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Central Pathways That Control the Urinary Bladder

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Handbook of Neurourology

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Abstract

This chapter describes central areas and pathways which are an intrinsic part of the micturition and continence reflex and areas and pathways which modulate these micturition and continence areas. The micturition reflex has three phases: (1) pre-micturition phase during realization of a safe environment; (2) relaxation phase during relaxation of the external urethral sphincter; and (3) contraction phase during contraction of the detrusor muscle. The micturition reflex can be turned on or off instantly, like a switch. Cortical and subcortical areas control the pontine micturition center (PMC) and pontine continence center (PCC). The descending axons from the PMC project to the sacral cord, controlling both the urethral sphincter relaxation and the detrusor muscle contraction. This chapter also describes the central alternations in patients with bladder dysfunction and the effects of treatment on brain areas that control bladder function. Supraspinal alterations in areas that control bladder function, such as the prefrontal cortex and the anterior cingulate cortex, have been described in patients with (neurogenic) lower urinary tract dysfunction. Pelvic floor physiotherapy, biofeedback, medication which pass the blood-brain barrier, transcutaneous electrical nerve stimulation, posterior tibial nerve stimulation, and sacral neuromodulation are treatments of bladder dysfunction that influence cortical and subcortical brain areas which modulate the micturition reflex components.

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Authors and Affiliations

  1. Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands

    Rosa Coolen, Sophie Berendsen, Tess van Doorn & Bertil Blok

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  1. Rosa Coolen
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  2. Sophie Berendsen
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  3. Tess van Doorn
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  4. Bertil Blok
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Correspondence to Bertil Blok .

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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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Coolen, R., Berendsen, S., van Doorn, T., Blok, B. (2023). Central Pathways That Control the Urinary Bladder. In: Liao, L., Madersbacher, H. (eds) Handbook of Neurourology. Springer, Singapore. https://doi.org/10.1007/978-981-99-1659-7_5

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