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L'innervation de l'uretère

Etude histochimique et ultrastructurale

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Résumé

Le rôle du système nerveux autonome dans la physiologie de l'uretère est un sujet controversé.

L'étude histochimique des catécholamines fluorescentes et de l'acétylcholinestérase démontre l'existence d'une riche innervation adrénergique et cholinergique de l'uretère humain et animal. Cette innervation se caractérise par la présence de fibres nerveuses terminales et de ganglions mixtes (adrénergiques et cholinergiques), situés dans la partie terminale de l'uretère.

L'étude ultrastructurale de l'innervation de l'uretère confirme l'existence d'axones adrénergiques et cholinergiques. Les deux types d'axones forment des varicosités préterminales et terminales tout le long de leur trajet. L'existence de fibres nerveuses adrénergiques est confirmée par l'utilisation de 5-hydroxydopamine, un ≪faux≫ transmetteur sympathique permettant leur indentification sélective. Les deux types d'axones sont observés dans un même filet nerveux en étroite relation l'un avec l'autre, suggérant une interaction possible entre composante adrénergique et cholinergique dans l'uretère. Les terminaisons cholinergiques sont considérées comme étant des récepteurs sensoriels. Des terminaisons purinergiques utilisant les nucléotides cycliques comme transmetteurs s'observent également dans la musculature et la sous-muqueuse urétérale.

Un modèle de l'innervation de l'uretère est proposé à la lumière de ces résultats ultrastructuraux; il prend en considération particulière les étroites et nombreuses connexions intermusculaires et d'autre part la rareté des contacts neuromusculaires étroits.

Ce modèle considère le péristaltisme urétéral comme un phénomène essentiellement myogène, l'influence du système nerveux autonome étant secondaire, susceptible de jouer un rôle dans la régulation de cette activité spontanée en influençant la tonicité urétérale.

Les ganglions urétérovésicaux représentent des ≪neurones adrénergiques courts≫ puisqu'ils dérivent de ganglions sympathiques situés dans l'organe innervé, et ce par opposition à la conception classique du système nerveux autonome.

L'étude en microscopie électronique précise l'ultrastructure des ganglions urétérovésicaux. Elle souligne l'existence de structures adrénergiques représentées par des terminaisons nerveuses adrénergiques et des petites cellules riches en catécholamines. Ces structures sont susceptibles de moduler l'activité ganglionnaire pour intégrer la fonction de l'uretère et de la vessie.

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  1. Service d'Urologie, Cliniques Universitaires de Bruxelles, Hôpital Erasme, 808, route de Lennick, B-1070, Bruxelles, Belgique

    C. C. Schulman

  2. Laboratoires de Neuroanatomie, Laboratoire d'Anatomie Pathologique et de Microscopie Electronique, Université Libre de Bruxelles, Bruxelles, Belgique

    C. C. Schulman

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Schulman, C.C. L'innervation de l'uretère. Anat. Clin 3, 127–142 (1981). https://doi.org/10.1007/BF01654504

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