Skip to main content
SpringerLink
Log in

Neurophysiology and neuropharmacology of the lower urinary tract

  • Review Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Recent advances in our understanding of the neurophysiology and neuropharmacology of the lower urinary tract have improved our ability to treat disorders of bladder and urethral function. Similarly, many classes of drugs currently used in treating various medical conditions can cause lower urinary tract symptoms and dysfunction. Based on objective modern techniques of urodynamic evaluation, the clinician is able to sort out bladder and urethral abnormalities and scientifically choose appropriate pharmacologic regimens to treat these conditions.

This paper reviews lower urinary tract physiology, the neurophysiology of voiding mechanisms and provides the clinician with a rational, objective, current neuropharmacologic approach to lower urinary tract disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bradley WE, Timm GW, Scott FB. Innervation of the detrusor muscle and urethra.Urol Clin North Am 1974; 1:3–27

    Google Scholar 

  2. Bradley WE, Rockswold GL, Timm GW, et al. Neurology of micturition.J Urol 1976; 115:481–486

    Google Scholar 

  3. Bissada ND, Finkbeiner AE, Welch LT. Lower urinary tract pharmacology. II. Review of neurology.Urol 1977; 9:113–118

    Google Scholar 

  4. Gosling JA, Dixon JS, Lendon RG. The autonomic innervation of the human male and female bladder neck and proximal urethra.J Urol 1977; 118:302–308

    Google Scholar 

  5. Ostergard DR. The neurological control of micturition and integral voiding reflexes.Obstet Gynecol Survey 1979; 34:417–423

    Google Scholar 

  6. Mahoney DT, Laberte RO, Blais DJ. Integral storage and voiding reflexes: neurophysiologic concept of continence and micturition.Urol 1977; 9:95–106

    Google Scholar 

  7. Wein A, Malloy T, Raezer D. The effects of bethanechol chloride in normal women and women with significant residual urine volumes.J Urol 1980; 124:397–405

    Google Scholar 

  8. Khanna OP, Heber D, Gonick P. Cholinergic and adrenergic neuroreceptors in urinary tract of female dogs.Urology 1975; 5:616

    Google Scholar 

  9. Drutz HP. The unstable bladder. In: Sciarra JJ, ed. Gynecology and Obstetrics, Philadelphia: Harper and Row 1983; vol. 6, chap. 93

    Google Scholar 

  10. Finkbeiner AE. Is bethanechol chloride clinically effective in promoting bladder emptying? A literature review.J Urol 1985; 134:443–449

    Google Scholar 

  11. Philp NH, Thomas DG, Clarke SJ. Drug effects on the voiding cystometrogram: a comparison of oral bethanechol and carbachol.Br J Urol 1980; 52:484–487

    Google Scholar 

  12. Tammela T. Prevention of prolonged voiding problems after unexpected postoperative urinary retention: comparison of phenoxybenzamine and carbachol.J Urol 1986: 136:1254–1257

    Google Scholar 

  13. Abrams PH, Fenely RC. The actions of prostaglandins on the smooth muscle of the human urinary tract in vitro.Br J Urol 1976; 47:909–915

    Google Scholar 

  14. Andersson K-E, Ek A, Persson, CG. Effects of prostaglandins on the isolated human bladder and urethra.Acta Physiol Scand 1977; 100:165–171

    Google Scholar 

  15. Andersson K-E, Henriksson L, Ulmsten U. Effects of protaglandin E2 applied locally on intravesical and intraurethral pressures in women.Eur Urol 1978; 4:366–369

    Google Scholar 

  16. Delaere K, Thomas C, Moonen T, Dibryne F. The values of prostaglandins E and F2 in women with abnormalities of bladder emptying.Br J Urol 1981; 53:306–309

    Google Scholar 

  17. Tammela T, Kontturi M, Kaar K, Lukkarinen O. Intravesical prostaglandin F2α for promoting bladder emptying after surgery for female stress incontinence.Br J Urol 1987; 60:43–46

    Google Scholar 

  18. Ostergard DR. Effect of drugs on the lower urinary tract. In: Ostergard DR, ed. Gynecologic urology and urodynamics: theory and practice, 2nd edn. Baltimore: Williams and Wilkins, 1985; 347–355

    Google Scholar 

  19. Ruffman R, Sartani A. Flavoxate, a drug with smooth muscle relaxing activity.Drugs Exptl Clin Res 1987; 13:57–62

    Google Scholar 

  20. Awad SA, Downie JW, Kirulata HG. Pharmacologic treatment of disorders of bladder and urethra: a review.Can J Surg 1979; 22:515–518

    Google Scholar 

  21. Baigrie RJ, Kelleher JP, Fawcett DP, Pengelly AW. Oxybutynin: Is it safe?Br J Urol 1988; 62:319–322

    Google Scholar 

  22. Jilig G, Madersbacher H. Intravesical application of oxybutynin-hydrochloride for control of detrusor hyperreflexia. Pro 19th annual meeting ICS, Sept 1989,Neurourol Urodyn 1989; 8:312

    Google Scholar 

  23. Constantinou CE, Sorensen S, Jonler S, Christiansen S, Djurhuus JC. Modulation of urethral closure by diltiazem and oxybutynin. Pro 19th annual meeting ICS, Sept 1989,Neurourol Urodyn 1989; 8:413–414

    Google Scholar 

  24. Gu F, Zong-Ying R, Gang-Zhi S et al. Treatment of urgency and urge incontinence with flavoxate in the People's Republic of China.J Int Med Res 1987; 15:312–318

    Google Scholar 

  25. Stanton SL. A comparison of emepronium bromide and flavoxate hydrochloride in the treatment of urinary incontinence.J Urol 1973; 110:529–531

    Google Scholar 

  26. Ritch AES, George CF, Castelden CM, Hall MRD. A second look at emepronium bromide in urinary incontinence.Lancet 1977; 1:504–506

    Google Scholar 

  27. Meyhoff HH, Nordling J. Different cystometric types of deficient micturition reflex control in female urinary incontinence with special reference to effects of parasympatholytic treatment.Br J Urol 1981; 53:129–133

    Google Scholar 

  28. Cardozo LD, Stanton SL. An objective comparison of the effects of parenterally administered drugs in patients suffering from detrusor instability.J Urol 1979; 122:58–59

    Google Scholar 

  29. Cardozo LD, Stanton SL, Robinson H, Hole D. Evaluation of flurbiprofen in detrusor instability.Br Med J 1980; 280:281–283

    Google Scholar 

  30. Andersson K-E. Effects of calcium and calcium antagonists on excitation-contraction coupling in striated and smooth muscle.Picta Pharmacol Toxicol (Copenh) 1978; 43 (Suppl 1):5

    Google Scholar 

  31. Ulmsten U, Ekman G, Andersson K-E. The effect of terodilene treatment in women with motor urgency incontinence.Am J Obstet Gynecol 1985; 153:619–622

    Google Scholar 

  32. Anderson JR, Lose G, Norgaard M, et al. Terodilene, emepromium bromide or placebo for treatment of female detrusor overactivity: a randomized double blind crossover study.Br J Urol 1988; 61:310–313

    Google Scholar 

  33. Iacovou JW, Hill SJ, Birmingham AT, Bates CP. Calcium dependence and inosital phosphate accumulation in human detrusor smooth muscle. Proc meeting ICS, Sept 1989.Neurourol Urodyn 1989; 8:418–419

    Google Scholar 

  34. Guarneri L, Angelico P, Schiaui S, Simonazzi I, Testa R. Calcium antagonist effects on the rat bladder of REC 15/2053, a new antispasmodic flavone-derivative. Proc 19th annual meeting ICS, Sept 1989.Neurourol Urodyn 1989; 8:60–61

    Google Scholar 

  35. Harris RC, Constantinou, CE, Stamey TA. Extravesical subtrigonal injection of 50 percent ethanol for detrusor instability.J Urol 1988; 140:111–116

    Google Scholar 

  36. Ewing R, Bultitude ML, Shuttleworth KE. Subtrigonal phenol injection therapy for incontinence in female patients with multiple sclerosis.Lancet 1983; 1:1304–1305

    Google Scholar 

  37. Blackford HN, Murray K, Stephenson TP, Mundy AR. Results of transvesical infiltration of the pelvic plexuses with phenol in 116 patients.Br J Urol 1984; 56:647–649

    Google Scholar 

  38. Farrar DJ, Osborne JL. The use of bromocriptine in the treatment of the unstable bladder.Br J Urol 1976; 48:235

    Google Scholar 

  39. Matos-Ferreira A, Corte-Real J, Palma J, Durao V. The effect of bromocriptine in benign prostatic hypertrophy and vesicosphincter dynamics.Br J Urol 1987; 60:143–149

    Google Scholar 

  40. Castleden C, George C, Renwick A, Asher M. Imipramine — a possible alternative to current therapy for urinary incontinence in the elderly.J Urol 1981; 125:318–320

    Google Scholar 

  41. Castleden CM, Duffin HM, Gulati RS. Double blind study of imipramine and placebo for incontinence due to bladder instability.Age Ageing 1986; 15:299–303

    Google Scholar 

  42. Van Putten T, Malkin MD, Weiss MS. Phenothiazine-induced stress incontinence.J Urol 1973; 109:625–626

    Google Scholar 

  43. Lindholm P, Lose G. Terbutaline (Bricanyl) in the treatment of female urge incontinence.Urol Int 1986; 41:158–160

    Google Scholar 

  44. Meyhoff HH, Gerstenberg TC, Nordling J. Placebo — the drug of choice in female motor urge incontinence?Br J. Urol 1983; 55:34–37

    Google Scholar 

  45. Karlmark B, Jensfelt B, Magnusson O. Adverse events with placebo in 458 patients treated for urinary urge and urge incontinence. Proc 19th annual meeting ICS, Sept 1989.Neurourol Urodyn 1989; 8:410–411

    Google Scholar 

  46. Moore KH, Goldstein M, Sutherst J. Response to drug treatment of detrusor instability, in relation to psychoneurotic score. Proc 19th annual meeting ICS, Sept 1989.Neurourol Urodyn 1989; 8:412–413

    Google Scholar 

  47. Diokno AC, Taub M. Ephedrine in treatment of urinary incontinence.Urology 1975; 5:624–625

    Google Scholar 

  48. Collste L, Lindskog M. Phenylpropanolamine in the treatment of female stress incontinence: double blind placebo controlled study in 24 patients.Urology 1987; 30:398–403

    Google Scholar 

  49. Lehtonen T, Ranniko S, Lindeil O, et al. The effect of phenylpropanolamine on female stress urinary incontinence.Ann Chir Gynaecol 1986; 75:236–241

    Google Scholar 

  50. Andersson K-E, Eckman G, Henrikson L, et al. The effect of midodrine and its active metabolic. ST 1059 on the human urethra in vitro and in vivo.Scand J Urol Nephrol 1983; 17:261

    Google Scholar 

  51. Caine M, Raz S. Some clinical implications of adrenergic receptors in the urinary tract.Arch Surg 1975; 110:247–250

    Google Scholar 

  52. Faber P, Kridenreich J. Treatment of stress incontinence with estrogen in post menopausal women.Urol Int 1977; 32:221–223

    Google Scholar 

  53. Versi E, Cardozo L, Brincat M, et al. Correlation of urethral physiology and skin collagen in post menopausal women.Br J Obstet Gynaecol 1988; 95:147–152

    Google Scholar 

  54. Wilson PD, Faragher B, Butler B, et al. Treatment with oral piperazine oestrone sulphate for genuine stress incontinence in post menopausal women.Br J Obstet Gynaecol 1987; 94:568–574

    Google Scholar 

  55. Kinn A, Lindskog M. Estrogens and phenylpropanolamine in combination for stress urinary incontinence in post menopausal women.Urology 1988; 32:273–280

    Google Scholar 

  56. Gleason DM, Reilly RJ, Bottaccini MR, et al. The urethral continence zone and its relations to stress incontinence.J Urol 1974; 112:81

    Google Scholar 

  57. Raz S, Zeigler M, Caine M. The effect of diphenylhydrantoin on the urethra.Invest Urol 1973; 10:293

    Google Scholar 

  58. Mobley DF. Phenoxybenzamine in the management of neurogenic vesical dysfunction.J Urol 1976; 116:737

    Google Scholar 

  59. Chappie CR, Stott M, Christmas TJ, Abrams P, Milroy EJG. What is the therapeutic role of long term selective prostatic alpha-1 adrenoreceptor blockade? Proc 19th annual meeting ICS, Sept 1989.Neurourol Urodyn 1989; 8:416–417

    Google Scholar 

  60. Teague CT, Merrill DC. Effect of baclofen and dantrolene on bladder stimulator-induced detrusor-sphincter dyssynergia in dogs.Urology 1978; 11:531

    Google Scholar 

  61. Kums JJM, Delhaas EM, Van Capelle JW, Lakke JP. Intrathecal baclofen infusion in patients with spasticity and neurogenic bladder disease. Proc 19th annual meeting ICS, Sept 1989.Neurourol Urodyn 1989; 8:313

    Google Scholar 

  62. Nishizawa O, Suzuki T, Sugaya K, Noto H, Tsuchida S. Urodynamic evaluation of baclofen in the lower urinary tract function in the decerebrate dog. Proc 19th annual meeting ICS, Sept 1989.Neurourol Urodyn 1989; 8:415–416

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Urogynecology, Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada

    H. P. Drutz (Head)

Authors
  1. H. P. Drutz
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Drutz, H.P. Neurophysiology and neuropharmacology of the lower urinary tract. Int Urogynecol J 1, 91–99 (1990). https://doi.org/10.1007/BF00600031

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00600031

Keywords

Search

Navigation