Voluntary Versus Reflex micturition Control
Book Title
Neuro-Urology Research: A Comprehensive Overview
Files
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Editors
Verstegen, Anne M.J.
Description
The functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain, spinal cord, and peripheral autonomic ganglia that coordinate the activity of smooth and striated muscles of the bladder and urethral outlet. Although the neural units that can induce contraction and relaxation of the bladder and urethra are located in the lumbosacral spinal cord and peripheral nervous pathways, the coordination between different components of the lower urinary tract necessary for efficient micturition requires a hierarchical neural system, in which spinal storage mechanisms are in turn regulated by circuitry in the rostral brainstem that initiates reflex voiding. Then, voluntary micturition depends on suprapontine inputs from the forebrain that modulate the brainstem circuitry. Many neural circuits controlling the lower urinary tract exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. The major component of the reflex micturition is a spinobulbospinal pathway that has essential connections between the lumbosacral spinal cord and brainstem structures such as the periaqueductal gray matter and Pontine micturition center, which can induce bladder contractions and reciprocal urethral relaxation during voiding. However, these suprapontine and spinobulbospinal pathways, which are responsible for voluntary and reflex voiding, respectively, are still immature in infants and young children, resulting in involuntary voiding, and are often impaired in adults due to diseases or injuries of the nervous system, leading to reemergence of involuntary micturition and urinary incontinence. This chapter summarizes anatomical, neurophysiological, pharmacological, and brain imaging studies in humans and animals that have provided insights into the neural circuitry and neurotransmitter mechanisms controlling voluntary and reflex micturition.
First Page
53
Last Page
79
ISBN
978-0-12-822455-7
Publication Date
2023
Publisher
Academic Press
City
Cambridge
Keywords
neuro-urology, micturition
Disciplines
Urology
Recommended Citation
Yoshimura N, Chancellor MB, Kitta T, Osawa T, de Groat WC. Voluntary versus reflex micturition control. In: Verstegen AMJ, editor. Neuro-urology research: a comprehensive overview. Cambridge: Academic Press; 2023. p. 53-79. doi:10.1016/B978-0-12-822455-7.00003-9.
Comments
Chapter 3