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Our understanding of the neurologic control of micturition has progressed since the description of the pontine micturition center by Barrington (see Brain 1921; 44:23). Recent PET studies in humans have shown activity in the medio-posterior pons during voiding. Likewise, a SPECT study has reported enhancement of periaqueduct gray matter during micturition.
This review describes how cortical lesions and strokes cause voiding dysfunction. It reminds us that multiple system atrophy (MSA) should be suspected if urinary symptoms and erectile dysfunction precede parkinsonism and that bladder outflow surgery should be avoided in these patients, as results are disappointing. MS and other spinal cord disease remain the most common cause of detrusor h…