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Anatomy and pathophysiology of the aging bladder

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The Aging Bladder

Abstract

Bladder function and dysfunction in elderly people differ from those in younger adults. Impairment of bladder function, such as detrusor instability or urinary retention, may occur alone or in combination with urinary incontinence. To identify the cause of each dysfunctional pattern , both the morphological and the physiological changes in the aging bladder need to be investigated, in particular the changes in the function of the lower urinary tract and its central control. Voiding disorders in elderly people are rarely related to isolated specific anatomical or physiological changes; most commonly, they are the result of several interacting factors which may include medication (particularly centrally acting agents], immobility, metabolic imbalances, and previous surgical procedures, as well as cerebrospinal degeneration and disease (Jüunemann 2000).

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References

  1. Blok BF, Holstege G (1997a) Ultrastructural evidence for a direct pathway from the pontine micturition center to the parasympathetic preganglionic motoneurons of the bladder of the cat. Neurosci Lett 222: 195–198

    Google Scholar 

  2. Blok BF, Holstege G (1998a) The central nervous system control of micturition in cats and humans. Behav Brain Res 92: 119–125

    Google Scholar 

  3. Blok BF, Holstege G (1998b) Brain activation during micturition in women. Brain 121: 2033–2042

    Google Scholar 

  4. Blok BF, Sturms LM, Holstege G (1997b) A PET study on cortical and subcortical control of pelvic floor musculature in women. J Comp Neurol 389: 535–544

    Google Scholar 

  5. Blok BF, Willemsen AT, Holstege G (1997c) A PET study on brain control of micturition in humans. Brain 120: 111–121

    Google Scholar 

  6. Braun PM, Boschert J, Bross S, Scheepe JR, Alken P, Jünemann KP (1999) Tailored laminectomy: a new technique for neuromodulator implantation. J Urol 162: 1607–1609

    Google Scholar 

  7. Bross S, Schumacher S, Scheepe JR, Braun PM, Alken P, Jünemann KP (2001) Combined evaluation of detrusor pressure and bladder wall thickness as a parameter for the assessment of detrusor function: an experimental in vivo study. J Urol 166: 1130–1135

    Google Scholar 

  8. Bross S, Schumacher S, Scheepe JR, Seif C, Jünemann KP, Alken P (1999a) Smooth muscle fatigue due to repeated urinary bladder neurostimulation: an in vivo study. Neurourol Urodyn 18: 41–53

    Google Scholar 

  9. Bross S, Schumacher S, Scheepe JR, Zendler S, Braun PM, Alken P, Jünemann KP (1999b) Effects of acute urinary bladder overdistension on bladder response during sacral neurostimulation. Eur Urol 36: 354–359

    Google Scholar 

  10. DeAraujo CG, Schmidt RA, Tanagho EA (1982) Neural pathway to the lower urinary tract identified by retrograde axonal transport of horseradish peroxidase. Urology 19: 290–295

    Google Scholar 

  11. deGroat WC, Steers WO (1990) Autonomic regulation of the urinary bladder and sex organs. In: Loewy AD, SKM (eds) Central regulation of autonomic function. University Press Oxford Oxford, pp 310–333

    Google Scholar 

  12. Dixon J, Gosling J (1987) Structure and innervation in the human. In: Torrens M, Morrison J (eds) The physiology of the lower urinary tract. Springer Berlin, Heidelberg, New York, Tokyo, pp 1–22

    Google Scholar 

  13. Dorschner W, Stolzenburg JU, Neuhaus J (2001) Anatomic principles of urinary incontinence. Urologe A 40: 223–233

    Google Scholar 

  14. Elbadawi A, Diokno AC, Millard RJ (1998) The aging bladder: morphology and urodynamics. World J Urol 16: S10–S34

    Google Scholar 

  15. Elbadawi A, Hailemariam S, Yalla SV, Resnick NM (l997) Structural basis of geriatric voiding dysfunction. VII. Prospective ultrastructural/urodynamic evaluation of its natural evolution. J Urol 157: 1814–1822

    Google Scholar 

  16. Elbadawi A, Yalla SV, Resnick NM (1993a) Structural basis of geriatric voiding dysfunction. II. Aging detrusor: normal versus impaired contractility. J Urol 150: 1657–1667

    Google Scholar 

  17. Elbadawi A, Yalla SV, Resnick NM (1993b) Structural basis of geriatric voiding dysfunction. IV. Bladder outlet obstruction. J Urol 150: 1681–1695

    Google Scholar 

  18. Hextall A, Bidmead J, Cardozo L, Hooper R (2001a) The impact of the menstrual cycle on urinary symptoms and the results of urodynamic investigation. BJOG 108: 1193–1196

    Google Scholar 

  19. Hextall A, Cardozo L (2001b) The role of estrogen supplementation in lower urinary tract dysfunction. Int Urogynecol J Pelvic Floor Dysfunct 12: 258–261

    Google Scholar 

  20. Hinman F (1993) Atlas of urosurgical anatomy. Saunders Philadelphia, pp 334–338

    Google Scholar 

  21. Holstege G, Griffiths D, de Wall H, Dalm E (1986) Anatomical and physiological observations on supraspinal control of bladder and urethral sphincter muscles in the cat. J Comp Neurol 250: 449–461

    Google Scholar 

  22. Hutch JA (1967) A new theory of the anatomy of the internal urinary sphincter and the physiology of micturition. V. The base plate and stress incontinence. Obstet Gynecol 30: 309–317

    Google Scholar 

  23. Jackson SR, Avery NC, Tarlton JF, Eckford SO, Abrams P, Bailey AJ (1996) Changes in metabolism of collagen in genitourinary prolapse. Lancet 347: 1658–1661

    Google Scholar 

  24. Johnson FB, Sinclair DA, Guarente L (1999) Molecular biology of aging. Cell 96: 291–302

    Google Scholar 

  25. Jünemann KP (2000) Therapeutische Optionen der Altersinkontinenz. In: Jocham D, Altwein J, Jünemann KP, Schmitz-Draeger BJ, Weidner W, Wirth M [eds] Aging Male Man(n) wird nicht jünger. Verlag im Kilian Marburg, pp 63–71

    Google Scholar 

  26. Jünemann KP (2001a) Comment on the contribution by Dorschner W, Neuhaus J, Stolzenburg JU. Anatomic principles of urinary incontinence. Urologe A 40: 237–238

    Google Scholar 

  27. Jünemann KP, Lue TF, Schmidt RA, Tanagho EA (1988) Clinical significance of sacral and pudendal nerve anatomy. J Urol 139: 74–80

    Google Scholar 

  28. Jünemann KP, Martinez Portillo FJ, Seif C, Braun PM, Leissner J, Hohenfellner R (2001b) Risiko der Detrusordenervation bei Antirefluxchirurgie verdeutlicht am neurophysiologischen Modell. Urologe A 40 (1) [Suppl]: 64

    Google Scholar 

  29. Jünemann KP, Melchior H (1990) Disorders of bladder function in Parkinson syndrome. Urologe A 29: 170–175

    Google Scholar 

  30. Jünemann KP, Schmidt RA, Melchior H, Tanagho EA (1987) Neuroanatomy and clinical significance of the external urethral sphincter. Urol Int 42: 132–136

    Google Scholar 

  31. Kotkin L, Milam DF (1996) Evaluation and management of the urologic consequences of neurologic disease. Tech Urol 2: 210–219

    Google Scholar 

  32. Lasanen LT, Tammela TL, Kallioinen M, Waris T (1992) Effect of acute distension on cholinergic innervation of the rat urinary bladder. Urol Res 20: 59–62

    Google Scholar 

  33. Leissner J, Allhoff EP, Wolff W, Feja C, Hockel M, Black P, Hohenfellner R (2001) The pelvic plexus and antireflux surgery: topographical findings and clinical consequences. J Urol 165: 1652–1655

    Google Scholar 

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

    Google Scholar 

  35. Lewin RJ, Porter RW (1965) Inhibition of spontaneous bladder activity by stimulation of the globus pallidus. Neurology 15: 1049–1052

    Google Scholar 

  36. Maggi C (1993) Nervous control of the urogenital system. In: Maggi CA (ed) Autonomic nervous system — Physiology. Harwood Academic Publishing Chur, Schweiz, pp 3

    Google Scholar 

  37. Mattson MP, Chan SL, Duan W (2002) Modification of brain aging and neurodegenerative disorders by genes, diet, and behavior. Physiol Rev 82: 637–672

    Google Scholar 

  38. McGuire EJ (1994) Idiopathic bladder instability. In: Kursh ED, McGuire EJ (eds) Female Urology. Philadelphia plLippincott, pp 95–101

    Google Scholar 

  39. Melchior H (1995) Disorders of bladder function in the elderly. Urologe A 34: 329–333

    Google Scholar 

  40. Moore KN (1999) A review of the anatomy of the male continence mechanism and the cause of urinary incontinence after prostatectomy. J Wound Ostomy Continence Nurs 26: 86–93

    Google Scholar 

  41. Murdock MI, Olsson CA, Sax DS, Krane RT (1975) Effects of levodopa on the bladder outlet. J Urol 113: 803–805

    Google Scholar 

  42. Myers RP, Goellner TR, Cahill DR (1987) Prostate shape, external striated urethral sphincter and radical prostatectomy: the apical dissection. J Urol 138: 543–550

    Google Scholar 

  43. Petros PE, Ulmsten UI (1990) An integral theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand [Suppl] 153: 7–31

    Google Scholar 

  44. Rauber A, Kopsch F (1988) Topographie der Organsysteme, Systematik der peripheren Leitungsbahnen. Thieme New York

    Google Scholar 

  45. Schmidt RA, Bruschini H, Tanagho EA (1978) Feasibility of inducing micturition through chronic stimulation of sacral roots. Urology 7: 471–477

    Google Scholar 

  46. Schreiter F, Fuchs P, Stockamp K (1976) Estrogenic sensitivity of alpha-receptors in the urethra musculature. Urol Int 31: 13–19

    Google Scholar 

  47. Schurch B (2000) Neurogenic voiding disorders. Current status of diagnosis and therapy. Schweiz Med Wochenschr 130: 1618–1626

    Google Scholar 

  48. Sehn JT (1979) The ultrastructural effect of distension on the neuromuscular apparatus of the urinary bladder. Invest Urol 16: 369–375

    Google Scholar 

  49. Seif C, Herzog J, van der Horst C, Volkmann J, Deuschl G, Jünemann KP, Braun PM (2003) Impact of STN stimulation on the bladder function in patients with idiopathic Parkinson syndrome. Ann Neurol [in press)

    Google Scholar 

  50. Smith AR, Hosker GL, Warrell DW (1989a) The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine. A neurophysiological study. Br J Obstet Gynaecol 96: 24–28

    Google Scholar 

  51. Smith AR, Hosker GL, Warrell DW (1989b) The role of pudendal nerve damage in the aetiology of genuine stress incontinence in women. Br J Obstet Gynaecol 96: 29–32

    Google Scholar 

  52. Snooks SJ, Swash M (1984a) Abnormalities of the innervation of the urethral striated sphincter musculature in continence. Br J Urol 56: 401–405

    Google Scholar 

  53. Snooks SL, Swash M, Setchell M, Henry MM (1984b) Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet 8: 546–550

    Google Scholar 

  54. Strasser H, Klima G, Poisel S, Horninger W, Bartsch G (1996) Anatomy and innervation of the rhabdosphincter of the male urethra. Prostate 28: 24–31

    Google Scholar 

  55. Sugiyama T, Matsuda H, Oonishi N, Kiwamoto H, Esa A, Park YC, Kurita T, Uchida A, Kunikata S (1993) Anticholinergic therapy of urinary incontinence and urinary frequency associated with the elderly-with special reference to dementia. Nippon Hinyokika Gakkai Zasshi 84: 1068–1073

    Google Scholar 

  56. Tammela T, Autio-Harmainen H, Lukkarinen O, Sormunen R (1987) Effect of distension on function and nervous ultrastructure in the canine urinary bladder. Urol Int 42: 265–270

    Google Scholar 

  57. Tanagho EA, Schmidt RA (1982) Bladder pacemaker: scientific basis and clinical future. Urology 20: 614–619

    Google Scholar 

  58. Tanagho EA, Schmidt RA (1988) Electrical stimulation in the clinical management of neurogenic bladder. J Urol 140: 1331–1339

    Google Scholar 

  59. Tanagho EA, Smith OR (1966) The anatomy and function of the bladder neck. Br J Urol 38: 54–71

    Google Scholar 

  60. Tanagho EA (1992) Anatomy of the lower urinay tract. In: Walsh PC, Retik AB, Stamey TA, Vaughn EO [eds] Campbell’s urology. Saunders Philadelphia, pp 40–45

    Google Scholar 

  61. Welch WJ, Gambetti P (1998) Chaperoning brain diseases. Nature 392: 23–24

    Google Scholar 

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Correspondence to C. van der Horst MD .

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© 2004 Springer-Verlag Wien

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van der Horst, C., Jünemann, K.P. (2004). Anatomy and pathophysiology of the aging bladder. In: Plas, E., Pflüger, H., Maier, U., Hübner, W.A. (eds) The Aging Bladder. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0631-0_1

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  • DOI: https://doi.org/10.1007/978-3-7091-0631-0_1

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-83858-7

  • Online ISBN: 978-3-7091-0631-0

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