Central pathways controlling micturition and urinary continence
Central pathways controlling micturition and urinary continence
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DOI：
10.1016/s0090-4295(01)01633-8
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发表时间：
2002-05-01
期刊：
影响因子：
2.1
通讯作者：
Blok, BFM
中科院分区：
文献类型：
--
作者：
Blok, BFM
猫和人类的排尿和排尿中枢控制以类似的方式组织。在猫的脑干和间脑中，有4个区域参与排尿的控制：（1）脑桥排尿中枢或Barrington区在排尿时直接兴奋骶髓内的膀胱运动神经元，同时通过抑制性骶髓内侧的γ-氨基丁酸能和甘氨酸能中间神经元，间接抑制尿道外括约肌运动神经元;（2）排尿时，脑桥排尿中枢激活尿道外括约肌运动神经元;（3）中脑导水管周围灰质接收膀胱充盈信息;（4）排尿开始时，下丘脑。根据正电子发射断层扫描研究，在人类中，相同的脊髓上区域在排尿期间活跃。此外，人类的扣带回和前额皮质在排尿和排尿期间都被激活，这表明这些区域对排尿的开始很重要，但对反射本身并不重要。骨盆底的初级运动皮质对骨盆底的自主收缩很重要，但它不参与正常的排尿。
The central control of micturition and urinary continence in cats and humans is organized in a similar manner. In cats, 4 areas in the brainstem and diencephalon are implicated in the control of micturition: (1) the pontine micturition center or Barrington area directly excites bladder motoneurons in the sacral cord during micturition; at the same time, it inhibits indirectly, via inhibitory gamma-aminobutyric acidergic and glycinergic interneurons in the medial sacral cord, the external urethral sphincter motoneurons; (2) the pontine continence center activates the external urethral sphincter motoneurons during continence; (3) the midbrain periaqueductal gray receives bladder filling information; and (4) the hypothalamus, in the beginning of micturition. According to positron emission tomography studies, in humans, the same supraspinal regions are active during micturition. Furthermore, the human cingulate and prefrontal cortices are activated during both micturition and continence, indicating that these areas are important for the onset of micturition, but not for the reflex itself. The primary motor cortex of the pelvic floor is important for voluntary pelvic floor contraction, but it is not involved in normal urinary continence.