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Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms in Men with Neurogenic Bladder
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Jeffrey Thavaseelan, Akhlil Hamid
DESD is defined by the International Continence Society (ICS) as a “detrusor contraction concurrent with an involuntary contraction of the urethral and/or periurethral striated muscle.5” Occasionally flow can be prevented altogether and can only be diagnosed with urodynamic studies (Figure 41.3). It only arises in the patient with pathology between the pontine micturition center (PMC) and the sacral micturition center (S2 through S4).9 Examples include spinal cord injury, multiple sclerosis, spinal dysraphism, and transverse myelitis.
Other diseases (transverse myelitis, tropical spastic paraparesis, progressive multifocal leukoencephalopathy, Lyme’s disease)
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
TM has various neurological manifestations. Bladder dysfunction is common and may be the only sequel. The neurological events during normal micturition that culminate in a detrusor contraction and urethral relaxation are integrated in the rostral brainstem in the area designated as pontine micturition center. Any lesion within the spinal cord, such as trauma, MS, myelodysplasia, and myelitis, which causes a disruption of this pathway, may result in detrusor external sphincter dyssynergia (DESD). If the disease involves the sacral (S2 to S4) cord or roots, a lower motor neuron lesion may occur as well, with pudendal or parasympathetic dysfunction. In case the thoracolumbar cord is affected, sympathetic dysfunction may occur. Urodynamic study is helpful in evaluating the bladder dysfunction and also in its management.
Structure and Function of the Lower Urinary Tract
Published in Anthony R. Mundy, John M. Fitzpatrick, David E. Neal, Nicholas J. R. George, The Scientific Basis of Urology, 2010
It has also been shown that afferent impulses do not project directly to the pontine micturition center (M-region) but to a relay center in the mesencephalic periaqueductal gray matter (PAG). This is an important relay center between the pontine micturition center and a number of higher centers in the brain, which seems to act as an interface between the afferent and efferent components of bladder control and specifically in registering the degree of bladder filling both with the pontine micturition center and with the higher centers responsible for conscious awareness (57).
Axonics® system for treatment of overactive bladder syndrome and urinary urgency incontinence
Published in Expert Review of Medical Devices, 2021
Alice Wang, Elizabeth Rourke, Elisabeth Sebesta, Roger Dmochowski
SNM for use in urology for voiding function dates back to the 1960s. The early theories of electrical stimulation to treat voiding dysfunction was based on stimulation of the motor nerves resulting in pelvic muscle contraction, which would in turn relax the bladder muscle. However, more recently, the thinking has focused more on sacral cord as the target of SNM [34]. The hypothesis is that the pathways projecting to the sacral cord inhibit inappropriate detrusor contractions via inhibiting local sacral interneurons and direct inhibition of the preganglionic parasympathetic bladder motor neurons. An alternative theory is that SNM inhibits the pontine micturition center and in turn, would decrease detrusor contractions. Higher brain areas, such as cortical sensory areas, have also been hypothesized to be altered by SNM as well [35]. (Table 1)
Spinal cord involvement in Lewy body-related α-synucleinopathies
Published in The Journal of Spinal Cord Medicine, 2020
Raffaele Nardone, Yvonne Höller, Francesco Brigo, Viviana Versace, Luca Sebastianelli, Cristina Florea, Kerstin Schwenker, Stefan Golaszewski, Leopold Saltuari, Eugen Trinka
Urinary symptoms usually affect the PD patients late in the course of the disease and their pathogenesis is likely to be multifactorial. Due to the dopaminergic cell loss in the substantia nigra the most accepted hypothesis is the disinhibition of the pontine micturition center,55 which projects to the sacral spinal cord, is involved in the regulation of the peripheral reflexes and is inhibited during the storage phase. Its activity is regulated by the periaqueductal gray (PAG), the anterior cingulate gyrus, the insula, and the prefrontal cortex. The activation of these brain regions during the micturition determines the activation of the pontine micturition center and finally of the sacral segments of the spinal cord. In cats, the bladder projects afferent inputs by the lateral funiculus to the PAG that in turn sends excitatory inputs to the pontine micturition center.
The clinical pharmacology of the medical treatment for overactive bladder in adults
Published in Expert Review of Clinical Pharmacology, 2020
Hadi Mostafaei, Shahrokh F. Shariat, Hanieh Salehi-Pourmehr, Florian Janisch, Keiichiro Mori, Fahad Quhal, Sakineh Hajebrahimi
Acetylcholine is the predominant peripheral neurotransmitter in detrusor muscle responsible for bladder contraction [25]. There are five muscarinic subtypes (M1 through M5) with M3 being the most relevant in the human bladder [26]. Stimulation of the sympathetic nervous system relaxes the detrusor muscle and stimulates sphincter closure in the urethra while the parasympathetic nervous system (S2-4) stimulates the contraction of the detrusor muscle and relaxes the urethral sphincter. Hence, the passing of urine is under parasympathetic control. Somatic innervation activates the tone in the pelvic floor musculature and striated muscles of the external urethral sphincter [27]. Bladder afferent signals ascend through the spinal cord and then project to the pontine micturition center (PMC) and cerebrum. Upon the voluntary decision to urinate, neurons of the PMC fire to excite the sacral preganglionic neurons. In addition, PMC inhibits Onuf’s nucleus, which then reduces the sympathetic stimulation to the internal urethral sphincter causing relaxation. Finally, a conscious signal from the cerebral cortex results in distention of the external urethral sphincter and the passing of urine [28]. (Figure 1)