Page 28 - Bladder Dysfunction in the Context of the Bladder-Brain Connection - Ilse Groenendijk.pdf

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Chapter 2
ABSTRACT
Purpose
Functional neuroimaging is a powerful and versatile tool to investigate central lower urinary tract (LUT) control. Despite the increasing body of literature there is a lack of comprehensive overviews on LUT control. Thus, we aimed to execute a coordinate based meta-analysis of all PET and fMRI evidence on descending central LUT control, i.e. pelvic floor muscle contraction (PFMC) and micturition.
Materials and methods
A systematic literature search of all relevant libraries was performed in March 2019. Coordinates of activity were extracted from eligible studies to perform an activation likelihood estimation (ALE) using a threshold of uncorrected p <0.001.
Results
19 of 5718 identified studies, published between 1997 and 2019, were included. Eleven studies investigated PFMC (1xPET, 10xfMRI) and eight micturition (3xPET, 5xfMRI). The PFMC ALE analysis (n=170, 113 foci) showed clusters in the primary motor cortex, supple- mentary motor cortex, cingulate gyrus, frontal gyrus, thalamus, supramarginal gyrus, and cerebellum. The micturition ALE analysis (n=107, 98 foci) showed active clusters in the pontine micturition center, periaqueductal gray, cingulate gyrus, frontal gyrus, insula and ventral pons. Overlap of PFMC and micturition was found in the cingulate gyrus and thalamus.
Conclusions
For the first time the involved core brain areas of LUT motor control were determined using ALE. Furthermore, the involved brain areas for PFMC and micturition are par- tially distinct. Further neuroimaging studies are required to extend this ALE analysis and determine the differences between a healthy and a dysfunctional LUT. This requires standardization of protocols and task-execution.