Abstract：
Neuro-imaging has given urologists a new tool to investigate the neural control of the lower urinary tract. Using functional magnetic resonance imaging (fMRI), it is now possible to understand which areas of the brain contribute to the proper function of the storage and voiding of the lower urinary tract. This field of research has evolved from simple anatomical descriptions to elucidating the complex micturition network. A keyword search of the Medline database was conducted by two reviewers for relevant studies from January 1, 2010, to August 2022. Of 2047 peer-reviewed articles, 49 are included in this review. In the last decade, a detailed understanding of the brain-bladder network has been described, elucidating a dedicated network, as well as activated areas in the brainstem, cerebellum, and cortex that share reproducible connectivity patterns. Research has shown that various urological diseases can lead to specific changes in this network and that therapies used by urologists to treat lower urinary tract symptoms (LUTS) are also able to modify neuronal activity. This represents a set of potential new therapeutic targets for the management of the lower urinary tract symptoms (LUTS). fMRI technology has made it possible to identify subgroups of responders to various treatments (biofeedback, anticholinergic, neuromodulation) and predict favourable outcomes. Lastly, this breakthrough understanding of neural control over bladder function has led to treatments that directly target brain regions of interest to improve LUTS. One such example is the use of non-invasive transcranial neuromodulation to improve voiding symptoms in individuals with multiple sclerosis.
摘要：
神经成像为泌尿科医师提供了一种新的工具来研究下尿路的神经控制。使用功能磁共振成像（fMRI），现在可以了解大脑的哪些区域有助于下尿路的储存和排泄的正常功能。这个研究领域已经从简单的解剖学描述发展到阐明复杂的排尿网络。从2010年1月1日至2022年8月，由两名审阅者对Medline数据库进行了关键字搜索，以进行相关研究。在2047篇同行评议的文章中，这次审查包括49个。在过去的十年里，已经描述了对脑-膀胱网络的详细了解，阐明专用网络，以及脑干的激活区域，小脑,和大脑皮层共享可重复的连接模式。研究表明，各种泌尿系统疾病可导致该网络的特定变化，泌尿科医师用于治疗下尿路症状（LUTS）的疗法也能够改变神经元活动。这代表了一组用于管理下尿路症状（LUTS）的潜在新治疗靶标。功能磁共振成像技术使识别各种治疗反应者的亚组成为可能(生物反馈，抗胆碱能，神经调节)并预测有利的结果。最后,这种对膀胱功能的神经控制的突破性理解导致了直接针对感兴趣的大脑区域以改善LUTS的治疗。一个这样的例子是使用非侵入性经颅神经调节来改善患有多发性硬化症的个体的排尿症状。
