Central Nervous System Control of Micturition

Holstege, Gert; Mouton, Leonora J.

doi:10.1016/s0074-7742(03)56004-4

Cited by 53 publications

(50 citation statements)

References 72 publications

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“…That robust sustained bladder contractions could not be evoked in the acute SCT cat indicated this low frequency pudendo-vesicle reflex is associated with the Aδ afferent fiber mediated spino-bulbo-spinal micturition reflex (Barrington, 1931. In cats, this supraspinal micturition reflex loop involves an initial convergence of pudendal and pelvic afferents in the sacral spinal column (de Groat, 2006, Thor, et al, 1989, Ueyama, et al, 1987, an ascending projection to the pontine micturition center (Blok, et al, 1995), and a descending projection terminating in the sacral parasympathetic nucleus (SPN) (Holstege and Mouton, 2003). As a consequence of the loss of these connections, limited bladder responses are evoked by low frequency pudendal nerve trunk stimulation in the SCI cat and in persons with chronic SCI (Gustafson, et al, 2004.…”

Section: Sustained Bladder Contractions Evoked By Pudendal Afferentsmentioning

confidence: 99%

Bladder activation by selective stimulation of pudendal nerve afferents in the cat

Yoo

Woock

Grill

2008

Experimental Neurology

114

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Bladder contractions evoked by pudendal nerve stimulation in both spinal intact and spinal transected cats support the possibility of restoring urinary function in persons with chronic spinal cord injury (SCI). However, electrically evoked bladder responses in persons with SCI were limited to transient contractions at relatively low pressures. This prompted the present study, which presents a detailed quantification of the responses evoked by selective stimulation of individual branches of the pudendal nerve at different stimulation frequencies. In spinal intact cats anesthetized with α-chloralose, selective frequency dependent electrical activation of the sensory (2 Hz ≤ f ≤ 50 Hz), cranial sensory (f ≤ 5 Hz), dorsal genital (f ≥ 20 Hz) and rectal perineal (f ≤ 10 Hz) branches of the pudendal nerve evoked sustained bladder contractions dependent on the stimulation frequency. Contractions evoked by selective electrical stimulation resulted in significant increases in voiding efficiency compared to bladder emptying by distension evoked contractions (p ANOVA < 0.05). Acute spinal transection abolished reflex bladder contractions evoked by low frequency stimulation of the cranial sensory or rectal perineal branches, whereas contractions evoked by high frequency stimulation of the dorsal genital branch remained intact. This study presents evidence for two distinct micturition pathways (spino-bulbo-spinal vs. spinal reflexes) activated by selective afferent pudendal nerve stimulation, the latter of which may be applied to restore bladder function in persons with SCI. Keywords electrical stimulation; cranial sensory nerve; deep perineal branch; lower urinary tract physiology; external urethral sphincter; spinal cord injury; pudendo-pudendal reflex; spinal-bulbo-spinal; prostatic urethra; dorsal nerve of penis

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Section: Sustained Bladder Contractions Evoked By Pudendal Afferentsmentioning

confidence: 99%

Bladder activation by selective stimulation of pudendal nerve afferents in the cat

Yoo

Woock

Grill

2008

Experimental Neurology

114

View full text Add to dashboard Cite

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“…7). Studies in cats have also suggested that neurons in the ventrolateral region of the pontine reticular formation provide a tonic excitatory input to de Groat et al Page 22 the EUS motoneurons (269,270). Electrical stimulation in this region (termed the PUSC) (363,364) excites the EUS motoneurons and induces contractions of the EUS (269,341,363).…”

Section: Subcortical Urine Storage Mechanismsmentioning

confidence: 99%

“…Axonal tracing studies in the cat, revealed that spinal tract neurons located in lamina I on the lateral edge of the sacral dorsal horn, a region receiving primary afferent input from the bladder (445), send a prominent direct axonal input through the lateral funiculus to the PAG (Fig. 8) (71,270). Injections of retrograde tracers into the lateral funiculus at the lumbar level labels the same group of sacral spinal tract neurons (164).…”

Section: Brain Stem Circuitry: Spinobulbospinal Micturition Reflexmentioning

confidence: 99%

“…Axonal tracing methods also identified projections from the PAG to the PMC (65, 354), raising the possibility that ascending afferent information from the bladder is relayed through synapses in the PAG to the PMC. Thus it has been proposed that the PAG has an essential role in the spinobulbospinal micturition reflex pathway (270,479).…”

Section: Brain Stem Circuitry: Spinobulbospinal Micturition Reflexmentioning

confidence: 99%

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Neural Control of the Lower Urinary Tract

2009

Encyclopedia of Neuroscience

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This article summarizes anatomical, neurophysiological, pharmacological, and brain imaging studies in humans and animals that have provided insights into the neural circuitry and neurotransmitter mechanisms controlling the lower urinary tract. The functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain, spinal cord, and peripheral autonomic ganglia that coordinates the activity of smooth and striated muscles of the bladder and urethral outlet. The neural control of micturition is organized as a hierarchical system in which spinal storage mechanisms are in turn regulated by circuitry in the rostral brain stem that initiates reflex voiding. Input from the forebrain triggers voluntary voiding by modulating the brain stem circuitry. Many neural circuits controlling the lower urinary tract exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. The major component of the micturition switching circuit is a spinobulbospinal parasympathetic reflex pathway that has essential connections in the periaqueductal gray and pontine micturition center. A computer model of this circuit that mimics the switching functions of the bladder and urethra at the onset of micturition is described. Micturition occurs involuntarily in infants and young children until the age of 3 to 5 years, after which it is regulated voluntarily. Diseases or injuries of the nervous system in adults can cause the re-emergence of involuntary micturition, leading to urinary incontinence. Neuroplasticity underlying these developmental and pathological changes in voiding function is discussed.

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“…The LUT is controlled by spinal, supraspinal and cerebral networks. [1][2][3] Because of the complexity of the neural interactions, damage of at least one of the components can cause LUT dysfunction (NLUTD). 4 Depending on the neurologic disease and the location of the lesion, various forms of NLUTD can occur.…”

Section: Introductionmentioning

confidence: 99%

Sacral neuromodulation in patients with neurogenic lower urinary tract dysfunction

2015

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Study design: This is a retrospective chart analysis. Objectives: The objective of this study was to evaluate the effect of sacral neuromodulation (SNM) in patients with neurogenic lower urinary tract dysfunction (NLUTD). Settings: This study was conducted in a spinal cord injury rehabilitation center in Switzerland. Methods: The charts of all patients who underwent SNM (testing and/or permanent implantation) because of NLUTD at our institution between 2007 and 2013 were evaluated. Treatment outcomes and complications were recorded. Results: A total of 50 patients, 30 women and 20 men, with a mean age of 46 (±14) years, fulfilled the inclusion criteria. The most frequent cause for SNM was spinal cord injury in 35 patients (70%). Median duration of the underlying disease was 9.5 (±9.3) years. In all, 35 patients (70%) received a permanent implant. The complication rate was 16% (8/50). At the last follow-up, SNM was in use in 32 patients. In 26 patients with SNM because of detrusor overactivity, voiding frequency per 24 h was significantly reduced from 9 to 6, and daily pad use rate was significantly improved (2.6 versus 0.6 pads per 24h). On comparing urodynamic assessment of detrusor function before and under SNM, no significant suppression of neurogenic detrusor overactivity (NDO) was detected. In nine patients with chronic neurogenic urinary retention, median postvoid residual urine was significantly reduced from 370 to 59 ml. In all, 94% of the patients were either very satisfied or satisfied with SNM. Conclusion: SNM might be an additional therapy option in carefully selected patients with NLUTD. On the basis of our results, urodynamic evaluation before SNM is mandatory, as the procedure does not seem to be suited to significantly alleviate NDO. INTRODUCTIONThe physiological function of the lower urinary tract (LUT) is storage and controlled evacuation of urine. The LUT is controlled by spinal, supraspinal and cerebral networks. 1-3 Because of the complexity of the neural interactions, damage of at least one of the components can cause LUT dysfunction (NLUTD). 4 Depending on the neurologic disease and the location of the lesion, various forms of NLUTD can occur. Depending on the type of dysfunction, NLUTD can affect the upper urinary tract with the risk of renal failure, and it can impair the quality of life. 5,6 Therefore, treatment of NLUTD is not based on symptoms alone, but it should focus on the results of urodynamic testing.Sacral neuromodulation (SNM) is a minimally invasive approach for the treatment of LUT dysfunction. The mechanism of action is not completely clarified, but a central modulation of afferent and efferent signals in the spinal cord and the supraspinal areas seems to have a crucial role. 2 Although the efficacy and safety of SNM in patients with idiopathic LUT dysfunction has been frequently demonstrated, its effectiveness in patients with NLUTD is not well documented. [7][8][9][10] In particular, there is a lack of clinical studies reporting urodynamic results after SNM.The aim of th...

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Central Nervous System Control of Micturition

Cited by 53 publications

References 72 publications

Bladder activation by selective stimulation of pudendal nerve afferents in the cat

Bladder activation by selective stimulation of pudendal nerve afferents in the cat

Neural Control of the Lower Urinary Tract

Sacral neuromodulation in patients with neurogenic lower urinary tract dysfunction

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