title: Afferent fibers of the pudendal nerve modulate sympathetic neurons controlling the bladder neck.
abstract: OBJECTIVE
  Pudendal nerve stimulation is known to have a potential modulative effect on bladder function. However, even if its efficiency has been established for various neurogenic and non-neurogenic bladder dysfunctions, the underlying neuronal mechanism, and the involved pathways in humans remain unknown. In this prospective study we focused on the effects of pudendal nerve stimulation in complete spinal cord injured patients to identify neuromodulative processes that occur on spinal level.
  
  
  METHODS
  Twenty complete spinal male presenting with upper motor neuron lesion and neurogenic incontinence underwent pudendal nerve stimulation. Bladder, bladder neck (BN), and external urethral sphincter (EUS) pressures were continuously recorded with a three channel microtip pressure transducer catheter. Fifty six pudendal stimulations using biphasic rectangular impulses (0.2 ms, 10 Hz) with intensities up to 100 mA were applied to the dorsal penile nerve. In six patients, 18 stimulations were repeated after intravenous (i.v.) administration of 7 mg phentolamine.
  
  
  RESULTS
  Mean BN and EUS pressure increased during stimulation significantly (P < 0.001). The latencies to the EUS responses range between 27 and 41 ms and those to the BN responses between 188 and 412 ms. Phentolamine decreased initial BN pressure and reduced the pressure rise during stimulation significantly (P < 0.05).
  
  
  CONCLUSIONS
  Pudendal nerve stimulation evoked somatic responses in the EUS and autonomic responses in the smooth muscle sphincter controlling the BN. Longer latencies of the BN responses and the sensitivity to the alpha-blocking agent phentolamine suggest that sympathetic alpha-adrenergic fibers are involved. Somatic afferent fibers of the pudendal nerve are supposed to project on sympathetic thoracolumbar neurons to the BN and modulate their function. This neuromodulative effect works exclusively at the spinal level and appears to be at least partly responsible for BN competence and at least continence.
authors.affiliation: Neuro-Urology, Swiss Paraplegic Center, Balgrist University Hospital, Zurich, Switzerland. areitz@balgrist.unizh.ch
authors.forename: André
authors.initials: A
authors.lastname: Reitz
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Schmid
authors.forename: Armin
authors.initials: A
authors.lastname: Curt
authors.forename: Peter A
authors.initials: PA
authors.lastname: Knapp
authors.forename: Brigitte
authors.initials: B
authors.lastname: Schurch
mesh_terms: D000320:Adrenergic Fibers / Q000187:drug effects / Q000502:physiology*; D000328:Adult; D004558:Electric Stimulation; D006801:Humans; D008297:Male; D009119:Muscle Contraction / Q000502:physiology; D009412:Nerve Fibers / Q000187:drug effects / Q000502:physiology*; D009475:Neurons, Afferent / Q000187:drug effects / Q000502:physiology*; D010413:Penis / Q000294:innervation / Q000502:physiology; D010646:Phentolamine; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000503:physiopathology*; D013127:Spinal Nerves / Q000502:physiology*; D013565:Sympatholytics; D014521:Urethra / Q000187:drug effects / Q000502:physiology; D001743:Urinary Bladder / Q000187:drug effects / Q000294:innervation* / Q000502:physiology; D014549:Urinary Incontinence / Q000503:physiopathology; D014563:Urodynamics / Q000187:drug effects / Q000502:physiology
chemical_list: D013565:Sympatholytics; D010646:Phentolamine