Skip to main content

Anatomy and Neurophysiology of the Lower Urinary Tract and Pelvic Floor

  • Chapter
  • First Online:
  • 684 Accesses

Part of the book series: Urodynamics, Neurourology and Pelvic Floor Dysfunctions ((UNPFD))

Abstract

With prime focus on the anatomy, neurophysiology and functional properties, this chapter overviews the development of the lower urinary tract and pelvic floor. Coordinating bladder function with sphincter and pelvic floor function is a highly complex physiological process. Currently urodynamic studies are probably our best method of evaluating this complex process. However, we face big challenges dealing with a sophisticated system in constant development, tested in a complex setting with numerous variables. These count precarious psychological aspects as well as the basic physical aspects of filling rate, medium, temperature, pressure/flow analysis methods and where to place the electrodes. In this chapter we elaborate on the variability of findings, even within normal subjects. These are extremely important to keep in mind and will force you to interpret investigative results, especially in paediatric urodynamics, with humility.

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

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Cuckow PM, Nyirady P, Winyard PJ. Normal and abnormal development of the urogenital tract. Prenat Diagn. 2001;21:908–16.

    Article  PubMed  CAS  Google Scholar 

  2. Chevalier RL. Chronic partial ureteral obstruction and the developing kidney. Pediatr Radiol. 2008;38(Suppl 1):S35–40.

    Article  PubMed  Google Scholar 

  3. Newman J, Antonakopoulos GN. The fine structure of the human fetal urinary bladder. Development and maturation. A light, transmission and scanning electron microscopic study. J Anat. 1989;166:135–50.

    PubMed  PubMed Central  CAS  Google Scholar 

  4. Coplen DE, Macarak EJ, Levin RM. Developmental changes in normal fetal bovine whole bladder physiology. JURO. 1994;151:1391–5.

    CAS  Google Scholar 

  5. Dean GE, Cargill RS, Macarak E, Snyder HM, Duckett JW, Levin R. Active and passive compliance of the fetal bovine bladder. JURO. 1997;158:1094–9.

    CAS  Google Scholar 

  6. Rabinowitz R, Peters MT, Vyas S, Campbell S, Nicolaides KH. Measurement of fetal urine production in normal pregnancy by real-time ultrasonography. Am J Obstet Gynecol. 1989;161:1264–6.

    Article  PubMed  CAS  Google Scholar 

  7. Sebe P, Schwentner C, Oswald J, Radmayr C, Bartsch G, Fritsch H. Fetal development of striated and smooth muscle sphincters of the male urethra from a common primordium and modifications due to the development of the prostate: an anatomic and histologic study. Prostate. 2005;62:388–93.

    Article  PubMed  Google Scholar 

  8. Ludwikowski B, Oesch Hayward I, Brenner E, Fritsch H. The development of the external urethral sphincter in humans. BJU Int. 2001;87:565–8.

    Article  PubMed  CAS  Google Scholar 

  9. Kokoua A, Homsy Y, Lavigne JF, Williot P, Corcos J, Laberge I, Michaud J. Maturation of the external urinary sphincter: a comparative histotopographic study in humans. JURO. 1993;150:617–22.

    CAS  Google Scholar 

  10. Holmdahl G, Hanson E, Hanson M, Hellström AL, Sillén U, Sölsnes E. Four-hour voiding observation in young boys with posterior urethral valves. JURO. 1998;160:1477–81.

    CAS  Google Scholar 

  11. Jansson UB, Hanson M, Hanson E, Hellström AL, Sillén U. Voiding pattern in healthy children 0 to 3 years old: a longitudinal study. JURO. 2000;164:2050–4.

    CAS  Google Scholar 

  12. Jensen KM, Nielsen KK, Jensen H, Pedersen OS, Krarup T. Urinary flow studies in normal kindergarten--and schoolchildren. Scand J Urol Nephrol. 1983;17:11–21.

    Article  PubMed  CAS  Google Scholar 

  13. Gladh G, Persson D, Mattsson S, Lindström S. Voiding pattern in healthy newborns. Neurourol Urodyn. 2000;19:177–84.

    Article  CAS  PubMed  Google Scholar 

  14. Mattsson S, Spångberg A. Urinary flow in healthy schoolchildren. Neurourol Urodyn. 1994;13:281–96.

    Article  CAS  PubMed  Google Scholar 

  15. Mattsson S, Spångberg A. Flow rate nomograms in 7- to 16-year-old healthy children. Neurourol Urodyn. 1994;13:267–80.

    Article  CAS  PubMed  Google Scholar 

  16. Mattsson SH. Voiding frequency, volumes and intervals in healthy schoolchildren. Scand J Urol Nephrol. 1994;28:1–11.

    Article  CAS  PubMed  Google Scholar 

  17. Bower WF, Kwok B, Yeung CK. Variability in normative urine flow rates. JURO. 2004;171:2657–9.

    CAS  Google Scholar 

  18. Jen PY, Dixon JS, Gosling JA. Immunohistochemical localization of neuromarkers and neuropeptides in human fetal and neonatal urinary bladder. Br J Urol. 1995;75:230–5.

    Article  PubMed  CAS  Google Scholar 

  19. Yeung CK, Godley ML, Ho CK, Ransley PG, Duffy PG, Chen CN, Li AK. Some new insights into bladder function in infancy. Br J Urol. 1995;76:235–40.

    Article  PubMed  CAS  Google Scholar 

  20. Schmidt F, Jørgensen TM, Djurhuus JC. Twenty-four-hour ambulatory urodynamics in healthy young men. Scand J Urol Nephrol Suppl. 2004;38:75–83.

    Article  Google Scholar 

  21. Lu YT, Jakobsen LK, Djurhuus JC, Bjerrum SN, Wen JG, Olsen LH. What is a representative voiding pattern in children with lower urinary tract symptoms? Lack of consistent findings in ambulatory and conventional urodynamic tests. J Pediatr Urol. 2016;12(3):154.e1–7.

    Article  CAS  Google Scholar 

  22. Olsen LH, Grothe I, Rawashdeh YF, Jørgensen TM. Urinary flow patterns in premature males. J Urol. 2010;183:2347–52.

    Article  PubMed  Google Scholar 

  23. Olsen LH, Grothe I, Rawashdeh YF, Jørgensen TM. Urinary flow patterns of healthy newborn males. J Urol. 2009;181:1857–61.

    Article  PubMed  Google Scholar 

  24. Olsen LH, Grothe I, Rawashdeh YF, Jørgensen TM. Urinary flow patterns in first year of life. J Urol. 2010;183:694–8.

    Article  PubMed  Google Scholar 

  25. Chang S-J, Yang SSD. Inter-observer and intra-observer agreement on interpretation of uroflowmetry curves of kindergarten children. J Pediatr Urol. 2008;4:422–7.

    Article  PubMed  Google Scholar 

  26. Gutierrez Segura C. Urine flow in childhood: a study of flow chart parameters based on 1,361 uroflowmetry tests. JURO. 1997;157:1426–8.

    CAS  Google Scholar 

  27. Gladh G, Mattsson S, Lindström S. Anogenital electrical stimulation as treatment of urge incontinence in children. BJU Int. 2001;87:366–71.

    Article  PubMed  CAS  Google Scholar 

  28. Sørensen SS, Nielsen JB, Nørgaard JP, Knudsen LM, Djurhuus JC. Changes in bladder volumes with repetition of water cystometry. Urol Res. 1984;12:205–8.

    Article  PubMed  Google Scholar 

  29. Nevéus T, Gontard von A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the standardisation Committee of the International Children's continence society. JURO. 2006;176:314–24.

    Google Scholar 

  30. Austin PF, Bauer SB, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the international Children's continence society. Neurourol Urodyn. 2015;35(4):471–81. https://doi.org/10.1002/nau.22751.

    Article  PubMed  Google Scholar 

  31. Koff SA. Estimating bladder capacity in children. Urology. 1983;21:248.

    Article  PubMed  CAS  Google Scholar 

  32. Rittig S, Kamperis K, Siggaard C, Hagstroem S, Djurhuus JC. Age related nocturnal urine volume and maximum voided volume in healthy children: reappraisal of international Children's continence society definitions. J Urol. 2010;183:1561–7.

    Article  PubMed  CAS  Google Scholar 

  33. Fairhurst JJ, Rubin CM, Hyde I, Freeman NV, Williams JD. Bladder capacity in infants. J Pediatr Surg. 1991;26:55–7.

    Article  PubMed  CAS  Google Scholar 

  34. Holmdahl G, Hanson E, Hanson M, Hellström AL, Hjälmås K, Sillén U. Four-hour voiding observation in healthy infants. JURO. 1996;156:1809–12.

    CAS  Google Scholar 

  35. Sillén U, Sölsnes E, Hellström AL, Sandberg K. The voiding pattern of healthy preterm neonates. JURO. 2000;163:278–81.

    Google Scholar 

  36. Sillén U. Bladder function in healthy neonates and its development during infancy. JURO. 2001;166:2376–81.

    Google Scholar 

  37. Bachelard M, Sillén U, Hansson S, Hermansson G, Jodal U, Jacobsson B. Urodynamic pattern in asymptomatic infants: siblings of children with vesicoureteral reflux. JURO. 1999;162:1733–7. discussion 1737–8.

    CAS  Google Scholar 

  38. Jansson UB, Hanson M, Sillén U, Hellström AL. Voiding pattern and acquisition of bladder control from birth to age 6 years–a longitudinal study. JURO. 2005;174:289–93.

    Google Scholar 

  39. de Groat WC. Central neural control of the lower urinary tract. Ciba Found Symp. 1990;151:27–44. discussion 44–56.

    PubMed  Google Scholar 

  40. Hjälmås K. Micturition in infants and children with normal lower urinary tract. A urodynamic study. Scand J Urol Nephrol Suppl. 1976;37:1–106.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lotte Kaasgaard Jakobsen .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Jakobsen, L.K., Djurhuus, J.C., Henning Olsen, L. (2018). Anatomy and Neurophysiology of the Lower Urinary Tract and Pelvic Floor. In: Mosiello, G., Del Popolo, G., Wen, J., De Gennaro, M. (eds) Clinical Urodynamics in Childhood and Adolescence. Urodynamics, Neurourology and Pelvic Floor Dysfunctions. Springer, Cham. https://doi.org/10.1007/978-3-319-42193-3_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-42193-3_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42191-9

  • Online ISBN: 978-3-319-42193-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics