Nerve regeneration: might this be the only solution for functional problems of the urinary tract?
OBJECTIVE
To assess the potential role of nerve regeneration in restoring urinary tract function, the rapidly developing and exciting area of central and peripheral nerve repair and regeneration is reviewed, with particular reference to papers in which animal models of nerve damage resulting in urogenital dysfunction have been used. The difficulties and potential of these techniques for therapeutic application to human subjects with functional problems of the urinary tract are discussed.


RESULTS
Methods for encouraging regeneration of cut axons and directed growth in the inhibitory environment of the central nervous system are being extensively explored. The recent discovery of the potential of olfactory ensheathing cells has proved a significant advance. Olfactory ensheathing cells are a type of glial cell which can be harvested from the olfactory mucosa. Transplantation of these cells, in conjunction with a biodegradable synthetic nerve guide or conduit, has been shown to restore urinary tract function after spinal cord injury. Artificial, biodegradable conduits have also restored bladder and spermatic duct function after sympathetic nerve damage. Other adjuvants facilitating the process of axonal recovery include the use of neurotrophins to accelerate and guide the formation of new nerve-fibre growth.


CONCLUSIONS
These revolutionary technologies may, in the future, provide a means of treating urinary tract dysfunction with some types of aetiology, including acute spinal cord injury, and injury to nerves following pelvic surgery. It is, however, less likely that these treatments will be used successfully in the near future in patients in which the neural damage is long term, or associated with death of post-ganglionic neurons.
Biers
Suzanne M
SM
University Department of Pharmacology, Oxford, UK. suzanne.biers@pharm.ox.ac.uk
Brading
Alison F
AF
D000818:Animals; D001341:Autonomic Nervous System / Q000502:physiology; D017690:Cell Transplantation; D004195:Disease Models, Animal; D052776:Female Urogenital Diseases / Q000628:therapy*; D006801:Humans; D052801:Male Urogenital Diseases; D009414:Nerve Growth Factors / Q000494:pharmacology; D009416:Nerve Regeneration; D009831:Olfactory Mucosa / Q000166:cytology; D011843:Radiculopathy / Q000628:therapy; D013119:Spinal Cord Injuries / Q000150:complications
D009414:Nerve Growth Factors