Alteration in brain activation sites in response to bladder filling may be related to the pathophysiology of detrusor overactivity in patients with Parkinson's disease.

Although patients with hypospadias had a slightly higher rate of dissatisfaction with penile size, their sexual behavior was not different from that in control subjects.

A review of functional brain imaging studies of bladder control in participants with normal control and pathological conditions. In the normal condition, bladder and urethral afferents received in the periaqueductal gray relay the information to the insula, the anterior cingulate cortex and the prefrontal cortex. During the storage phase, these superior regions control the pontine micturition center to inhibit voiding. In overactive bladder patients, brain responses are different. Cortical responses become exaggerated, especially in the anterior cingulate cortex and the supplementary motor area. That is what presumably evokes the "urgency". The supplementary motor area is activated during contraction of the pelvic floor muscles, and provides protection against incontinence. We believe that functional brain imaging studies are promising not only for the understanding of bladder dysfunction, but also as an aid to the development of therapeutic options for chronic disorders.

Miyazato M, Kaiho Y, Kamo I, Kitta T, Chancellor MB, Sugaya K, Arai Y, de Groat WC, Yoshimura N. Role of spinal serotonergic pathways in sneeze-induced urethral continence reflex in rats. Am J Physiol Renal Physiol 297: F1024 -F1031, 2009. First published July 29, 2009 doi:10.1152/ajprenal.00297.2009.-To clarify the role of spinal serotonergic mechanisms in preventing stress urinary incontinence (SUI) during sneezing, we investigated the effect of intrathecal (it) application of 8-OH-DPAT (a 5-HT1A agonist), mCPP (a 5-HT2B/2C agonist), and fluoxetine (a serotonin reuptake inhibitor) using a rat model that can examine the neurally evoked continence reflex during sneezing. Amplitudes of urethral pressure responses during sneezing (A-URS), urethral baseline pressure (UBP) at the midurethra, and sneeze-induced leak point pressure (S-LPP) were measured in normal female adult rats and rats with SUI induced by vaginal distention (VD). In normal rats, 8-OH-DPAT decreased A-URS by 48.9%, whereas mCPP increased A-URS by 33.6%. However, A-URS was not changed after fluoxetine. 8-OH-DPAT, mCPP, or fluoxetine did not alter UBP. The effect of 8-OH-DPAT and mCPP was antagonized by WAY-100635 (it), a selective 5-HT1A antagonist, and RS-102221 (it), a selective 5-HT2C antagonist, respectively. Fluoxetine in the presence of WAY-100635 did not change either A-URS or UBP, but fluoxetine in the presence of RS-102221 decreased A-URS. In VD rats, S-LPP was decreased by 14.6 cmH2O after 8-OH-DPAT, whereas it was increased by 12.8 cmH2O after mCPP. However, S-LPP was not changed after fluoxetine. These results indicate that activation of 5-HT2C receptors enhances the active urethral closure reflex during sneezing at the spinal level, whereas 5-HT1A inhibits it and that no apparent changes in the sneeze-induced continence reflex after fluoxetine treatment are due to coactivation of excitatory 5-HT2C receptors and inhibitory 5-HT receptors other than the 5-HT1A subtype. Thus, activation of excitatory 5-HT receptor subtypes such as 5-HT2C could be effective for the treatment of SUI. urinary incontinence; neural pathway; serotonergic reuptake inhibitors; birth trauma STRESS URINARY INCONTINENCE (SUI) is the most common type of urinary incontinence in women after middle age. Urethral hypermobility and intrinsic sphincter deficiency are two main conditions found in patients with SUI (17). The mechanisms that maintain urinary continence during elevation of abdominal pressure include both passive and active closures of the urethra (5). We previously established a rat model that can be used to examine sneeze-induced active urethral closure mechanisms that are mediated by somatic nerve-induced reflex contractions of external urethral sphincter and pelvic floor striated muscles (14). Our previous study also showed that these active urethral closure mechanisms during sneezing are impaired in a rat model of SUI induced by simulated birth trauma (15).Onuf's nucleus in the sacral cord, which sends somatic input to external urethral sphincter and pelvi...