title: Neural mechanisms underlying lower urinary tract dysfunction.
abstract: This article summarizes anatomical, neurophysiological, and pharmacological studies in humans and animals to provide insights into the neural circuitry and neurotransmitter mechanisms controlling the lower urinary tract and alterations in these mechanisms in lower urinary tract dysfunction. The functions of the lower urinary tract, to store and periodically release urine, are dependent on the activity of smooth and striated muscles in the bladder, urethra, and external urethral sphincter. During urine storage, the outlet is closed and the bladder smooth muscle is quiescent. When bladder volume reaches the micturition threshold, activation of a micturition center in the dorsolateral pons (the pontine micturition center) induces a bladder contraction and a reciprocal relaxation of the urethra, leading to bladder emptying. During voiding, sacral parasympathetic (pelvic) nerves provide an excitatory input (cholinergic and purinergic) to the bladder and inhibitory input (nitrergic) to the urethra. These peripheral systems are integrated by excitatory and inhibitory regulation at the levels of the spinal cord and the brain. Therefore, injury or diseases of the nervous system, as well as disorders of the peripheral organs, can produce lower urinary tract dysfunction, leading to lower urinary tract symptoms, including both storage and voiding symptoms, and pelvic pain. Neuroplasticity underlying pathological changes in lower urinary tract function is discussed.
authors.affiliation: Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yoshimura
authors.affiliation: Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Ogawa
authors.affiliation: Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Minoru
authors.initials: M
authors.lastname: Miyazato
authors.affiliation: Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Takeya
authors.initials: T
authors.lastname: Kitta
authors.affiliation: Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Akira
authors.initials: A
authors.lastname: Furuta
authors.affiliation: Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Chancellor
authors.affiliation: Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Tyagi
keywords: Detrusor overactivity; Lower urinary tract; Nerve growth factor; Overactive urinary bladder