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Neurogenic urinary retention

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Abstract

This review article on neurogenic urinary retention is divided into three main sections. The first covers the neuroanatomy of the bladder and urethral sphincters, developing the peripheral innervation as well as the spinal cord organization and the cortical and subcortical brain control of micturition. The second discusses the main central and peripheral neurological lesions and diseases causing urinary retention. The last section gives an updated view of the neurophysiological techniques which are now available to test the central and peripheral pathways controlling micturition.

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References

  1. Fletcher TF, Bradley WE. Neuroanatomy of the bladderurethra. J Urol 1978; 119:153–160

    Google Scholar 

  2. Fletcher TF, Hammer RF, Bradley WE. Nerve endings in the urinary bladder of the cat. J Comp Neurol 1969; 136:1–20

    Google Scholar 

  3. Bradley WE, Long DM. Morphology of the developing mammalian bladder. Invest Urol 1969; 7:66–73

    Google Scholar 

  4. Elbadawi A, Schenk EA. A new theory of the innervation of the bladder musculature. Part 3. Postganglionic synapses in uretero-vesico-urethral-autonomic pathways. J Urol 1971; 105:372–374

    Google Scholar 

  5. Onufrowicz B. On the arrangement and function of the cell groups in the sacral region of the spinal cord in man. Arch Neurol Psychopathol 1900; 3:387–412

    Google Scholar 

  6. Kuru M. Nervous control of micturition. Physiol Rev 1965; 45:425–494

    Google Scholar 

  7. Ek A, Alm P, Anderson KE, Persson CGA. Adrenergic and cholinergic nerves in the human urethra and urinary bladder. A histochemical study. Acta Physiol Scand 1977; 90:345–352

    Google Scholar 

  8. Benson GS, McConnell JA, Wood JG. Adrenergic innervation of the human bladder body. J Urol 1979; 122:189–191

    Google Scholar 

  9. Gosling JA, Dixon JS, Lendon RG. The autonomic innervation of the human male and female bladder neck and proximal urethra. J Urol 1977; 118:302–305

    Google Scholar 

  10. Saum WR, De Groat WC. Parasympathetic ganglia activation of an adrenergic inhibitory mechanism by cholinomimetic agents. Science 1972; 175:659–661

    Google Scholar 

  11. Hamberger B, Norberg KA. Adrenergic synaptic terminals and nerve cells in bladder ganglia of the cat. Int J Neuropharmacol 1965; 4:41–45

    Google Scholar 

  12. Fletcher TF, Bradley WE. Afferent nerve endings in the urinary bladder of the cat. Am J Anat 1970; 128:147–157

    Google Scholar 

  13. Iggo A. Tension receptors in the stomach and the urinary bladder. J Physiol 1955; 128:593–607

    Google Scholar 

  14. Talaat M. Afferent impulses in the nerves supplying the urinary bladder. J Physiol 1937; 89:1–13

    Google Scholar 

  15. Edvardsen P. Nervous control of urinary bladder in cats. I. The collecting phase. Acta Physiol Scand 1968; 72:157–171

    Google Scholar 

  16. Head H, Riddoch G. The automatic bladder, excessive sweating and some other reflex conditions, in gross injuries of the spinal cord. Brain 1917; 40:188–192

    Google Scholar 

  17. Nathan PW. Thermal sensation in the bladder. J Neurol Neurosurg Psychiat 1952; 15:150–151

    Google Scholar 

  18. Learmonth JR. A contribution to the neurophysiology of the urinary bladder in man. Brain 1931; 54:147–176

    Google Scholar 

  19. Hilton P. The mechanism of continence. In: Stanton SL, Tanagho EA. Surgery of female incontinence. Springer-Verlag, 1986;1–21

  20. Bowen JM, Timm GW, Bradley WE. Some contractile and electrophysiologic properties of the periurethral striated muscle of the cat. Invest Urol 1976; 13:327–330

    Google Scholar 

  21. Mahony DT, Laferte RO, Blais DJ. Intergral storage and voiding reflexes. Neurophysiologic concept of continence and micturition. Urology 1977; 9:95–107

    Google Scholar 

  22. Bradley WE. Micturition reflex amplification. J Urol 1969; 101:403–407

    Google Scholar 

  23. Fletcher TF, Bradley WE. Neuroanatomy of the bladderurethra. J Urol 1978; 119:153–160

    Google Scholar 

  24. Andrew J, Nathan PW, Spanos NC. Disturbances of micturition and defecation due to aneurysms of anterior communicating or anterior cerebral arteries. J Neurosurg 1966; 24:1–10

    Google Scholar 

  25. Eardley I, Nagendran K, Kirby RS, Fowler CJ. A new technique for assessing the efferent innervation of the human striated urethral sphincter. J Urol 1990; 144:948–951

    Google Scholar 

  26. Ertekin C, Hansen MV, Larsson LE, Sjodahl R. Examination of the descending pathway to the external anal sphincter and pelvic floor muscles by transcranial cortical stimulation. Electroencephalog Clin Neurophysiol 1990; 75:500–510

    Google Scholar 

  27. Haldeman S, Bradley WE, Bhatia NN, Johnson BK. Pudendal evoked responses. Arch Neurol 1982; 39:280–283

    Google Scholar 

  28. McLeod JG. The representation of the splanchnic afferent pathways in the thalamus of the cat. J Physiol 1958; 140:462–478

    Google Scholar 

  29. Lewin RJ, Dillard GV, Porter RW. Extrapyramidal inhibition of the urinary bladder. Brain Res 1967; 4:301–307

    Google Scholar 

  30. Martner J. Influences on the defecation and micturition reflexes by the cerebellar fastigial nucleus. Acta Physiol Scand 1975; 94:95–104

    Google Scholar 

  31. Fontanarosa PB, Roush WR. Acute urinary retention. Emerg Med Clin North Am 1988; 6:419–437

    Google Scholar 

  32. Wheeler JS, Culkin DJ, Walter JS, Flanigan RC. Female urinary retention. Urology 1990; 35:428–432

    Google Scholar 

  33. Blaivas JG. The neurophysiology of micturition: a clinical study of 550 patients. Urol 1982; 127:958–963

    Google Scholar 

  34. Blaivas JG, Sinha HP, Zayed AAH et al. External sphincter dyssynergia: a detailed electromyographic study. J Urol 1981; 125:545–548

    Google Scholar 

  35. Brindley GS, Polkey CE, Rushton DN. Sacral anterior root stimulation for bladder control in paraplegia. Paraplegia 1982; 20:365–381

    Google Scholar 

  36. Tanagho EA. Neuropathic bladder disorders. In Smith DR (ed), General Urology. Los Altos, California, Lange Medical 1981;354–372

    Google Scholar 

  37. Khan Z, Starer P, Yang WC, Bhola A. Analysis of voiding disorders in patients with cerebrovascular accident. Urology 1990; 35:265–270

    Google Scholar 

  38. Andrew J, Nathan PW. Lesions of the anterior frontal lobes and disturbances of micturition and defecation. Brain 1964; 87:233–262

    Google Scholar 

  39. Maurice-Williams RS. Micturition symptoms in frontal tumors. J Neurol Neurosurg Psychiat 1974; 37:431–436

    Google Scholar 

  40. Brocklehurst JC, Dillane JB. Studies of the female bladder in old age. I. Cystometrograms in non-incontinent women. Geront Clin 1966; 8:285–290

    Google Scholar 

  41. Tsuchida S, Noto H, Yamaguchi O, Itoh M. Urodynamic studies on hemiplegic patients after cerebrovascular accident. Urology 1983; 21:315–318

    Google Scholar 

  42. Klutzow FW, Gleason DF, Lancaster HK, Murray KB. Incontinence associated with bilateral lesions of putamen. Arch Neurol 1989; 46:168–172

    Google Scholar 

  43. Pavlakis AJ, Siroky MB, Goldstein I, Krane RJ. Neurourologic findings in Parkinson's disease. J Urol 1983; 129:80–83

    Google Scholar 

  44. Andersen JT, Bradley WE. Cystometric, sphincter and electromyographic abnormalities in Parkinson's disease. J Urol 1976; 116:75–78

    Google Scholar 

  45. Kirby R, Fowler C, Gosling J, Bannister R. Urethrovesical dysfunction in progressive autonomic failure with multiple system atrophy. J Neurol Neurosurg Psychiat 1986; 49:554–562

    Google Scholar 

  46. Miller H, Simpson CA, Yeates WK. Bladder dysfunction in multiple sclerosis. Br Med J 1965; 1:1265–1269

    Google Scholar 

  47. Goldstein I, Siroky MB, Sax DS, Krane RJ. Neurologic abnormalities in multiple sclerosis. J Urol 1982; 128:541–545

    Google Scholar 

  48. Andersen JT, Bradley WE. Abnormalities of detrusor and sphincter function in multiple sclerosis. Br J Urol 1976; 48:193–198

    Google Scholar 

  49. Schoenberg HW, Gutrich JM, Banno J. Urodynamic patterns in multiple sclerosis. J Urol 1979; 122:648–650

    Google Scholar 

  50. Perkash I. Treatment of voiding dysfunction in spinal-cordinjured patients: surgical. In: Barrett DM, Wein AJ eds. Controversies in neuro-urology. New York: Churchill Livingstone, 1984;425–435

    Google Scholar 

  51. Beric A, Dimitrijevic MR, Light JK. A clinical syndrome of rostral and caudal spinal injury: neurological, neurophysiological and urodynamic evidence for occult sacral lesion. J Neurol Neurosurg Psychiat 1987; 50:600–606

    Google Scholar 

  52. Perkash I. Management of neurogenic bladder dysfunctions following acute traumatic cervical cord syndrome (incomplete tetraplegia). Paraplegia 1977; 15:21–37

    Google Scholar 

  53. Lipton HL, Teasdall RD. Acute transverse myelopathy in adults. Arch Neurol 1973; 28:252–257

    Google Scholar 

  54. Adams RD, Victor M. Principles of neurology, 3rd edn. New York: McGraw-Hill, 1985;673–678

    Google Scholar 

  55. Chancellor MB, Dato VM, Yang JY. Lyme disease presenting as urinary retention. J Urol 1990; 143:1223–1224

    Google Scholar 

  56. Berger Y, Blaivas JG, Oliver L. Urinary dysfunction in transverse myelitis. J Urol 1990; 144:103–105.

    Google Scholar 

  57. Aho AJ, Avranen A, Pesonen K. Analysis of cauda equina symptoms in patients with lumbar disc prolapse. Acta Chir Scand 1969; 135:413

    Google Scholar 

  58. Scott PJ. Bladder paralysis in cauda equina lesions from disc prolapse. J Bone Joint Surg 1965; 47B:224–235

    Google Scholar 

  59. Nielsen B, De Nully M, Schmidt K, Hansen RI. A urodynamic study of cauda equina syndrome due to lumbar disc herniation. Urol Int 1980; 35:167–170

    Google Scholar 

  60. Emmett JL, Love JG. Urinary retention in women caused by asymptomatic protruded lumbar disc: report of 5 cases. J Urol 1968; 99:597–606

    Google Scholar 

  61. Gleave JRW, Macfarlane R. Prognosis for recovery of bladder function following lumbar central disc prolapse. Br J Neurosurg 1990; 4:205–210

    Google Scholar 

  62. Sharr MM, Garfield JS, Jenkins JD. The association of bladder dysfunction with degenerative lumbar spondylosis. Br J Urol 1973; 45:616–620

    Google Scholar 

  63. Smith AY, Woodside JR. Urodynamic evaluation of patients with spinal stenosis. Urology 1988; 32:474–477

    Google Scholar 

  64. Garfield JS, Lytle SN. Urinary presentation of cauda equina lesions without neurological symptoms. Br J Urol 1970; 42:551–554

    Google Scholar 

  65. Kondo A, Kato K, Kanai S, Sakakibara T. Bladder dysfunction secondary to tethered cord syndrome in adults: is it curable? J Urol 1986; 135:313–316

    Google Scholar 

  66. Fidas A, MacDonald HL, Elton RA, McInnes A, Chisholm GD. Neurological defects of the voiding reflex arcs in chronic urinary retention and their relation to spina bifida occulta. Br J Urol 1989; 63:16–20

    Google Scholar 

  67. Herbaut AG, Voordecker P, Monseu G, Germeau F. Benign transient urinary retention. J Neurol Neurosurg Psychiat 1987; 50:354–355

    Google Scholar 

  68. Herbaut AG, Nogueira MC, Wespes E. Urinary retention due to sacral myeloradiculitis: a clinical and neurophysiological study. J Urol 1990; 144:1206–1208

    Google Scholar 

  69. Oates JK, Greenhouse PRDH. Retention of urine in anogenital herpetic infection. Lancet 1978; 1:691–692

    Google Scholar 

  70. Kogan BA, Solomon MH, Diokno AC. Urinary retention secondary to Landry-Guillain-Barré Syndrome. J Urol 1981; 126:643–644

    Google Scholar 

  71. Charnock ED, Newton N. Case report: AIDS peripheral neuropathy. Am J Med Sci 1989; 298:256–260

    Google Scholar 

  72. Kirby RS, Fowler CJ, Gilpin SA et al. Non-obstructive detrusor failure. A urodynamic, electromyographic, neurohistochemical and autonomic study. Br J Urol 1983; 55:652–659

    Google Scholar 

  73. Fowler CJ, Kirby RS, Harrison MJG. Decelerating burst and complex repetitive discharges in the striated muscle of the urethral sphincter, associated with urinary retention in women. J Neurol Neurosurg Psychiat 1985; 48:1004–1009

    Google Scholar 

  74. Snooks SJ, Swash M. Nerve stimulation techniques. In: Henry MM, Swash M, (eds) Coloproctology and the pelvic floor: pathophysiology and management. London: Butterworths 1985;112–128

    Google Scholar 

  75. Snooks SJ, Swash M. Abnormalities in the innervation of the urethral striated sphincter musculature in incontinence. Br J Urol 1984; 56:401–405

    Google Scholar 

  76. Snooks SJ, Swash M, Setchell M, Henry MM. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet 1984; 2:546–550

    Google Scholar 

  77. Snooks SJ, Barnes RPH, Swash M. Damage to the voluntary anal and urethral sphincter musculature in incontinence. J Neurol Neurosurg Psychiat 1984; 47:1269–1273

    Google Scholar 

  78. Snooks SJ, Swash M, Henry MM, Setchell M. Risk factors in childbirth causing damage to the pelvic floor innervation: a precursor of stress incontinence. Int J Colored Dis 1986; 1:2–6

    Google Scholar 

  79. Parks AG, Swash M, Urich H. Sphincter denervation in anorectal incontinence and rectal prolapse Gut 1977; 18:656–665

    Google Scholar 

  80. Ertekin C, Reed F. Bulbocavernosus reflex in normal men and in patients with neurogenic bladder and/or impotence. J Neurol Sci 1976; 28:1–15

    Google Scholar 

  81. Varma JS, Smith AN, McInnes A. Electrophysiological observations on the human pudendo-anal reflex. J Neurol Neurosurg Psychiat 1986; 49:1411–1416

    Google Scholar 

  82. Bilkey WJ, Awad EA, Smith AD. Clinical application of sacral reflex latency. J Urol 1983; 129:1187–1189

    Google Scholar 

  83. Opsomer RJ, Caramia MD, Zarola F, Pesce F, Rossini PM. Neurophysiological evaluation of central-peripheral sensory and motor pudendal fibers. Electroencephalog Clin Neurophysiol 1989; 74:260–270

    Google Scholar 

  84. Herbaut AG, Nogueira MC. Neurophysiological investigations in diabetic impotent and potent men. Electroencephalog Clin Neurophysiol 1989; 72:108

    Google Scholar 

  85. Nogueira MC, Herbaut AG, Wespes E. Neurophysiological investigations of 200 men with erectile dysfunction. Eur Urol 1990; 18:37–41

    Google Scholar 

  86. Swash M, Snooks SJ. Electromyography in pelvic floor disorders. In Henry MM, Swash M (eds) Coloproctology and the pelvic floor: pathophysiology and management. London: Butterworths 1985;88–103

    Google Scholar 

  87. Fowler CJ, Kirby RS, Harrison MJG, Milroy EJG, Turner-Warwick R. Individual motor unit analysis in the diagnosis of disorders of urethral sphincter innervation. J Neurol Neurosurg Psychiat 1984; 47:637–641

    Google Scholar 

  88. Dibenedetto M, Yalla SV. Electrodiagnosis of striated urethral sphincter dysfunction. J Urol 1979; 122:361–365

    Google Scholar 

  89. Nordling J, Meyhoff HH. Dissociation of urethral and anal sphincter activity in neurogenic bladder dysfunction. J Urol 1979; 122:352–356

    Google Scholar 

  90. Diokno AC, Koff SA, Bender LF. Periurethral striated muscle activity in neurogenic bladder dysfunction. J Urol 1974; 112:743–749

    Google Scholar 

  91. Eardley I, Quinn NP, Fowler CJ, Kirby RS, Parkhouse HF et al. The value of urethral sphincter electromyography in the differential diagnosis of Parkinsonism. Br J Urol 1989; 64:360–362

    Google Scholar 

  92. Fowler CJ, Kirby RS. Electromyography of urethral sphincter in women with urinary retention. Lancet 1986;1455–1456

  93. Fowler CJ, Kirby RS. Abnormal electromyographic activity (decelerating burst and complex repetitive discharges) in the striated muscle of the urethral sphincter in 5 women with persisting urinary retention. Br J Urol 1985; 57:67–70

    Google Scholar 

  94. Blaivas J, Labib K, Bauer S, Tetik A. A new approach to electromyography of the external urethral sphincter. J Urol 1977; 117:773–777

    Google Scholar 

  95. Eardley I, Nagendran K, Lecky B, Chapple CR, Kirby RS, Fowler CJ. Neurophysiology of the striated urethral sphincter in multiple sclerosis. Br J Urol 1991; 68:81–88

    Google Scholar 

  96. Kaneko S, Park YC, Yachiku S, Kurita T. Evoked central somatosensory potentials after penile stimulation in man. Urology 1983; 21:58–59

    Google Scholar 

  97. Haldeman S, Bradley WE, Bhatia NN, Johnson BK. Cortical evoked potentials on stimulation of pudendal nerve in women. Urology 1983; 21:590–593

    Google Scholar 

  98. Haldeman S, Bradley WE, Bhatia N. Evoked responses from the pudendal nerve. J Urol 1982; 128:974–980

    Google Scholar 

  99. Haldeman S, Bradley WE, Bhatia NN, Johnson BK. Pudendal evoked responses. Arch Neurol 1982; 39:280–283

    Google Scholar 

  100. Badr G, Carlsson CA, Fall M, Friberg S, Lindstrom L et al. Cortical evoked potentials following stimulation of the urinary bladder in man. Electroencephalog Clin Neurophysiol 1982; 54:494–498

    Google Scholar 

  101. Sarica Y, Karacan I. Cerebral responses evoked by stimulation of the vesico-urethral junction in normal subjects. Electroencephalog Clin Neurophysiol 1986; 65:440–446

    Google Scholar 

  102. Deltenre PF, Thiry AJ. Urinary bladder cortical evoked potentials in man: suitable stimulation techniques. Br J Urol 1989; 64:381–384

    Google Scholar 

  103. Snooks SJ, Swash M. Perineal nerve and transcutaneous spinal stimulation: new methods for investigations of the urethral striated sphincter musculature. Br J Urol 1984; 56:406–409

    Google Scholar 

  104. Eardley I, Nagendran K, Kirby RS, Fowler CJ. A new technique for assessing the efferent innervation of the human striated urethral sphincter. J Urol 1990; 144:948–951

    Google Scholar 

  105. Ertekin C, Hansen MV, Larsson LE, Sjodahl R. Examination of the descending pathway to the external anal sphincter and pelvic floor muscles by transcranial cortical stimulation Electroencephalog Clin Neurophysiol 1990; 75:500–510

    Google Scholar 

  106. Bemelmans BLH, Van Kerrebroeck PEV, Notermans SLH, Wijksta H, De Bruyne FMJ. Motor evoked potentials from the bladder on magnetic stimulation of the cauda equina; a new technique for investigation of autonomic bladder innervation. J Urol 1992; 147:658–661

    Google Scholar 

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  1. Service de Neurologie, Université Libre de Bruxelles, Hôpital Erasme, Route de Lennik 808, B-1070, Brussels, Belgium

    A. G. Herbaut

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Herbaut, A.G. Neurogenic urinary retention. Int Urogynecol J 4, 221–228 (1993). https://doi.org/10.1007/BF00372344

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