Potential insights into lower urinary function derived from CNS imaging

Powerful advances in central nervous system (CNS) imaging technology offer an unprecedented opportunity to identify which CNS structures coordinate lower urinary tract (LUT) function in health and disease. Positron emission tomography and functional magnetic resonance imaging studies have already yielded preliminary insights into the neural control of continence mechanisms and their dysfunction. Such technologies have also enabled researchers to begin investigating the changes in CNS activity that occur with age, or after implementation of incontinence therapies, such as sacral neuromodulation. Nonetheless, the use of CNS imaging for understanding LUT function remains in a state of infancy. Several challenges, such as the relative spatial and temporal resolutions of the different technologies, and valid and reliable interpretation of the findings under non-physiological conditions, limit the ability to constructively understand LUT control. This paper reviews state-of-the-art CNS knowledge, discusses issues related to the use of CNS technology in LUT research, and raises key questions that need to be addressed.