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Pathology-Pathophysiology: Ultrastructure of the Neurogenic Bladder

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Handbook of Neurourology

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Abstract

The knowledge of the lower urinary tract (LUT) ultrastructure has increased substantially during the last decades. It has resulted in discovering new structures and a detailed picture of tissue, nerves, receptors, transmitters acting to create a sensation, motor relaxation, bladder wall elasticity, and muscle contraction. It has led to a stronger hypothesis on how bladder and urethra usually work and how in pathological conditions.

To understand why different parts of the LUT show specific actions in neurologic conditions, besides the remaining innervation and changes in these structures, changes in the tissues’ microstructure are essential. It is generally agreed that microstructure and function are highly interrelated and influence each other and provoke changes both ways.

Haferkamp summarizes three distinctive patterns occurring separately or in combination: degeneration associated with impaired detrusor contractility; dysfunction as in detrusor overactivity; myohypertrophy of the detrusor with bladder outflow obstruction (Haferkamp, Textbook of the Neurogenic Bladder. CRC Press, 2016). On top of this come the changes related to age, also in the neurological impaired LUT.

Most patients with neurogenic bladder need alternative ways to regulate filling and special techniques to empty it. These treatments can, in their own right, lead to extra changes during follow-up.

In the following, data from animal studies and human studies will be discussed. It shows how much the ultrastructure changed and the consequences for the neurogenic LUT function.

Often distinction has been made between lower motor neuron lesions (LMNL) and upper motor neuron lesions (UML).

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  1. University Antwerp, Antwerp, Belgium

    J. J. Wyndaele

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Correspondence to J. J. Wyndaele .

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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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Wyndaele, J.J. (2023). Pathology-Pathophysiology: Ultrastructure of the Neurogenic Bladder. In: Liao, L., Madersbacher, H. (eds) Handbook of Neurourology. Springer, Singapore. https://doi.org/10.1007/978-981-99-1659-7_9

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