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1Center for Uroneurology, University Medical Center Groningen, Groningen, The Netherlands. g.holstege@med.umcg.n
Neurourology and Urodynamics
|December 22, 2009
Summary
The brain and brainstem control urination through a reflex arc involving Gert's Nucleus (GN) and the periaqueductal gray (PAG). Higher brain centers can override this reflex, enabling voluntary control over micturition.
Area of Science:
- Neuroscience
- Urology
- Physiology
Background:
- Micturition, or urination, is a complex motor act controlled by the central nervous system.
- Understanding the neural pathways governing micturition is crucial for addressing bladder dysfunction.
Purpose of the Study:
- To review the neural mechanisms by which the brain and brainstem control the process of micturition.
- To elucidate the roles of specific brain regions and pathways in regulating bladder function.
Main Methods:
- Review of existing literature on the neuroanatomy and neurophysiology of micturition.
- Analysis of neural pathways from the sacral cord to higher brain centers.
Main Results:
- The micturition reflex arc originates in Gert's Nucleus (GN) in the sacral cord, relaying afferent signals to the periaqueductal gray (PAG).
- The PAG, upon significant bladder filling, activates the pontine micturition center (PMC), initiating the micturition reflex via descending pathways.
- Higher cortical and limbic regions project to the PAG, enabling voluntary inhibition of the micturition reflex for postponement.
Conclusions:
- The brainstem and specific brain regions orchestrate voluntary control over micturition.
- Disruptions in the inhibitory pathways from higher brain centers to the PAG may contribute to urge incontinence in the elderly.
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