The Role of the Periaqueductal Gray Matter in Lower Urinary Tract Function

Aryo Zare*, Ali Jahanshahi, Mohammad-Sajjad Rahnama'i, Sandra Schipper, Gommert A. van Koeveringe*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

17 Citations (Web of Science)

Abstract

The periaqueductal gray matter (PAG), as one of the mostly preserved evolutionary components of the brain, is an axial structure modulating various important functions of the organism, including autonomic, behavioral, pain, and micturition control. It has a critical role in urinary bladder physiology, with respect to storage and voiding of urine. The PAG has a columnar composition and has extensive connections with its cranially and caudally located components of the central nervous system (CNS). The PAG serves as the control tower of the detrusor and sphincter contractions. It serves as a bridge between the evolutionary higher decision-making brain centers and the lower centers responsible for reflexive micturition. Glutamatergic cells are the main operational neurons in the vlPAG, responsible for the reception and relay of the signals emerging from the bladder, to related brain centers. Functional imaging studies made it possible to clarify the activity of the PAG in voiding and filling phases of micturition, and its connections with various brain centers in living humans. The PAG may be affected in a wide spectrum of disorders, including multiple sclerosis (MS), migraine, stroke, Wernicke's encephalopathy, and idiopathic normal pressure hydrocephalus, all of which may have voiding dysfunction or incontinence, in certain stages of the disease. This emphasizes the importance of this structure for the basic understanding of voiding and storage disorders and makes it a potential candidate for diagnostic and therapeutic interventions.

Original languageEnglish
Pages (from-to)920-934
Number of pages15
JournalMolecular Neurobiology
Volume56
Issue number2
DOIs
Publication statusPublished - Feb 2019

Keywords

  • Periaqueductal gray matter
  • Bladder
  • Incontinence
  • Micturition
  • Brain
  • MEDIAL PREOPTIC AREA
  • PONTINE MICTURITION CENTER
  • LUMBOSACRAL SPINAL-CORD
  • DEEP BRAIN-STIMULATION
  • NITRIC-OXIDE
  • BARRINGTONS NUCLEUS
  • SACRAL NEUROMODULATION
  • DEFENSIVE BEHAVIORS
  • PARKINSONS-DISEASE
  • DIRECT PROJECTIONS

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