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The Basic Science Behind Practical/Clinical Urodynamic Analysis

  • Matthew O. FraserEmail author
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Abstract

While the purpose of the lower urinary tract seems simple, to store and periodically release urine, the physiological control of these functions is quite complex. Normal lower urinary tract function depends on finely coordinated active contraction and active relaxation of different smooth muscle layers across the bladder-urethral unit, with opposing activity states depending on the phase of the micturition cycle (i.e. filling vs. voiding), and governed by the two limbs of the autonomic nervous system. An additional level of storage assurance is afforded by the somatomotor system that controls the rhabdosphincter. All of these are regulated by reflexes organized at the sacral and thoracolumbar spinal cord and the brainstem, with an overlay of conscious (coritcal) control to insure environmental appropriateness of voiding.

Our best tools to directly query the health of this system are urodynamic tests. In order to understand our measurements and their meanings, it is important to understand the anatomy, physiology and biomechanics of the system and the physics behind the measurements. This chapter will provide an overview of these important concepts as a scientific base for the subsequent chapters.

Keywords

Urodynamics Fluid dynamics Cystometry Bladder Urethra Lower urinary tract Biomechanics Physiology Tissue mechanics 

References

  1. 1.
    Fowler CJ, Griffiths D, de Groat WC. The neural control of micturition. Nat Rev Neurosci. 2008;9(6):453–66.PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Viana R, Batourina E, Huang H, Dressler GR, Kobayashi A, Behringer RR, Shapiro E, Hensle T, Lambert S, Mendelsohn C. The development of the bladder trigone, the center of the anti-reflux mechanism. Development. 2007;134(20):3763–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Miftahof RN, Nam HG. Biomechanics of the human urinary bladder. Berlin: Springer; 2013.CrossRefGoogle Scholar
  4. 4.
    Tanagho EA, Smith DR. The anatomy and function of the bladder neck. Br J Urol. 1966;38(1):54–71.CrossRefPubMedGoogle Scholar
  5. 5.
    Dass N, McMurray G, Greenland JE, Brading AF. Morphological aspects of the female pig bladder neck and urethra: quantitative analysis using computer assisted 3-dimensional reconstructions. J Urol. 2001;165(4):1294–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Elbadawi A. Comparative neuromorphology in animals. In: Torrens M, Morrison JFB, editors. The physiology of the lower urinary tract. London: Springer; 1987. p. 23–51.CrossRefGoogle Scholar
  7. 7.
    de Groat WC, Fraser MO, Yoshiyama M, Smerin S, Tai C, Chancellor MB, Yoshimura N, Roppolo JR. Neural control of the urethra. Scand J Urol Nephrol Suppl. 2001;35(207):35–43.CrossRefGoogle Scholar
  8. 8.
    Dokita S, Morgan WR, Wheeler MA, Yoshida M, Latifpour J, Weiss RM. NG-nitro-L-arginine inhibits non-adrenergic, non-cholinergic relaxation in rabbit urethral smooth muscle. Life Sci. 1991;48(25):2429–36.CrossRefPubMedGoogle Scholar
  9. 9.
    Garcia-Pascual A, Costa G, Garcia-Sacristan A, Andersson KE. Relaxation of sheep urethral muscle induced by electrical stimulation of nerves: involvement of nitric oxide. Acta Physiol Scand. 1991;141(4):531–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Sadananda P, Drake MJ, Paton JF, Pickering AE. A functional analysis of the influence of β3-adrenoceptors on the rat micturition cycle. J Pharmacol Exp Ther. 2013;347(2):506–15.PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Barrington FJF. The component reflexes of micturition in the cat. Brain. 1931;54:177–88.CrossRefGoogle Scholar
  12. 12.
    Barrington FJF. The component reflexes of micturition in the cat. Part III. Brain. 1941;64:239–43.CrossRefGoogle Scholar
  13. 13.
    Cooper MA, Fletter PC, Zaszczurynski PJ, Damaser MS. Comparison of air-charged and water-filled urodynamic pressure measurement catheters. Neurourol Urodyn. 2011;30(3):329–34.CrossRefPubMedGoogle Scholar
  14. 14.
    Damaser MS, Lehman SL. Two mathematical models explain the variation in cystometrograms of obstructed urinary bladders. J Biomech. 1996;29:1615–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Nitti VW. Pressure flow urodynamic studies: the gold standard for diagnosing bladder outlet obstruction. Rev Urol. 2005;7 Suppl 6:S14–21.PubMedCentralPubMedGoogle Scholar
  16. 16.
    Coolsaet B. Bladder compliance and detrusor activity during the collection phase. Neurourol Urodyn. 1985;4:263–73.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Surgery, Division of UrologyDuke University Medical CenterDurhamUSA

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