title: Redefining the Autonomic Nerve Distribution of the Bladder Using 3-Dimensional Image Reconstruction.
abstract: OBJECTIVE
  We sought to create a 3-dimensional reconstruction of the autonomic nervous tissue innervating the bladder using male and female cadaver histopathology.
  
  
  METHODS
  We obtained bladder tissue from a male and a female cadaver. Axial cross sections of the bladder were generated at 3 to 5 mm intervals and stained with S100 protein. We recorded the distance between autonomic nerves and bladder mucosa. We manually demarcated nerve tracings using ImageScope software (Aperio, Vista, California), which we imported into Blender™ graphics software to generate 3-dimensional reconstructions of autonomic nerve anatomy.
  
  
  RESULTS
  Mean nerve density ranged from 0.099 to 0.602 and 0.012 to 0.383 nerves per mm2 in female and male slides, respectively. The highest concentrations of autonomic innervation were located in the posterior aspect of the bladder neck in the female specimen and in the posterior region of the prostatic urethra in the male specimen. Nerve density at all levels of the proximal urethra and bladder neck was significantly higher in posterior vs anterior regions in female specimens (0.957 vs 0.169 nerves per mm2, p<0.001) and male specimens (0.509 vs 0.206 nerves per mm2, p=0.04).
  
  
  CONCLUSIONS
  Novel 3-dimensional reconstruction of the bladder is feasible and may help redefine our understanding of human bladder innervation. Autonomic innervation of the bladder is highly focused in the posterior aspect of the proximal urethra and bladder neck in male and female bladders.
authors.affiliation: Department of Urology, University of California-Irvine, Orange, California.
authors.forename: Kyle
authors.initials: K
authors.lastname: Spradling
authors.affiliation: Department of Urology, University of California-Irvine, Orange, California.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Khoyilar
authors.affiliation: Department of Urology, University of California-Irvine, Orange, California.
authors.forename: Garen
authors.initials: G
authors.lastname: Abedi
authors.affiliation: Department of Urology, University of California-Irvine, Orange, California.
authors.forename: Zhamshid
authors.initials: Z
authors.lastname: Okhunov
authors.affiliation: Department of Anatomy and Neurobiology, University of California-Irvine, Orange, California.
authors.forename: Jamie
authors.initials: J
authors.lastname: Wikenheiser
authors.affiliation: Department of Urology, University of California-Irvine, Orange, California.
authors.forename: Renai
authors.initials: R
authors.lastname: Yoon
authors.affiliation: Department of Pathology, University of California-Los Angeles, Los Angeles, California.
authors.forename: Jiaoti
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Urology, University of California-Irvine, Orange, California.
authors.forename: Ramy F
authors.initials: RF
authors.lastname: Youssef
authors.affiliation: Department of Urology, University of California-Irvine, Orange, California.
authors.forename: Gamal
authors.initials: G
authors.lastname: Ghoniem
authors.affiliation: Department of Urology, University of California-Irvine, Orange, California. Electronic address: landmanj@uci.edu.
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
mesh_terms: D000369:Aged, 80 and over; D001341:Autonomic Nervous System / Q000033:anatomy & histology*; D003196:Computer Graphics; D017076:Computer-Aided Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional; D008297:Male; D009418:S100 Proteins / Q000032:analysis; D012984:Software; D014521:Urethra / Q000294:innervation; D001743:Urinary Bladder / Q000294:innervation*; D019459:Urothelium / Q000294:innervation; D014584:User-Computer Interface
chemical_list: D009418:S100 Proteins
keywords: anatomic; autonomic pathways; cadaver; models; urethra; urinary bladder