Spinal reflex control of micturition after spinal cord injury.
OBJECTIVE
This review summarizes possible spinal reflexes involved in micturition control as well as current treatments for lower urinary tract dysfunction after spinal cord injury (SCI) in an effort to further promote the development of new treatments for people with SCI.


METHODS
A systematic literature search was conducted on the Medline database, and on the Web of Science.


RESULTS
After SCI normal functions of the lower urinary tract are lost. The detrusor contracts frequently even at a small bladder volume, which results in urinary incontinence. In addition, the hyperactive bladder can not empty well because the urethral sphincter contracts simultaneously with the bladder (detrusor sphincter dyssynergia), which results in a large residual volume of urine. The malfunction of the lower urinary tract after SCI is caused by remaining and newly emerged bladder and urethral sphincter spinal reflexes. Current treatments have either limited success or troublesome side effects, and many new treatments are under development.


CONCLUSIONS
In order to restore the functions of the lower urinary tract after SCI, efforts should be directed at re-establishing the coordination between the spinal reflex control of bladder and urethral sphincter using either pharmacological or neurophysiological approaches.
Tai
Changfeng
C
Department of Pharmacology, University of Pittsburgh, Pittsburgh, PA 15261, USA. cftai@pitt.edu
Roppolo
James R
JR
de Groat
William C
WC
D000818:Animals; D006801:Humans; D008954:Models, Biological; D009130:Muscle, Smooth / Q000187:drug effects / Q000503:physiopathology; D012018:Reflex / Q000187:drug effects / Q000502:physiology*; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000628:therapy; D001743:Urinary Bladder / Q000187:drug effects / Q000294:innervation* / Q000503:physiopathology; D014549:Urinary Incontinence / Q000209:etiology* / Q000628:therapy