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Peripheral Neural Control of the Lower Urinary Tract

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Handbook of Neurourology

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Abstract

Storage and elimination of urine are dependent upon the coordinated activity of two functional units in the lower urinary tract, the urinary bladder, and its outlet (the urethral sphincter and the urethra). These structures are innervated by three sets of peripheral nerves: sacral parasympathetic (pelvic nerves), thoracolumbar sympathetic (hypogastric nerves and sympathetic chain), and sacral somatic nerves (pudendal nerves).

The pelvic nerve afferents monitor the volume of the bladder and the amplitude of the bladder contraction. These afferents are small myelinated (Aδ) and unmyelinated (C) fibers, which convey information from receptors in the bladder wall to second-order neurons in the spinal cord.

During the storage phase, thoracolumbar sympathetic efferent pathways elicit various effects including (1) inhibition of detrusor muscle through stimulation of β3-adrenoceptors and (2) excitation of the bladder base and the urethra through stimulation of α1-adrenoceptors. Sacral somatic efferent pathways originated from Onuf’s nucleus, sphincter motoneurons, send their axons through the pudendal nerves and excite sphincter muscles via the release of acetylcholine.

When the switch turns from the storage to the voiding phase, both thoracolumbar sympathetic and sacral somatic efferent pathways are inhibited, and the sacral parasympathetic pathways are activated, which provides the major excitatory input to bladder smooth muscle via the release of cholinergic (acetylcholine) and non-adrenergic, noncholinergic transmitters (ATP and others) and inhibits urethral smooth muscle via the release of nitric oxide (NO) through the pelvic nerves.

Afferent sensitivity to mechanical and chemical stimuli in the bladder and the urethra is modulated by various sensory receptors (TRP ion channels, CB receptors, etc.) located in the urothelial cells, detrusor smooth muscle cells, and sensory nerves and mediators (NO, ATP, ACh, etc.) released from the urothelium.

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  1. Department of Urology, Nagano Prefectural Shinshu Medical Center, Suzaka City, Japan

    Yasuhiko Igawa

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  1. Department of Urology Department of Neurourology, China Rehabiliation Research Center China Rehabilitation Science InstituteCapital Medical University, Beijing, China

    Limin Liao

  2. Department of Urology, Medical University Innsbruck, University Hospital, Innsbruck, Austria

    Helmut Madersbacher

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Igawa, Y. (2023). Peripheral Neural Control of the Lower Urinary Tract. In: Liao, L., Madersbacher, H. (eds) Handbook of Neurourology. Springer, Singapore. https://doi.org/10.1007/978-981-99-1659-7_3

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