Functional MRI in neuro-urology: A narrative review

Area of Science:

• Neuroimaging and urology
• Neural control of the lower urinary tract
• Brain-bladder network mapping

Background:

• The neural control of bladder storage and voiding is complex.
• Understanding the brain-bladder network has evolved significantly.
• Urological diseases can alter neural pathways controlling the lower urinary tract.

Approach:

• A systematic review of Medline-indexed studies (2010-2022) was performed.
• 49 peer-reviewed articles were included to analyze brain activity related to lower urinary tract function.
• Functional magnetic resonance imaging (fMRI) was used to investigate brain regions involved.

Key Points:

• fMRI elucidates specific brain networks (brainstem, cerebellum, cortex) involved in micturition.
• Therapies for lower urinary tract symptoms (LUTS) can modify neuronal activity.
• fMRI aids in identifying patient subgroups who respond to treatments like neuromodulation.

Conclusions:

• The brain-bladder network is a potential therapeutic target for LUTS.
• fMRI can predict treatment outcomes for conditions like overactive bladder.
• Neuromodulation targeting brain regions shows promise for treating voiding dysfunction, e.g., in multiple sclerosis.