at a significance threshold of P < 0.05 with correction for multiple independent comparisons. Micturition versus rest was associated with bilateral activation of areas close to the postcentral gyrus, inferior frontal gyrus, globus pallidus, cortex cerebelli, vermis and midbrain. On the left side, activation of the middle frontal gyrus, superior frontal gyrus, superior precentral gyrus, thalamus and the caudal part of the anterior cingulate gyrus was seen, while on the right side we found activation in the supramarginal gyrus, mesencephalon and insula. When the threshold value was lowered to P < 0.001 (Z > 3.09) without correction for multiple comparisons, we found additional activation in the medial pontine tegmentum, mesencephalon, right thalamus, right middle frontal gyrus and left insula. When urine- withholding was compared with rest, the left insula showed a tendency to activate. We conclude from this study, in which urinary bladder contraction was verified cystometrically, that the onset and maintenance of micturition in normal men is associated with a vast network of cortical and subcortical regions, confirming observations from clinical and animal studies.
特定的脑部病变已表明大脑在排尿控制中起着关键作用。精确识别参与排尿的脑部解剖结构有助于更好地理解排尿控制及治疗模型的开发。各种神经病理学和动物研究都提到延髓、脑桥、边缘系统、额上叶和运动前皮质区域是与排尿控制有关的区域。本研究的目的是调查在正常男性中，正电子发射断层扫描（PET）能否证实这些区域在排尿过程中的活动。静脉注射（15）O水后区域脑血流的分布被用作脑激活的间接指标。PET扫描在以下三种情况下进行：（i）膀胱排空时休息；（ii）向膀胱内注入等渗盐水后模拟排尿期间；（iii）憋尿（盐水）。12名右利手正常受试者中有8人使用该模型实现了正常排尿。在整个扫描过程中，通过膀胱测压装置在线监测膀胱收缩、膀胱压力和腹内压的变化。使用统计参数映射分析图像，显著性阈值为P < 0.05，并对多个独立比较进行校正。排尿与休息相比，与中央后回、额下回、苍白球、小脑皮质、蚓部和中脑附近区域的双侧激活有关。在左侧，可见额中回、额上回、中央前回上部、丘脑和前扣带回尾部的激活，而在右侧，我们发现缘上回、中脑和岛叶有激活。当将阈值降低到P < 0.001（Z > 3.09）且不进行多重比较校正时，我们发现脑桥内侧被盖、中脑、右侧丘脑、右侧额中回和左侧岛叶有额外激活。当将憋尿与休息进行比较时，左侧岛叶有激活趋势。我们从这项通过膀胱测压证实膀胱收缩的研究中得出结论，正常男性排尿的起始和维持与广泛的皮质和皮质下区域网络有关，这证实了临床和动物研究的观察结果。
