Evaluation of Cortical Activity Associated with Filling of Urinary Bladder Using Functional Magnetic Resonance Imaging

Authors: P. Holý 1;  J. Krhut 2;  J. Tintěra 3;  P. Zvara 4;  R. Zachoval 1,5
Authors‘ workplace: Urologické oddělení, Thomayerova nemocnice, Praha 1;  Urologické oddělení, FN Ostrava 2;  IKEM Praha 3;  Division of Urology, University of Vermont, Burlington, USA 4;  1. LF UK v Praze 5
Published in: Cesk Slov Neurol N 2013; 76/109(1): 45-51
Category: Original Paper


The aim of the study was to assess: 1. the feasibility of a novel method combining functional magnetic resonance imaging (fMRI) evaluation of the central nervous system (CNS) with synchronously performed filling cystometry, 2. fMRI evaluation of brain cortical activity associated with filling of the urinary bladder.

A urodynamic system was adapted to enable synchronous filling cystometry with fMRI. Fourteen female volunteers with no urological disorder (20–68 yrs) were enrolled. Standard filling cystometry protocol was extended to strengthen the afferent sensory signal: the sensory activation was elicited by cyclic phases of filling and emptying. Synchronously with extended cystometry, cortical activity was evaluated using fMRI. To yield representative data, we repeated each examination after 4–6 weeks having 28 data sets for analysis at the end. All examinations were performed on 3T scanner (Siemens Trio) using gradient-echo EPI sequence with the following parameters: TE = 30 ms, TR = 2 s, voxel = 3 × 3 × 3 mm.

Adjustments of the urodynamic system enabled successful implementation of synchronous filling cystometry with fMRI evaluation of cortical activity. All urodynamic records presented normal findings. Twenty four data sets were evaluated by an independent component analysis. The fMRI data were interpreted considering the synchronous cystometry record. The following cortical activity was detected: middle and inferior frontal gyrus, angular gyrus, posterior and anterior cingulate gyrus and subcortical grey nuclei.

fMRI evaluation of cortical activity associated with evaluation of the lower urinary tract function is an experimental method with a number of technical difficulties. Synchronous urodynamic examination is a feasible method that facilitates precise interpretation of fMRI data acquired. The presented study demonstrates the activity of the central nervous system structures associated with filling of the urinary bladder.

Key words:
functional magnetic resonance imaging – urodynamics – lower urinary tract

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


1. Blok BF, Sturms LM, Holstege G. Brain activation during micturition in women. Brain 1998; 121(Pt 11): 2033–2042.

2. Seseke S, Baudewig J, Kallenberg K, Ringert RH, Seseke F, Dechent P. Gender differences in voluntary micturition control: an fMRI study. Neuroimage 2008; 43(2): 183–191.

3. Fowler CJ, Griffiths DJ. A decade of functional brain imaging applied to bladder control. Neurourol Urodyn 2010; 29(1): 49–55.

4. Tadic SD, Griffiths D, Schaefer W, Cheng CI, Resnick NM. Brain activity measured by functional magnetic resonance imaging is related to patient reported severity of urgency urinary incontinence. J Urol 2010; 183(1): 221–228.

5. Schäfer W, Abrams, Liao L, Mattiasson A, Pesce F, Spangberg A et al. Good urodynamic practisces: uro­flowmetry, filling cystometry and pressure-flow studies. Neurourol Urodyn 2002; 21(3): 261–274.

6. Griffiths D, Derbyshire S, Stenger A, Resnick N. Brain control of normal and overactive bladder. J Urol 2005; 174(5): 1862–1867.

7. Talairach J, Tournoux P. Co-planar stereotaxic atlas of the human brain. Stuttgart: Thieme 1988.

8. Holstege G. Micturition and the soul. J Comp Neurol 2005; 493(1): 15–20.

9. Kuipers R, Mouton LJ, Holstege G. Afferent projections to the pontine micturition center in the cat. J Comp Neurol 2006; 494(1): 36–53.

10. De Groat WC. Nervous control of the urinary bladder of the cat. Brain Res 1975; 87(2–3): 201–211.

11. Blok BF, Holstege G. Direct projections from the periaqueductal gray to the pontine micturition center (M-region): an anterograde and retrograde tracing study in the cat. Neurosci Lett 1994; 166(1): 93–96.

12. Griffiths D, Tadic DS, Schaefer W, Resnick NM. Cerebral control of the bladder in normal and urge-incontinent woman. Neuroimage 2007; 37(1): 1–7.

13. Griffiths D, Tadic SD. Bladder control, urgency and urge incontinence: evidence from functional brain imaging. Neurourol Urodyn 2008; 27(6): 466–474.

14. Blok BF, Sturms LM, Holstege G. Brain activation during micturition in women. Brain 1998; 121(Pt 11): 2033–2042.

15. Athwal BS, Berkley KJ, Hussain I, Brennan A, Craggs M, Sakakibara R et al. Brain responses to changes in bladder volume and urge to void in healthy men. Brain 2001; 124(Pt 2): 369–377.

16. Matsuura S, Kakizaki H, Mitsui T, Shiga T, Tamaki N, Koyanagi T. Human brain region response to distention or cold stimulation of the bladder: a positron emission tomography study. J Urol 2002; 168(5): 2035–2039.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 1

2013 Issue 1

Most read in this issue

This topic is also in:

Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account