Skip to main content
SpringerLink
Log in

Neuroanatomy of the Lower Urinary Tract

  • Chapter
  • First Online:
Urinary Tract

Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 2011))

Abstract

The lower urinary tract (LUT), which consists of the urinary bladder and its outlet, the urethra, is responsible for the storage and periodic elimination of bodily waste in the form of urine. The LUT is controlled by a complex set of peripheral autonomic and somatic nerves, which in turn are controlled through neural pathways in the spinal cord and brain. This influence of the central nervous system allows for the conscious control of the bladder, allowing the individual to choose an appropriate place to urinate. Defects in the CNS pathways that control the LUT can lead to incontinence, an embarrassing condition that affects over 200 million people worldwide. As a first step in understanding the neural control of the bladder, we will discuss the neuroanatomy of the LUT, focusing first on the peripheral neural pathways, including the sensory pathways that transmit information on bladder filling and the motoneurons that control LUT muscle contractility. We will also discuss the organization of the central pathways in the spinal cord and brainstem that are responsible for coordinating bladder activity, promoting continuous storage of urine except for a few short minutes per day when micturition takes place. To conclude, we will discuss current studies underway that aim to elucidate the higher areas of the brain that control the voluntary nature of micturition in higher organisms.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 259.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 329.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 329.99
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

Institutional subscriptions

References

  • Andersson KE, Arner A (2004) Urinary bladder contraction and relaxation: physiology and pathophysiology. Physiol Rev 84:935–986

    Article  CAS  PubMed  Google Scholar 

  • Apodaca G, Balestreire E, Birder LA (2007) The uroepithelial-associated sensory web. Kidney Int 72:1057–1064

    Article  CAS  PubMed  Google Scholar 

  • Araki I, De Groat WC (1996) Unitary excitatory synaptic currents in preganglionic neurons mediated by two distinct groups of interneurons in neonatal rat sacral parasympathetic nucleus. J Neurophysiol 76:215–226

    CAS  PubMed  Google Scholar 

  • Aston-Jones G, Cohen JD (2005) Adaptive gain and the role of the locus coeruleus-norepinephrine system in optimal performance. J Comp Neurol 493:99–110

    Article  CAS  PubMed  Google Scholar 

  • Bahns E, Ernsberger U, Janig W et al (1986) Functional characteristics of lumbar visceral afferent fibres from the urinary bladder and the urethra in the cat. Pflugers Arch 407:510–518

    Article  CAS  PubMed  Google Scholar 

  • Bandler R, Carrive P, Zhang SP (1991) Integration of somatic and autonomic reactions within the midbrain periaqueductal grey: viscerotopic, somatotopic and functional organization. Prog Brain Res 87:269–305

    Article  CAS  PubMed  Google Scholar 

  • Barrington F (1925) The effect of lesions of the hind- and mid-brain on micturition in the cat. Q J Exp Physiol 15:81–102

    Google Scholar 

  • Behbehani MM (1995) Functional characteristics of the midbrain periaqueductal gray. Prog Neurobiol 46:575–605

    Article  CAS  PubMed  Google Scholar 

  • Bennett BC, Kruse MN, Roppolo JR et al (1995) Neural control of urethral outlet activity in vivo: role of nitric oxide. Br J Urol 153:2004–2009

    CAS  Google Scholar 

  • Birder LA, de Groat WC (1993) Induction of c-fos expression in spinal neurons by nociceptive and nonnociceptive stimulation of LUT. Am J Physiol 265:R326–R333

    CAS  PubMed  Google Scholar 

  • Blok BF, Holstege G (1994) Direct projections from the periaqueductal gray to the pontine micturition center (M-region). An anterograde and retrograde tracing study in the cat. Neurosci Lett 166:93–96

    Article  CAS  PubMed  Google Scholar 

  • Blok BF, Holstege G (1997) 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

    Article  CAS  PubMed  Google Scholar 

  • Blok BF, Holstege G (2000) The pontine micturition center in rat receives direct lumbosacral input. An ultrastructural study. Neurosci Lett 282:29–32

    Article  CAS  PubMed  Google Scholar 

  • Blok BF, De Weerd H, Holstege G (1995) Ultrastructural evidence for a paucity of projections from the lumbosacral cord to the pontine micturition center or M-region in the cat: a new concept for the organization of the micturition reflex with the periaqueductal gray as central relay. J Comp Neurol 359:300–309

    Article  CAS  PubMed  Google Scholar 

  • Blok BF, de Weerd H, Holstege G (1997a) The pontine micturition center projects to sacral cord GABA immunoreactive neurons in the cat. Neurosci Lett 233:109–112

    Article  CAS  PubMed  Google Scholar 

  • Blok BF, Willemsen AT, Holstege G (1997b) A PET study on brain control of micturition in humans. Brain 120(Pt 1):111–121

    Article  PubMed  Google Scholar 

  • Blok BF, van Maarseveen JT, Holstege G (1998a) Electrical stimulation of the sacral dorsal gray commissure evokes relaxation of the external urethral sphincter in the cat. Neurosci Lett 249:68–70

    Article  CAS  PubMed  Google Scholar 

  • Blok BF, Sturms LM, Holstege G (1998b) Brain activation during micturition in women. Brain 121(Pt 11):2033–2042

    Article  PubMed  Google Scholar 

  • Brooks JD (2007) Anatomy of the lower urinary tract and male genitalia. In: Wein AJ, Kavoussi LR, Novick AC et al (eds) Cambell-Walsh urology. Philadelphia, Saunders Elsevier

    Google Scholar 

  • Carroll P, Lewin GR, Koltzenburg M et al (1998) A role for BDNF in mechanosensation. Nat Neurosci 1:42–46

    Article  CAS  PubMed  Google Scholar 

  • Cheng CL, Ma CP, de Groat WC (1993) Effects of capsaicin on micturition and associated reflexes in rats. Am J Physiol 265:R132–R138

    CAS  PubMed  Google Scholar 

  • Chuang YC, Fraser MO, Yu Y et al (2001) The role of bladder afferent pathways in bladder hyperactivity induced by the intravesical administration of nerve growth factor. J Urol 165:975–979

    Article  CAS  PubMed  Google Scholar 

  • Dang K, Bielefeldt K, Gebhart GF (2005) Differential responses of bladder lumbosacral and thoracolumbar dorsal root ganglion neurons to purinergic agonists, protons, and capsaicin. J Neurosci 25:3973–3984

    Article  CAS  PubMed  Google Scholar 

  • Dang K, Lamb K, Cohen M et al (2008) Cyclophosphamide-induced bladder inflammation sensitizes and enhances P2X receptor function in rat bladder sensory neurons. J Neurophysiol 99:49–59

    Article  CAS  PubMed  Google Scholar 

  • de Groat WC, Booth AM (1993) Neural control of penile erection. In: Maggi CA (ed) Nervous control of the urogenital system. London, Harwood

    Google Scholar 

  • de Groat WC, Saum WR (1976) Synaptic transmission in parasympathetic ganglia in the urinary bladder of the cat. J Physiol 256:137–158

    Google Scholar 

  • Derbyshire SW (2003) A systematic review of neuroimaging data during visceral stimulation. Am J Gastroenterol 98:12–20

    Article  PubMed  Google Scholar 

  • Ding YQ, Wang D, Xu JQ et al (1999) Direct projections from the medial preoptic area to spinally-projecting neurons in Barrington's nucleus: an electron microscope study in the rat. Neurosci Lett 271:175–178

    Article  CAS  PubMed  Google Scholar 

  • England S, Bevan S, Docherty RJ (1996) PGE2 modulates the tetrodotoxin-resistant sodium current in neonatal rat dorsal root ganglion neurones via the cyclic AMP-protein kinase A cascade. J Physiol 495(Pt 2):429–440

    CAS  PubMed  Google Scholar 

  • Fowler CJ, Griffiths D, de Groat WC (2008) The neural control of micturition. Nat Rev Neurosci 9:453–466

    Article  CAS  PubMed  Google Scholar 

  • Genzen JR, Van Cleve W, McGehee DS (2001) Dorsal root ganglion neurons express multiple nicotinic acetylcholine receptor subtypes. J Neurophysiol 86:1773–1782

    CAS  PubMed  Google Scholar 

  • Giuliano F, Rampin O, Brown K et al (1996) Stimulation of the medial preoptic area of the hypothalamus in the rat elicits increases in intracavernous pressure. Neurosci Lett 209:1–4

    Article  CAS  PubMed  Google Scholar 

  • Gjone R (1966) Excitatory and inhibitory bladder responses to stimulation of 'limbic', diencephalic and mesencephalic structures in the cat. Acta Physiol Scand 66:91–102

    Article  CAS  PubMed  Google Scholar 

  • Griffiths D, Holstege G, Dalm E et al (1990) Control and coordination of bladder and urethral function in the brainstem of the cat. Neurourol Urodyn 9:63–82

    Article  Google Scholar 

  • Habler HJ, Janig W, Koltzenburg M (1990) Activation of unmyelinated afferent fibres by mechanical stimuli and inflammation of the urinary bladder in the cat. J Physiol 425:545–562

    CAS  PubMed  Google Scholar 

  • Holstege G (1987) Some anatomical observations on the projections from the hypothalamus to brainstem and spinal cord: an HRP and autoradiographic tracing study in the cat. J Comp Neurol 260:98–126

    Article  CAS  PubMed  Google Scholar 

  • Holstege G (1989) Anatomical study of the final common pathway for vocalization in the cat. J Comp Neurol 284:242–252

    Article  CAS  PubMed  Google Scholar 

  • Holstege G (1991) Descending motor pathways and the spinal motor system: limbic and nonlimbic components. Prog Brain Res 87:307–421

    Article  CAS  PubMed  Google Scholar 

  • Holstege G (1992) The emotional motor system. Eur J Morphol 30:67–79

    CAS  PubMed  Google Scholar 

  • Holstege G (1998) The emotional motor system in relation to the supraspinal control of micturition and mating behavior. Behav Brain Res 92:103–109

    Article  CAS  PubMed  Google Scholar 

  • Holstege G (2005) Micturition and the soul. J Comp Neurol 493:15–20

    Article  PubMed  Google Scholar 

  • Holstege G, Griffiths D (1990) Neuronal organization of micturition. In: Paxinos G (ed) The human nervous system. Academic, New York

    Google Scholar 

  • Holstege G, Kuypers HG (1982) The anatomy of brain stem pathways to the spinal cord in cat. A labeled amino acid tracing study. Prog Brain Res 57:145–175

    Article  CAS  PubMed  Google Scholar 

  • Holstege G, Mouton LJ (2003) Central nervous system control of micturition. Int Rev Neurobiol 56:123–145

    Article  PubMed  Google Scholar 

  • Holstege G, Tan J (1987) Supraspinal control of motoneurons innervating the striated muscles of the pelvic floor including urethral and anal sphincters in the cat. Brain 110(Pt 5):1323–1344

    Article  PubMed  Google Scholar 

  • Holstege G, Kuypers HG, Boer RC (1979) Anatomical evidence for direct brain stem projections to the somatic motoneuronal cell groups and autonomic preganglionic cell groups in cat spinal cord. Brain Res 171:329–333

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  • Hong-Sheng L, Zhi-Qi Z (1998) Small sensory neurons in the rat dorsal root ganglia express functional NK-1 tachykinin receptor. Eur J Neurosci 10:1292–1299

    Article  Google Scholar 

  • Janig W, McLachlan EM (1986) The sympathetic and sensory components of the caudal lumbar sympathetic trunk in the cat. J Comp Neurol 245:62–73

    Article  CAS  PubMed  Google Scholar 

  • Janig W, Morrison JF (1986) Functional properties of spinal visceral afferents supplying abdominal and pelvic organs, with special emphasis on visceral nociception. Prog Brain Res 67:87–114

    Article  CAS  PubMed  Google Scholar 

  • Kavia RB, Dasgupta R, Fowler CJ (2005) Functional imaging and the central control of the bladder. J Comp Neurol 493:27–32

    Article  PubMed  Google Scholar 

  • Klop EM, Mouton LJ, Kuipers R et al (2005) Neurons in the lateral sacral cord of the cat project to periaqueductal grey, but not to thalamus. Eur J Neurosci 21:2159–2166

    Article  PubMed  Google Scholar 

  • Kuipers R, Mouton LJ, Holstege G (2006) Afferent projections to the pontine micturition center in the cat. J Comp Neurol 494:36–53

    Article  PubMed  Google Scholar 

  • Kuo DC, Hisamitsu T, de Groat WC (1984) A sympathetic projection from sacral paravertebral ganglia to the pelvic nerve and to postganglionic nerves on the surface of the urinary bladder and large intestine of the cat. J Comp Neurol 226:76–86

    Article  CAS  PubMed  Google Scholar 

  • Llewellyn-Smith IJ, Dicarlo SE, Collins HL et al (2005) Enkephalin-immunoreactive interneurons extensively innervate sympathetic preganglionic neurons regulating the pelvic viscera. J Comp Neurol 488:278–289

    Article  CAS  PubMed  Google Scholar 

  • Lovick TA (1997) The medullary raphe nuclei: a system for integration and gain control in autonomic and somatomotor responsiveness? Exp Physiol 82:31–41

    CAS  PubMed  Google Scholar 

  • Maiorov DN, Malpas SC, Head GA (2000) Influence of pontine A5 region on renal sympathetic nerve activity in conscious rabbits. Am J Physiol Regul Integr Comp Physiol 278:R311–R319

    CAS  PubMed  Google Scholar 

  • Mannen T (2000) Neuropathological findings of Onuf’s nucleus and its significance. Neuropathology 20(Suppl):S30–S33

    Article  PubMed  Google Scholar 

  • Mannen T, Iwata M, Toyokura Y et al (1982) The Onuf's nucleus and the external anal sphincter muscles in amyotrophic lateral sclerosis and Shy-Drager syndrome. Acta Neuropathol 58:255–260

    Article  CAS  PubMed  Google Scholar 

  • Matsumoto G, Hisamitsu T, de Groat WC (1995) Role of glutamate and NMDA receptors in the descending limb of the spinobulbospinal micturition reflex pathway of the rat. Neurosci Lett 183:58–61

    Article  CAS  PubMed  Google Scholar 

  • McMahon SB, Morrison JF (1982) Two group of spinal interneurones that respond to stimulation of the abdominal viscera of the cat. J Physiol 322:21–34

    CAS  PubMed  Google Scholar 

  • McMahon SB, Morrison JF, Spillane K (1982) An electrophysiological study of somatic and visceral convergence in the reflex control of the external sphincters. J Physiol 328:379–387

    CAS  PubMed  Google Scholar 

  • Morgan C, Nadelhaft I, de Groat WC (1981) The distribution of visceral primary afferents from the pelvic nerve to Lissauer's tract and the spinal gray matter and its relationship to the sacral parasympathetic nucleus. J Comp Neurol 201:415–440

    Article  CAS  PubMed  Google Scholar 

  • Morgan CW, de Groat WC, Felkins LA et al (1991) Axon collaterals indicate broad intraspinal role for sacral preganglionic neurons. Proc Natl Acad Sci USA 88:6888–6892

    Article  CAS  PubMed  Google Scholar 

  • Morgan CW, De Groat WC, Felkins LA et al (1993) Intracellular injection of neurobiotin or horseradish peroxidase reveals separate types of preganglionic neurons in the sacral parasympathetic nucleus of the cat. J Comp Neurol 331:161–182

    Article  CAS  PubMed  Google Scholar 

  • Nadelhaft I, Vera PL, Card JP et al (1992) Central nervous system neurons labelled following the injection of pseudorabies virus into the rat urinary bladder. Neurosci Lett 143:271–274

    Article  CAS  PubMed  Google Scholar 

  • Nishii H, Nomura M, Fujimoto N et al (2008) Thalamic neural activation in the cyclophosphamide-induced visceral pain model in mice. Neurosci Res 60:219–227

    Article  CAS  PubMed  Google Scholar 

  • Nyo M (1969) Innervation of the bladder and urethra. J Anat 105:210

    CAS  PubMed  Google Scholar 

  • Oztas E (2003) Neuronal tracing. Neuroanatomy 2:2–5

    Google Scholar 

  • Patel AK, Chapple CR (2008) Anatomy of the lower urinary tract. Surgery 26:127–132

    Google Scholar 

  • Petras JM, Cummings JF (1978) Sympathetic and parasympathetic innervation of the urinary bladder and urethra. Brain Res 153:363–369

    Article  CAS  PubMed  Google Scholar 

  • Pool JL, Ransohoff J (1949) Autonomic effects on stimulating rostral portion of cingulate gyri in man. J Neurophysiol 12:385–392

    CAS  PubMed  Google Scholar 

  • Pullen AH, Tucker D, Martin JE (1997) Morphological and morphometric characterisation of Onuf’s nucleus in the spinal cord in man. J Anat 191:201–213

    Article  PubMed  Google Scholar 

  • Qin C, Foreman RD (2004) Viscerovisceral convergence of urinary bladder and colorectal inputs to lumbosacral spinal neurons in rats. Neuroreport 15:467–471

    Article  PubMed  Google Scholar 

  • Rohner TJ, Hannigan J (1980) Effect of norepinephrine and isoproterenol on in vitro detrusor muscle contractility and cyclic AMP content. Invest Urol 17:324–327

    CAS  PubMed  Google Scholar 

  • Rong W, Spyer KM, Burnstock G (2002) Activation and sensitisation of low and high threshold afferent fibres mediated by P2X receptors in the mouse urinary bladder. J Physiol 541:591–600

    Article  CAS  PubMed  Google Scholar 

  • Sallanon M, Denoyer M, Kitahama K et al (1989) Long-lasting insomnia induced by preoptic neuron lesions and its transient reversal by muscimol injection into the posterior hypothalamus in the cat. Neuroscience 32:669–683

    Article  CAS  PubMed  Google Scholar 

  • Sasaki M (1994) Morphological analysis of external urethral and external anal sphincter motoneurones of cat. J Comp Neurol 349:269–287

    Article  CAS  PubMed  Google Scholar 

  • Schmidt MH, Valatx JL, Sakai K et al (2000) Role of the lateral preoptic area in sleep-related erectile mechanisms and sleep generation in the rat. J Neurosci 20:6640–6647

    CAS  PubMed  Google Scholar 

  • Shefchyk SJ, Espey MJ, Carr P et al (1998) Evidence for a strychnine-sensitive mechanism and glycine receptors involved in the control of urethral sphincter activity during micturition in the cat. Exp Brain Res 119:297–306

    Article  CAS  PubMed  Google Scholar 

  • Sie JA, Blok BF, de Weerd H et al (2001) Ultrastructural evidence for direct projections from the pontine micturition center to glycine-immunoreactive neurons in the sacral dorsal gray commissure in the cat. J Comp Neurol 429:631–637

    Article  CAS  PubMed  Google Scholar 

  • Subramanian HH, Balnave RJ, Holstege G (2008) The midbrain periaqueductal gray control of respiration. J Neurosci 28:12274–12283

    Article  CAS  PubMed  Google Scholar 

  • Sugaya K, Matsuyama K, Takakusaki K et al (1987) Electrical and chemical stimulations of the pontine micturition center. Neurosci Lett 80:197–201

    Article  CAS  PubMed  Google Scholar 

  • Thor KB, Morgan C, Nadelhaft I et al (1989) Organization of afferent and efferent pathways in the pudendal nerve of the female cat. J Comp Neurol 288:263–279

    Article  CAS  PubMed  Google Scholar 

  • Todd JK, Mack AJ (1969) A study of human bladder detrusor muscle. Br J Urol 41:448–454

    Article  CAS  PubMed  Google Scholar 

  • Vanderhorst VG, Holstege G (1997) Organization of lumbosacral motoneuronal cell groups innervating hindlimb, pelvic floor, and axial muscles in the cat. J Comp Neurol 382:46–76

    Article  CAS  PubMed  Google Scholar 

  • Vanderhorst VG, Mouton LJ, Blok BF et al (1996) Distinct cell groups in the lumbosacral cord of the cat project to different areas in the periaqueductal gray. J Comp Neurol 376:361–385

    Article  CAS  PubMed  Google Scholar 

  • Vera PL, Nadelhaft I (1992) Afferent and sympathetic innervation of the dome and the base of the urinary bladder of the female rat. Brain Res Bull 29:651–658

    Article  CAS  PubMed  Google Scholar 

  • Vizzard MA (2000) Alterations in spinal cord Fos protein expression induced by bladder stimulation following cystitis. Am J Physiol Regul Integr Comp Physiol 278:R1027–R1039

    CAS  PubMed  Google Scholar 

  • Vizzard MA, Erickson VL, Card JP et al (1995) Transneuronal labeling of neurons in the adult rat brainstem and spinal cord after injection of pseudorabies virus into the urethra. J Comp Neurol 355:629–640

    Article  CAS  PubMed  Google Scholar 

  • Vizzard MA, Brisson M, de Groat WC (2000) Transneuronal labeling of neurons in the adult rat central nervous system following inoculation of pseudorabies virus into the colon. Cell Tissue Res 299:9–26

    Article  CAS  PubMed  Google Scholar 

  • Wang JG, Strong JA, Xie W et al (2007) Local inflammation in rat dorsal root ganglion alters excitability and ion currents in small-diameter sensory neurons. Anesthesiology 107:322–332

    Article  PubMed  Google Scholar 

  • Yamada Y, Daneshgari F, Liu G, et al (2007) Spinal c-fos expression induced by neuroselective electrostimulation of bladder afferent pathways (abstract). Society for Neuroscience Annual Meeting, Program # 821.2 (www.sfn.org)

  • Yoshimura N, Seki S, Erickson KA et al (2003) Histological and electrical properties of rat dorsal root ganglion neurons innervating the lower urinary tract. J Neurosci 23:4355–4361

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anatomy and Cell Biology, University of Pennsylvania, 431 Levy Hall, 240 S. 40th Street, Philadelphia, PA, 19104, USA

    Jonathan M. Beckel

  2. Center for Uroneurology, Triadegebouw ingang 23, C1.02a, University Medical Center Groningen, 30001, Groningen, 9700 RB, The Netherlands

    Gert Holstege

Authors
  1. Jonathan M. Beckel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gert Holstege
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Jonathan M. Beckel or Gert Holstege .

Editor information

Editors and Affiliations

  1. Wake Forest University, Medical Center Blvd., Winston-Salem, 27157-1088, North Carolina, USA

    Karl-Erik Andersson

  2. Academic Medical Center, Dept. Pharmacology & Pharmacotherapy, University of Amsterdam, Meibergdreef 15, Amsterdam, 1105 AZ, Netherlands

    Martin C. Michel

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Beckel, J.M., Holstege, G. (2011). Neuroanatomy of the Lower Urinary Tract. In: Andersson, KE., Michel, M. (eds) Urinary Tract. Handbook of Experimental Pharmacology, vol 2011. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-16499-6_6

Download citation

Publish with us

Policies and ethics

Search

Navigation