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Neural Mechanisms Underlying Lower Urinary Tract Dysfunction
Naoki Yoshimura,Teruyuki Ogawa,Minoru Miyazato,Takeya Kitta,Akira Furuta,Michael B. Chancellor,Pradeep Tyagi 대한비뇨의학회 2014 Investigative and Clinical Urology Vol.55 No.2
This article summarizes anatomical, neurophysiological, and pharmacological studiesin humans and animals to provide insights into the neural circuitry and neurotransmittermechanisms controlling the lower urinary tract and alterations in thesemechanisms in lower urinary tract dysfunction. The functions of the lower urinarytract, to store and periodically release urine, are dependent on the activity of smoothand striated muscles in the bladder, urethra, and external urethral sphincter. Duringurine storage, the outlet is closed and the bladder smooth muscle is quiescent. Whenbladder volume reaches the micturition threshold, activation of a micturition centerin the dorsolateral pons (the pontine micturition center) induces a bladder contractionand a reciprocal relaxation of the urethra, leading to bladder emptying. During voiding,sacral parasympathetic (pelvic) nerves provide an excitatory input (cholinergic and purinergic)to the bladder and inhibitory input (nitrergic) to the urethra. These peripheralsystems are integrated by excitatory and inhibitory regulation at the levels of the spinalcord and the brain. Therefore, injury or diseases of the nervous system, as well as disordersof the peripheral organs, can produce lower urinary tract dysfunction, leadingto lower urinary tract symptoms, including both storage and voiding symptoms, andpelvic pain. Neuroplasticity underlying pathological changes in lower urinary tractfunction is discussed.
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