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Fardadi M, Leiter JC, Lu DC, Iwasaki T. Model-based analysis of the acute effects of transcutaneous magnetic spinal cord stimulation on micturition after spinal cord injury in humans. PLoS Comput Biol 2024; 20:e1012237. [PMID: 38950067 DOI: 10.1371/journal.pcbi.1012237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 06/07/2024] [Indexed: 07/03/2024] Open
Abstract
AIM After spinal cord injuries (SCIs), patients may develop either detrusor-sphincter dyssynergia (DSD) or urinary incontinence, depending on the level of the spinal injury. DSD and incontinence reflect the loss of coordinated neural control among the detrusor muscle, which increases bladder pressure to facilitate urination, and urethral sphincters and pelvic floor muscles, which control the bladder outlet to restrict or permit bladder emptying. Transcutaneous magnetic stimulation (TMS) applied to the spinal cord after SCI reduced DSD and incontinence. We defined, within a mathematical model, the minimum neuronal elements necessary to replicate neurogenic dysfunction of the bladder after a SCI and incorporated into this model the minimum additional neurophysiological features sufficient to replicate the improvements in bladder function associated with lumbar TMS of the spine in patients with SCI. METHODS We created a computational model of the neural circuit of micturition based on Hodgkin-Huxley equations that replicated normal bladder function. We added interneurons and increased network complexity to reproduce dysfunctional micturition after SCI, and we increased the density and complexity of interactions of both inhibitory and excitatory lumbar spinal interneurons responsive to TMS to provide a more diverse set of spinal responses to intrinsic and extrinsic activation of spinal interneurons that remains after SCI. RESULTS The model reproduced the re-emergence of a spinal voiding reflex after SCI. When we investigated the effect of monophasic and biphasic TMS at two frequencies applied at or below T10, the model replicated the improved coordination between detrusor and external urethral sphincter activity that has been observed clinically: low-frequency TMS (1 Hz) within the model normalized control of voiding after SCI, whereas high-frequency TMS (30 Hz) enhanced urine storage. CONCLUSION Neuroplasticity and increased complexity of interactions among lumbar interneurons, beyond what is necessary to simulate normal bladder function, must be present in order to replicate the effects of SCI on control of micturition, and both neuronal and network modifications of lumbar interneurons are essential to understand the mechanisms whereby TMS reduced bladder dysfunction after SCI.
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Affiliation(s)
- Mahshid Fardadi
- Department of Mechanical Engineering, University of California, Los Angeles, California, United States of America
| | - J C Leiter
- White River Junction VA Medical Center, White River Junction, Vermont, United States of America
| | - Daniel C Lu
- Department of Neurosurgery, University of California, Los Angeles, California, United States of America
| | - Tetsuya Iwasaki
- Department of Mechanical Engineering, University of California, Los Angeles, California, United States of America
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Doelman AW, Streijger F, Majerus SJA, Damaser MS, Kwon BK. Assessing Neurogenic Lower Urinary Tract Dysfunction after Spinal Cord Injury: Animal Models in Preclinical Neuro-Urology Research. Biomedicines 2023; 11:1539. [PMID: 37371634 DOI: 10.3390/biomedicines11061539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/20/2023] [Accepted: 05/21/2023] [Indexed: 06/29/2023] Open
Abstract
Neurogenic bladder dysfunction is a condition that affects both bladder storage and voiding function and remains one of the leading causes of morbidity after spinal cord injury (SCI). The vast majority of individuals with severe SCI develop neurogenic lower urinary tract dysfunction (NLUTD), with symptoms ranging from neurogenic detrusor overactivity, detrusor sphincter dyssynergia, or sphincter underactivity depending on the location and extent of the spinal lesion. Animal models are critical to our fundamental understanding of lower urinary tract function and its dysfunction after SCI, in addition to providing a platform for the assessment of potential therapies. Given the need to develop and evaluate novel assessment tools, as well as therapeutic approaches in animal models of SCI prior to human translation, urodynamics assessment techniques have been implemented to measure NLUTD function in a variety of animals, including rats, mice, cats, dogs and pigs. In this narrative review, we summarize the literature on the use of animal models for cystometry testing in the assessment of SCI-related NLUTD. We also discuss the advantages and disadvantages of various animal models, and opportunities for future research.
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Affiliation(s)
- Adam W Doelman
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Femke Streijger
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Steve J A Majerus
- Department of Electrical, Computer and Systems Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA
| | - Margot S Damaser
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Brian K Kwon
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
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3
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Franco I. Anatomy, physiology, and evaluation: Bowel, bladder, and sexual disorders. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:403-423. [PMID: 37620081 DOI: 10.1016/b978-0-323-98817-9.00009-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Our present understanding of bowel and bladder control has changed dramatically with the introduction of functional imagining technologies such as PET, SPECT, fMRI scanning, and near-infrared spectroscopy of the brain. Urologists tend to see control of urination and defecation as processes that occurred at or below the level of the pons for the most part. In this chapter, we examine the control of storing and emptying of urine and stool from what will be a more neurocentric perspective, integrating the frontal lobes into the process and moving beyond the pons on which most of the literature has focused in the past. Utilizing this approach gives us a better understanding of why there is an overlapping of neuropsychiatric problems in many patients with voiding dysfunction.
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Affiliation(s)
- Israel Franco
- Yale School of Medicine, Yale-New Haven Children's Bladder and Continence Program, Yale New Haven Children's Hospital, New Haven, CT, United States.
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4
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Koizumi H, Yamamoto D, Maruhashi T, Kataoka Y, Inukai M, Asari Y, Kumabe T. Relationship between subarachnoid hemorrhage and nonocclusive mesenteric ischemia as a fatal complication: patient series. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22199. [PMID: 36046708 PMCID: PMC9301345 DOI: 10.3171/case22199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/03/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Nonocclusive mesenteric ischemia (NOMI) causes intestinal necrosis due to irreversible ischemia of the intestinal tract. The authors evaluated the incidence of NOMI in patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysms, and they present the clinical characteristics and describe the outcomes to emphasize the importance of recognizing NOMI. OBSERVATIONS Overall, 7 of 276 consecutive patients with SAH developed NOMI. Their average age was 71 years, and 5 patients were men. Hunt and Kosnik grades were as follows: grade II, 2 patients; grade III, 3 patients; grade IV, 1 patient; and grade V, 1 patient. Fisher grades were as follows: grade 1, 1 patient; grade 2, 1 patient; and grade 3, 5 patients. Three patients were treated with endovascular coiling, 3 with microsurgical clipping, and 1 with conservative management. Five patients had abdominal symptoms prior to the confirmed diagnosis of NOMI. Four patients fell into shock. Two patients required emergent laparotomy followed by second-look surgery. Four patients could be managed conservatively. The overall mortality of patients with NOMI complication was 29% (2 of 7 cases). LESSONS NOMI had a high mortality rate. Neurosurgeons should recognize that NOMI can occur as a fatal complication after SAH.
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Affiliation(s)
- Hiroyuki Koizumi
- Departments of Neurosurgery and
- Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | | | - Takaaki Maruhashi
- Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Yuichi Kataoka
- Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | | | - Yasushi Asari
- Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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5
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A review of the neural control of micturition in dogs and cats: neuroanatomy, neurophysiology and neuroplasticity. Vet Res Commun 2022; 46:991-998. [PMID: 35802232 DOI: 10.1007/s11259-022-09966-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
This article discusses the current knowledge on the role of the neurological structures, especially the cerebellum and the hypothalamus, and compares the information with human medicine. Micturition is a complex voluntary and involuntarily mechanism. Its physiological completion strictly depends on the hierarchical organisation of the central nervous system pathways in the peripheral nervous system. Although the role of the peripheral nervous system and subcortical areas, such as brainstem centres, are well established in veterinary medicine, the role of the cerebellum and hypothalamus have been poorly investigated and understood. Lower urinary tract dysfunction is often associated with neurological diseases that cause neurogenic bladder (NB). The neuroplasticity of the nervous system in the developmental changes of the mechanism of micturition during the prenatal and postnatal periods is also analysed.
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6
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Neural circuit control of innate behaviors. SCIENCE CHINA. LIFE SCIENCES 2022; 65:466-499. [PMID: 34985643 DOI: 10.1007/s11427-021-2043-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/10/2021] [Indexed: 12/17/2022]
Abstract
All animals possess a plethora of innate behaviors that do not require extensive learning and are fundamental for their survival and propagation. With the advent of newly-developed techniques such as viral tracing and optogenetic and chemogenetic tools, recent studies are gradually unraveling neural circuits underlying different innate behaviors. Here, we summarize current development in our understanding of the neural circuits controlling predation, feeding, male-typical mating, and urination, highlighting the role of genetically defined neurons and their connections in sensory triggering, sensory to motor/motivation transformation, motor/motivation encoding during these different behaviors. Along the way, we discuss possible mechanisms underlying binge-eating disorder and the pro-social effects of the neuropeptide oxytocin, elucidating the clinical relevance of studying neural circuits underlying essential innate functions. Finally, we discuss some exciting brain structures recurrently appearing in the regulation of different behaviors, which suggests both divergence and convergence in the neural encoding of specific innate behaviors. Going forward, we emphasize the importance of multi-angle and cross-species dissections in delineating neural circuits that control innate behaviors.
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Harnessing rAAV-retro for gene manipulations in multiple pathways that are interrupted after spinal cord injury. Exp Neurol 2021; 350:113965. [PMID: 34973965 DOI: 10.1016/j.expneurol.2021.113965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 12/12/2022]
Abstract
This paper explores the potential of rAAV2-retro to deliver gene modifying cargoes to the cells of origin of multiple pathways that are interrupted by spinal cord injury (SCI), summarizing data from previous studies and new data from additional experiments. rAAV-retro exhibits uniquely robust and reliable long-distance retrograde transport from pre-terminal axons and synapses back to neuronal bodies. Previous studies have documented that various AAV-based genetic modifications can enable axon regeneration after SCI, but these have targeted the cells of origin of one pathway at a time. In contrast, rAAV-retro can simultaneously transduce large numbers of neurons of origin of multiple spinal pathways with single injections into the spinal cord. Our initial studies use RosatdTomato and double transgenic PTENf/f; RosatdTomato mice in which transfection with rAAV-retro/Cre deletes PTEN and activates tdT expression in the same neurons. Injections of rAAV-retro/Cre into the cervical, thoracic and lumbar spinal cord led to topographically specific retrograde transduction in cortical motoneurons and neurons in subcortical regions that give rise to different spinal pathways. Our results confirm and extend previous studies indicating selective transduction of neurons that terminate at the level of the injection with minimal retrograde transduction of axons in transit to lower levels. We document feasibility of using rAAV-retro expressing shRNA against PTEN along with a GFP reporter (rAAV-retro-shPTEN/GFP) to effectively knock down PTEN in multiple populations of neurons, which can be used in any species. Some limitations and caveats of currently available rAAV-retros are discussed. Together, our results support the potential applications of rAAV-retro for AAV-based gene-modifications for SCI.
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8
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Kawatani M, deGroat W, Itoi K, Uchida K, Sakimura K, Yamanaka A, Yamashita T, Kawatani M. Downstream projection of Barrington's nucleus to the spinal cord in mice. J Neurophysiol 2021; 126:1959-1977. [PMID: 34731061 DOI: 10.1152/jn.00026.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Barrington's nucleus (Bar) which controls micturition behavior through downstream projections to the spinal cord contains two types of projection neurons BarCRH and BarESR1 that have different functions and target different spinal circuitry. Both types of neurons project to the L6-S1 spinal intermediolateral (IML) nucleus while BarESR1 neurons also project to the dorsal commissural nucleus (DCN). To obtain more information about the spinal circuits targeted by Bar, we used patch-clamp recording in spinal slices from adult mice in combination with optogenetic stimulation of Bar terminals. Recording of opto-evoked excitatory post synaptic currents (oEPSCs) in DiI-labeled lumbosacral preganglionic neurons (LS-PGN) revealed that both Bar neuronal populations make strong glutamatergic monosynaptic connections with LS-PGN, while BarESR1 neurons also elicited smaller amplitude glutamatergic polysynaptic oEPSCs or polysynaptic inhibitory post synaptic currents (oIPSCs) in some LS-PGN. Optical stimulation of BarCRH and BarESR1 terminals also elicited monosynaptic oEPSCs and polysynaptic oIPSCs in sacral DCN neurons, some of which must include interneurons projecting either to the IML or ventral horn. Application of capsaicin increased opto-evoked firing during repetitive stimulation of Bar terminals through the modulation of spontaneous post synaptic currents in LS-PGN. In conclusion, our experiments have provided insights into the synaptic mechanisms underlying the integration of inputs from Bar to autonomic circuitry in the lumbosacral spinal cord that may control micturition.
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Affiliation(s)
- Masahiro Kawatani
- Department of Neurophysiology, Graduate School of Medicine, Akita University, Akita, Japan.,Department of Neuroscience II, Research Institute of Environmental Medicine, Nagoya University, Aichi, Japan.,Department of Physiology, School of Medicine, Fujita Health University, Aichi, Japan
| | - William deGroat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Keiichi Itoi
- Department of Neuroendocrinology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Katsuya Uchida
- Department of Neuroendocrinology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Kenji Sakimura
- Department of Animal Model Development, Brain Research Institute, Niigata University, Niigata, Japan
| | - Akihiro Yamanaka
- Department of Neuroscience II, Research Institute of Environmental Medicine, Nagoya University, Aichi, Japan
| | - Takayuki Yamashita
- Department of Neuroscience II, Research Institute of Environmental Medicine, Nagoya University, Aichi, Japan.,Department of Physiology, School of Medicine, Fujita Health University, Aichi, Japan
| | - Masahito Kawatani
- Department of Neurophysiology, Graduate School of Medicine, Akita University, Akita, Japan
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9
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Quaghebeur J, Petros P, Wyndaele JJ, De Wachter S. The innervation of the bladder, the pelvic floor, and emotion: A review. Auton Neurosci 2021; 235:102868. [PMID: 34391125 DOI: 10.1016/j.autneu.2021.102868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/26/2021] [Accepted: 08/05/2021] [Indexed: 12/30/2022]
Abstract
The innervation of the pelvic region is complex and includes extensive neurologic pathways. The higher centres' organisation determining the pelvic floor and organs' function remains a challenge understanding the physiological and pain mechanisms. Psychological and emotional factors have a profound influence on the pelvic floor and organ dysfunction such as LUTS. LUTS are associated with stress, depression, and anxiety. Neuroception is a subconscious neuronal system for detecting threats and safety and might explain the permanent disturbance of higher brain centres maintaining functional urological and gastrointestinal disorders and sphincter dysfunction.
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Affiliation(s)
- Jörgen Quaghebeur
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium.
| | - Peter Petros
- Faculty of Medicine, University of New South Wales, Kensington, Sydney, Australia
| | | | - Stefan De Wachter
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
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10
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Past, Present, and Future in the Study of Neural Control of the Lower Urinary Tract. Int Neurourol J 2020; 24:191-199. [PMID: 33017890 PMCID: PMC7538290 DOI: 10.5213/inj.2040318.159] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 09/08/2020] [Indexed: 12/13/2022] Open
Abstract
The neurological coordination of the lower urinary tract can be analyzed from the perspective of motor neurons or sensory neurons. First, sensory nerves with receptors in the bladder and urethra transmits stimuli to the cerebral cortex through the periaqueductal gray (PAG) of the midbrain. Upon the recognition of stimuli, the cerebrum carries out decision-making in response. Motor neurons are divided into upper motor neurons (UMNs) and lower motor neurons (LMNs) and UMNs coordinate storage and urination in the brainstem for synergic voiding. In contrast, LMNs, which originate in the spinal cord, cause muscles to contract. These neurons are present in the sacrum, and in particular, a specific neuron group called Onuf’s nucleus is responsible for the contraction of the external urethral sphincter and maintains continence in states of rising vesical pressure through voluntary contraction of the sphincter. Parasympathetic neurons originating from S2–S4 are responsible for the contraction of bladder muscles, while sympathetic neurons are responsible for contraction of the urethral smooth muscle, including the bladder neck, during the guarding reflex. UMNs are controlled in the pons where various motor stimuli to the LMNs are directed along with control to various other pelvic organs, and in the PAG, where complex signals from the brain are received and integrated. Future understanding of the complex mechanisms of micturition requires integrative knowledge from various fields encompassing these distinct disciplines.
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11
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Tish MM, Geerling JC. The Brain and the Bladder: Forebrain Control of Urinary (In)Continence. Front Physiol 2020; 11:658. [PMID: 32719609 PMCID: PMC7349519 DOI: 10.3389/fphys.2020.00658] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/25/2020] [Indexed: 12/11/2022] Open
Abstract
Neural circuits extending from the cerebral cortex to the bladder maintain urinary continence and allow voiding when it is socially appropriate. Injuries to certain brain regions produce a specific disruption known as urge incontinence. This neurologic symptom is distinguished by bladder spasticity, with sudden urges to void and frequent inability to maintain continence. The precise localization of neural circuit disruptions responsible for urge incontinence remains poorly defined, partly because the brain regions, cell types, and circuit connections that normally maintain continence are unknown. Here, we review what is known about the micturition reflex circuit and about forebrain control of continence from experimental animal studies and human lesion data. Based on this information, we hypothesize that urge incontinence results from damage to a descending pathway that normally maintains urinary continence. This pathway begins with excitatory neurons in the prefrontal cortex and relays subcortically, through inhibitory neurons that may help suppress reflex micturition during sleep and until it is safe and socially appropriate to void. Identifying the specific cell types and circuit connections that constitute the continence-promoting pathway, from the forebrain to the brainstem, will help us better understand why some brain lesions and neurodegenerative diseases disrupt continence. This information is needed to pave the way toward better treatments for neurologic patients suffering from urge incontinence.
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Affiliation(s)
- Margaret M Tish
- Department of Neurology, University of Iowa, Iowa City, IA, United States
| | - Joel C Geerling
- Department of Neurology, University of Iowa, Iowa City, IA, United States
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12
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Abstract
PURPOSE OF REVIEW In this review, we summarize recent advances in the understanding of the neural control of the bladder, bowel and sexual function, in both men and women. RECENT FINDINGS Evidence of supraspinal areas controlling the storage of urine and micturition in animals, such as the pontine micturition centre, emerged in the early 20th century. Neurological stimulation and lesion studies in humans provided additional indirect evidence for additional bladder-related brain areas. Thereafter, functional neuroimaging in humans with PET and fMRI provided more direct evidence of the involvement of these brain areas. The areas involved in the storage and expulsion of urine also seem to be involved in the central control of storage and expulsion of feces. Furthermore, most knowledge on the brain control of sexual function is obtained from dynamic imaging in human volunteers. Relatively little is known about the dysfunctional central circuits in patients with pelvic organ dysfunction. SUMMARY fMRI has been the most widely used functional neuroimaging technique in the last decade to study the central control of bladder function, anorectal function and sexual function. The studies described in this review show which sensory and motor areas are involved, including cortical and subcortical areas. We propose the existence of a switch-like phenomenon located in the pons controlling micturition, defecation and orgasm.
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13
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Ito H, Sales AC, Fry CH, Kanai AJ, Drake MJ, Pickering AE. Probabilistic, spinally-gated control of bladder pressure and autonomous micturition by Barrington's nucleus CRH neurons. eLife 2020; 9:56605. [PMID: 32347794 PMCID: PMC7217699 DOI: 10.7554/elife.56605] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/28/2020] [Indexed: 12/27/2022] Open
Abstract
Micturition requires precise control of bladder and urethral sphincter via parasympathetic, sympathetic and somatic motoneurons. This involves a spino-bulbospinal control circuit incorporating Barrington’s nucleus in the pons (Barr). Ponto-spinal glutamatergic neurons that express corticotrophin-releasing hormone (CRH) form one of the largest Barr cell populations. BarrCRH neurons can generate bladder contractions, but it is unknown whether they act as a simple switch or provide a high-fidelity pre-parasympathetic motor drive and whether their activation can actually trigger voids. Combined opto- and chemo-genetic manipulations along with multisite extracellular recordings in urethane anaesthetised CRHCre mice show that BarrCRH neurons provide a probabilistic drive that generates co-ordinated voids or non-voiding contractions depending on the phase of the micturition cycle. CRH itself provides negative feedback regulation of this process. These findings inform a new inferential model of autonomous micturition and emphasise the importance of the state of the spinal gating circuit in the generation of voiding.
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Affiliation(s)
- Hiroki Ito
- School of Physiology, Pharmacology and Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom.,Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Anna C Sales
- School of Physiology, Pharmacology and Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
| | - Anthony J Kanai
- Department of Medicine and Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, United States
| | - Marcus J Drake
- School of Physiology, Pharmacology and Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom.,Bristol Urology Institute, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Anthony E Pickering
- School of Physiology, Pharmacology and Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom.,Anaesthetic, Pain and Critical Care research group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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14
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Coindreau V, Chesnel C, Babany F, Declemy A, Savard E, Charlanes A, Lebreton F, Amarenco G. [Urinary tract symptoms in Lewy body dementia: About 19 cases]. Prog Urol 2020; 30:267-272. [PMID: 32224094 DOI: 10.1016/j.purol.2020.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 02/10/2020] [Accepted: 02/13/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Lewy Body Dementia (LBD) is a Parkinsonian disorder which often leads to Lower Urinary Tract Symptoms (LUTS), especially an Overactive Bladder (OAB). There have been few LBD related LUTS depictions in the literature, which is why we did this retrospective study. METHODS Retrospective single institution study. RESULTS Nineteen patients with confirmed LBD diagnosis were found, (63% of men, mean age 74 years old). The main symptom was OAB (100% of patients) with frequent stress urinary incontinence (94%) associated with detrusor overactivity (93%) with pressure elevation (79%). Voiding difficulties were found in 16% of medical interviews, and in 53% of urodynamics. In total, 92% of patients complained of constipation, with 44% suffering from fecal incontinence. DISCUSSION LBD is characterized by alpha-synuclein aggregates in the cerebral cortex, thus explaining associated cognitive impairment. The most commonly found LUTS is stress incontinence. We also found voiding difficulties in smaller proportion, sometimes associated with prostatism. Topographically, these symptoms could be explained by alpha-synuclein aggregates in the frontal and temporal cortex and the pons. Anorectal disorder and sexual dysfunction were frequently associated. Urological complications are scarce in this population, screening is focused in increasing quality of life, and the possibility to discriminate the different types of Parkinsonisms. CONCLUSION OAB is the most common lower urinary tract symptom in LBD often associated with detrusor overactivity, and less frequently voiding difficulties sometimes associated to prostatism. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- V Coindreau
- Groupe de recherche clinique en neuro-urologie (GREEN GRC-01 UPMC), Sorbonne universités, 75005 Paris, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - C Chesnel
- Groupe de recherche clinique en neuro-urologie (GREEN GRC-01 UPMC), Sorbonne universités, 75005 Paris, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - F Babany
- Groupe de recherche clinique en neuro-urologie (GREEN GRC-01 UPMC), Sorbonne universités, 75005 Paris, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A Declemy
- Groupe de recherche clinique en neuro-urologie (GREEN GRC-01 UPMC), Sorbonne universités, 75005 Paris, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - E Savard
- Groupe de recherche clinique en neuro-urologie (GREEN GRC-01 UPMC), Sorbonne universités, 75005 Paris, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A Charlanes
- Groupe de recherche clinique en neuro-urologie (GREEN GRC-01 UPMC), Sorbonne universités, 75005 Paris, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - F Lebreton
- Groupe de recherche clinique en neuro-urologie (GREEN GRC-01 UPMC), Sorbonne universités, 75005 Paris, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - G Amarenco
- Groupe de recherche clinique en neuro-urologie (GREEN GRC-01 UPMC), Sorbonne universités, 75005 Paris, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
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Neural Correlates of Urinary Retention in Lateral Medullary Infarction. Int Neurourol J 2019; 23:205-210. [PMID: 31607099 PMCID: PMC6790816 DOI: 10.5213/inj.1836256.128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/01/2019] [Indexed: 12/04/2022] Open
Abstract
Purpose The brainstem plays an important role in the control of micturition, and brainstem strokes are known to present with micturition dysfunction. Micturition dysfunction in cases of lateral medullary infarction (LMI) is uncommon, but often manifests as urinary retention. In this study, we investigated the neuro-anatomical correlates of urinary retention in patients with LMI. Methods This was a hospital-based retrospective study conducted in the neurology unit of a quaternary-level teaching hospital. Inpatient records from January 2008 to May 2018 were searched using a computerized database. Cases of isolated LMI were identified and those with micturition dysfunction were reviewed. MRI brain images of all patients were viewed, and individual lesions were mapped onto the Montreal Neurological Institute (MNI) space manually using MRIcron. Nonparametric mapping toolbox software was used for voxel-based lesion-symptom analysis. The Liebermeister test was used for statistical analysis, and the resultant statistical map was displayed on the MNI template using MRIcron. Results During the study period, 31 patients with isolated LMI were identified. Their mean age was 48 years and 28 (90%) were male. Six of these patients (19%) developed micturition dysfunction. All 6 patients had urinary retention and 1 patient each had urge incontinence and overflow incontinence. In patients with LMI, the lateral tegmentum of the medulla showed a significant association with urinary retention. Conclusions In patients with isolated LMI, we postulate that disruption of the descending pathway from the pontine micturition centre to the sacral spinal cord at the level of the lateral tegmentum results in urinary retention.
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16
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Verstegen AMJ, Klymko N, Zhu L, Mathai JC, Kobayashi R, Venner A, Ross RA, VanderHorst VG, Arrigoni E, Geerling JC, Zeidel ML. Non-Crh Glutamatergic Neurons in Barrington's Nucleus Control Micturition via Glutamatergic Afferents from the Midbrain and Hypothalamus. Curr Biol 2019; 29:2775-2789.e7. [PMID: 31422881 PMCID: PMC6736713 DOI: 10.1016/j.cub.2019.07.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/21/2019] [Accepted: 07/02/2019] [Indexed: 11/23/2022]
Abstract
Lower urinary tract symptoms (LUTS) are exceptionally common and debilitating, and they are likely caused or exacerbated by dysfunction of neural circuits controlling bladder function. An incomplete understanding of neural control of bladder function limits our ability to clinically address LUTS. Barrington's nucleus (Bar) provides descending control of bladder and sphincter function, and its glutamatergic neurons expressing corticotropin releasing hormone (BarCrh/Vglut2) are implicated in bladder control. However, it remains unclear whether this subset of Bar neurons is necessary for voiding, and the broader circuitry providing input to this control center remains largely unknown. Here, we examine the contribution to micturition behavior of BarCrh/Vglut2 neurons relative to the overall BarVglut2 population. First, we identify robust, excitatory synaptic input to Bar. Glutamatergic axons from the periaqueductal gray (PAG) and lateral hypothalamic area (LHA) intensely innervate and are functionally connected to Bar, and optogenetic stimulation of these axon terminals reliably provokes voiding. Similarly, optogenetic stimulation of BarVglut2 neurons triggers voiding, whereas stimulating the BarCrh/Vglut2 subpopulation causes bladder contraction, typically without voiding. Next, we genetically ablate either BarVglut2 or BarCrh/Vglut2 neurons and found that only BarVglut2 ablation replicates the profound urinary retention produced by conventional lesions in this region. Fiber photometry recordings reveal that BarVglut2 neuron activity precedes increased bladder pressure, while activity of BarCrh/Vglut2 is phase delayed. Finally, deleting Crh from Bar neurons has no effect on voiding and related bladder physiology. Our results help identify the circuitry that modulates Bar neuron activity and identify subtypes that may serve different roles in micturition.
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Affiliation(s)
- Anne M J Verstegen
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA.
| | - Nataliya Klymko
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA
| | - Lin Zhu
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA
| | - John C Mathai
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA
| | - Reina Kobayashi
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA
| | - Anne Venner
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA
| | - Rachel A Ross
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA
| | - Veronique G VanderHorst
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA
| | - Elda Arrigoni
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA
| | - Joel C Geerling
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA
| | - Mark L Zeidel
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA
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Predeterminative role of Onuf's nucleus ischemia on mesenteric artery vasospasm in spinal subarachnoid hemorrhage: A preliminary experimental study. Asian J Surg 2019; 42:797-804. [DOI: 10.1016/j.asjsur.2018.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/23/2018] [Accepted: 12/07/2018] [Indexed: 12/11/2022] Open
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18
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Caglar O, Firinci B, Aydin MD, Karadeniz E, Ahiskalioglu A, Sipal SA, Yigiter M, Bedii Salman A. Disruption of the network between Onuf's nucleus and myenteric ganglia, and developing Hirschsprung-like disease following spinal subarachnoid haemorrhage: an experimental study. Int J Neurosci 2019; 129:1076-1084. [PMID: 31215289 DOI: 10.1080/00207454.2019.1634069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose/Aim of the study: Auerbach/Meissner network of lower abdominopelvic organs managed by parasympathetic nerve fibres of lumbosacral roots arising from Onuf's nucleus located in conus medullaris. Aim of this study is to evaluate if there is any relationship between Onuf's nucleus ischemia and Auerbach/Meissner network degeneration following spinal subarachnoid haemorrhage (SAH). Materials and Methods: Study was conducted on 24 male rabbits included control (Group I, n = 5), serum saline-SHAM (Group II, n = 5), and spinal SAH (Group III, n = 14) groups. Spinal SAH performed by injecting homologous blood into subarachnoid space at Th12-L4 level and followed three weeks. Live and degenerated neuron densities of Onuf's nucleus, Auerbach and Meissner ganglia (n/mm3) were determined by Stereological methods. Results: The mean degenerated neuron density of Onuf's nucleus was significantly higher in Group III than in Groups I-II (152 ± 26, 2 ± 1 and 5 ± 2/mm3 respectively, p < 0.005). The degenerated neuron density of Auerbach's ganglia was significantly higher in Group III than in Groups I-II (365 ± 112, 3 ± 1 and 9 ± 3/mm3 respectively, p < 0.005). The degenerated neuron density of Meissner's ganglia was significantly higher in Group III than in Groups I-II (413 ± 132, 2 ± 1 and 11 ± 4/mm3 respectively, p < 0.005). Conclusions: Onuf's nucleus pathologies should be considered as Auerbach/Meissner ganglia degeneration and also related Hirschsprung-like diseases in the future.
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Affiliation(s)
- Ozgur Caglar
- Medical Faculty, Department of Pediatric Surgery, Ataturk University , Erzurum , Turkey
| | - Binali Firinci
- Medical Faculty, Department of Pediatric Surgery, Ataturk University , Erzurum , Turkey
| | - Mehmet Dumlu Aydin
- Medical Faculty, Department of Neurosurgery, Ataturk University , Erzurum , Turkey
| | - Erdem Karadeniz
- Medical Faculty, Department of General Surgery, Ataturk University , Erzurum , Turkey
| | - Ali Ahiskalioglu
- Medical Faculty, Department of Anesthesiology and Reanimation, Ataturk University , Erzurum , Turkey
| | - Sare Altas Sipal
- Medical Faculty, Department of Pathology, Ataturk University , Erzurum , Turkey
| | - Murat Yigiter
- Medical Faculty, Department of Pediatric Surgery, Ataturk University , Erzurum , Turkey
| | - Ahmet Bedii Salman
- Medical Faculty, Department of Pediatric Surgery, Ataturk University , Erzurum , Turkey
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19
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Suditu N, Negru I, Miron A, Novac B, Ciuta C. Is nocturnal enuresis a predisposing factor for the overactive bladder? Turk J Med Sci 2019; 49:703-709. [PMID: 31203588 PMCID: PMC7018347 DOI: 10.3906/sag-1604-116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background/aim This study aimed to perform a limited observational study to ascertain whether there is statistical support that nocturnal enuresis (NE) is a predisposing factor in the development of overactive bladder (OAB). Materials and methods The authors recruited patients diagnosed with OAB over a period of twelve months, and those who declared a history of NE were asked additional questions regarding the features of their NE. Results A total of 285 patients were diagnosed with overactive bladder, and 98 (34.38%) of them had previously displayed NE symptoms that had diminished before reaching the median age of 9.83. Separation of patients by sex revealed a male majority (58.16%). Additionally, most patients had urban origins (75.51%). The median time span from remission of NE to diagnosis of OAB was 24.79 years, and the median age at which patients began to suffer was 31.80 years. Behavioral factors (smoking, alcohol consumption) and psychological and infectious factors (past history of urinary tract infection) were identified at varying degrees. Conclusion The presence of NE in a third of the patients who developed over time OAB and the earlier onset of OAB for these patients suggests a causal physiopathological relationship between NE and OAB. The preponderance of urban patients confirms the existence of acquired urban triggering factors of OAB (nutritious, social, or professional).
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Affiliation(s)
| | - Irina Negru
- Department of Surgery, Arcadia Hospital, Iaşi, Romania
| | - Adelina Miron
- Department of Urology and Kidney Transplant, “Dr. C.I. Parhon” Clinical Hospital, Iaşi, Romania
| | - Bogdan Novac
- Department of Urology and Kidney Transplant, “Dr. C.I. Parhon” Clinical Hospital, Iaşi, Romania
| | - Catalin Ciuta
- Department of Urology and Kidney Transplant, “Dr. C.I. Parhon” Clinical Hospital, Iaşi, Romania
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20
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Roy HA, Green AL. The Central Autonomic Network and Regulation of Bladder Function. Front Neurosci 2019; 13:535. [PMID: 31263396 PMCID: PMC6585191 DOI: 10.3389/fnins.2019.00535] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/08/2019] [Indexed: 12/30/2022] Open
Abstract
The autonomic nervous system (ANS) is involved in the regulation of physiologic and homeostatic parameters relating particularly to the visceral organs and the co-ordination of physiological responses to threat. Blood pressure and heart rate, respiration, pupillomotor reactivity, sexual function, gastrointestinal secretions and motility, and urine storage and micturition are all under a degree of ANS control. Furthermore, there is close integration between the ANS and other neural functions such as emotion and cognition, and thus brain regions that are known to be important for autonomic control are also implicated in emotional functions. In this review we explore the role of the central ANS in the control of the bladder, and the implications of this for bladder dysfunction in diseases of the ANS.
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Affiliation(s)
- Holly Ann Roy
- Department of Neurosurgery, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | - Alexander L Green
- Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
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21
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[Interest of transcranial stimulation in pelvic and perineal disorders]. Prog Urol 2019; 29:349-359. [PMID: 31036483 DOI: 10.1016/j.purol.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/26/2019] [Accepted: 03/08/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this article was to describe the diagnostic and therapeutic value of transcranial stimulation in pelvic and perineal disorders. METHODS A literature review (Medline database and Google scholar) with no time limit was performed using keywords: "transcranial direct stimulation", "transcranial magnetic stimulation", "neurogenic bladder", "urinary incontinence", "Parkinson disease", "multiple sclerosis", "stroke", "muscle spasticity", "pelvic pain", "visceral pain". RESULTS Twelve articles have been selected. Transcranial magnetic or electrical stimulation is a noninvasive neuromodulation technique widely used to establish brain maps to highlight causal relationships between brain and function. Regarding pelvic-perineal disorders, repeated transcranial stimulation has shown significant effects for the treatment of overactive bladder in Parkinson's disease (P<0.05) and multiple sclerosis, but also for the treatment of refractory chronic pelvic pain (P=0.026). Finally, therapeutic effects have also been demonstrated in irritable bowel syndrome. No evidence of efficacy was found on genito-sexual disorders. CONCLUSION Data from the literature suggest that transcranial stimulation is a noninvasive treatment that may have a role in the management of pelvic and perineal disorders. Its promising field of action would require prospective and randomized studies on a larger scale.
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22
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Peyronnet B, Mironska E, Chapple C, Cardozo L, Oelke M, Dmochowski R, Amarenco G, Gamé X, Kirby R, Van Der Aa F, Cornu JN. A Comprehensive Review of Overactive Bladder Pathophysiology: On the Way to Tailored Treatment. Eur Urol 2019; 75:988-1000. [PMID: 30922690 DOI: 10.1016/j.eururo.2019.02.038] [Citation(s) in RCA: 175] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 02/28/2019] [Indexed: 01/06/2023]
Abstract
CONTEXT Current literature suggests that several pathophysiological factors and mechanisms might be responsible for the nonspecific symptom complex of overactive bladder (OAB). OBJECTIVE To provide a comprehensive analysis of the potential pathophysiology underlying detrusor overactivity (DO) and OAB. EVIDENCE ACQUISITION A PubMed-based literature search was conducted in April 2018, to identify randomised controlled trials, prospective and retrospective series, animal model studies, and reviews. EVIDENCE SYNTHESIS OAB is a nonspecific storage symptom complex with poorly defined pathophysiology. OAB was historically thought to be caused by DO, which was either "myogenic" (urgency initiated from autonomous contraction of the detrusor muscle) or "neurogenic" (urgency signalled from the central nervous system, which initiates a detrusor contraction). Patients with OAB are often found to not have objective evidence of DO on urodynamic studies; therefore, alternative mechanisms for the development of OAB have been postulated. Increasing evidence on the role of urothelium/suburothelium and bladder afferent signalling arose in the early 2000s, emphasising an afferent "urotheliogenic" hypothesis, namely, that urgency is initiated from the urothelium/suburothelium. The urethra has also recently been regarded as a possible afferent origin of OAB-the "urethrogenic" hypothesis. Several other pathophysiological factors have been implicated, including metabolic syndrome, affective disorders, sex hormone deficiency, urinary microbiota, gastrointestinal functional disorders, and subclinical autonomic nervous system dysfunctions. These various possible mechanisms should be considered as contributing to diagnostic and treatment algorithms. CONCLUSIONS There is a temptation to label OAB as "idiopathic" without obvious causation, given the poorly understood nature of its pathophysiology. OAB should be seen as a complex, multifactorial symptom syndrome, resulting from multiple potential pathophysiological mechanisms. Identification of the underlying causes on an individual basis may lead to the definition of OAB phenotypes, paving the way for personalised medical care. PATIENT SUMMARY Overactive bladder (OAB) is a storage symptom syndrome with multiple possible causes. Identification of the mechanisms causing a patient to experience OAB symptoms may help tailor treatment to individual patients and improve outcomes.
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Affiliation(s)
- Benoit Peyronnet
- Department of Urology, University Hospital of Rennes, Rennes, France.
| | - Emma Mironska
- Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK
| | | | - Linda Cardozo
- Department of Urology, St. Antonius Hospital, Gronau, Germany
| | - Matthias Oelke
- Department of Urology, Vanderbilt University, Nashville, TN, USA
| | | | - Gérard Amarenco
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Xavier Gamé
- Department of Urology, University Hospital of Toulouse, Toulouse, France
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Roy HA, Griffiths DJ, Aziz TZ, Green AL, Menke RAL. Investigation of urinary storage symptoms in Parkinson's disease utilizing structural MRI techniques. Neurourol Urodyn 2019; 38:1168-1175. [PMID: 30869824 DOI: 10.1002/nau.23976] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/17/2019] [Accepted: 02/26/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Lower urinary tract symptoms occur in 27% to 86% of patients with Parkinson's disease (PD), however, the mechanisms responsible for bladder dysfunction are not fully understood. This study utilized magnetic resonance imaging (MRI) to test the hypothesis that key brainstem bladder control areas (including the pontine micturition center and the pontine continence center (PCC) and their links with the basal ganglia are important in the development of urinary storage symptoms in PD. METHODS Seventeen patients with PD completed a "bladder symptom questionnaire" and underwent diffusion-weighted MRI (1.5 T). Storage symptom severity and MRI measures of white matter microstructural integrity were correlated using tract-based spatial statistics. RESULTS Mean diffusivity in the ventral brainstem correlated significantly with the bladder symptom severity in areas close to the predicted anatomical co-ordinates of the PCC. Tracts seeded from these regions passed via areas involved in pelvic floor musculature control and urinary voiding including the cerebellum, pallidum, and precentral gyrus. CONCLUSION We used diffusion-weighted MRI to investigate the role of the brainstem and its structural connections in the development of urinary storage symptoms in PD. Our data suggest that the brainstem degenerative change in the vicinity of the PCC may be implicated in the pathogenesis of storage symptoms in these patients.
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Affiliation(s)
- Holly A Roy
- Department of Functional Neurosurgery, John Radcliffe Hospital, Oxford, United Kingdom.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Derek J Griffiths
- Division of Geriatric Medicine and Institute on Ageing (retired), University of Pittsburgh
| | - Tipu Z Aziz
- Department of Functional Neurosurgery, John Radcliffe Hospital, Oxford, United Kingdom.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Alexander L Green
- Department of Functional Neurosurgery, John Radcliffe Hospital, Oxford, United Kingdom.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Ricarda A L Menke
- Oxford Centre for Functional Magnetic Resonance of the Brain, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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Jeanson G, Lebreton F. [Neuroanatomical correlates between stroke lesions and urinary disorders: A narrative review]. Prog Urol 2018; 29:226-234. [PMID: 30527571 DOI: 10.1016/j.purol.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 10/15/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
CONTEXT Stroke generates diverse urinary disorders, frequent but often under-diagnosed and thus untreated. Even though advances in the comprehension of the physiological voiding control and involved brain areas, the precise correspondence between lesion sites and observed urinary symptoms is not clearly established. OBJECTIVE This review aimed to update on this neuroanatomical correlates. DOCUMENTARY SOURCES The search focused on articles written in French or English, on PubMed, studying human beings or animals, published between the 1st of January 2000 and the 31st of August 2018 using the following keywords (stroke or hemiplegia) and (urinary incontinence or low urinary tract symptom or retention or overactive bladder or dysuria) and (anatomy or location or localization or area or lesion). STUDIES SELECTION The main author selected the most pertinent articles on abstracts and then on full text. RESULTS Twelve studies were included in our review. We could not fully confirm the neuroanatomical correlates based on the animal model. Frontoparietal lesions in urinary incontinence, role of the insula in the urinary retention, and systematic but different urinary symptoms in the brain stem lesions are the main findings. LIMITS Few studies were included, with varying methodologies and types of population. CONCLUSION A few cerebral areas damaged by stroke seem to be linked to certain urinary troubles, but new studies with a higher methodological quality are required to confirm this result.
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Affiliation(s)
- G Jeanson
- Service de MPR Neurologie, CHU Grenoble-Alpes, 38700 La Tronche, France.
| | - F Lebreton
- Service de neuro-urologie, hôpital Tenon, AP-HP, Paris 75020, France.
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Harvie C, Weissbart SJ, Kadam-Halani P, Rao H, Arya LA. Brain activation during the voiding phase of micturition in healthy adults: A meta-analysis of neuroimaging studies. Clin Anat 2018; 32:13-19. [PMID: 30069958 DOI: 10.1002/ca.23244] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 01/06/2023]
Abstract
Several studies have used a variety of neuroimaging techniques to measure brain activity during the voiding phase of micturition. However, there is a lack of consensus on which regions of the brain are activated during voiding. The aim of this meta-analysis is to identify the brain regions that are consistently activated during voiding in healthy adults across different studies. We searched the literature for neuroimaging studies that reported brain co-ordinates that were activated during voiding. We excluded studies that reported co-ordinates only for bladder filling, during pelvic floor contraction only, and studies that focused on abnormal bladder states such as the neurogenic bladder. We used the activation-likelihood estimation (ALE) approach to create a statistical map of the brain and identify the brain co-ordinates that were activated across different studies. We identified nine studies that reported brain activation during the task of voiding in 91 healthy subjects. Together, these studies reported 117 foci for ALE analysis. Our ALE map yielded six clusters of activation in the pons, cerebellum, insula, anterior cingulate cortex (ACC), thalamus, and the inferior frontal gyrus. Regions of the brain involved in executive control (frontal cortex), interoception (ACC, insula), motor control (cerebellum, thalamus), and brainstem (pons) are involved in micturition. This analysis provides insight into the supraspinal control of voiding in healthy adults and provides a framework to understand dysfunctional voiding. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Camryn Harvie
- Division of Urogynecology, Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven J Weissbart
- Department of Urology, Stony Brook School of Medicine, Stony Brook, New York
| | - Priyanka Kadam-Halani
- Division of Urogynecology, Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hengyi Rao
- Center for Functional Neuroimaging, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lily A Arya
- Division of Urogynecology, Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
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[Evidence of sensory bladder inhibitor reflex]. Prog Urol 2018; 28:502-508. [PMID: 29903631 DOI: 10.1016/j.purol.2018.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 03/28/2018] [Accepted: 05/15/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Need to void level depends on two parameters, bladder volume and attentional process. If it is well known that the maximum voluntary contraction of the perineal muscles may transiently inhibit the micturition reflex itself, no work demonstrates the effect of this contraction on the intensity of the need itself. METHODS An experimental, prospective, open, monocentric study was conducted between March and April 2017. In total, 15 subjects with no neurological history or neuro-perineal disorders consulting for functional constipation were included. Need to void level was evaluated by means of an electronic urgentometer. A control contraction of the dominant hand muscles was compared to a voluntary contraction of the external anal sphincter during a strong desire to void (B3). These contractions were recorded by means of surface electromyography. The main evaluation criterion was the comparison between the difference in visual analogic scale of the desire to void before (VAS-base) and after control voluntary contraction (VAS-hand) versus the same index (BAS-base then VAS-anal) after contraction of the external anal sphincter during a new B3. The comparison of maximum bladder capacities (MBC) measured after each record was the secondary endpoint. Wilcoxon signed rank test was used for statistical analysis. RESULTS Voiding desire VAS decreased significantly (-13.14±12 vs -1.5±6; P=0.03) and MBC increased significantly (502.43±96.71mL vs 435.78±125.54mL; P=0.02) after anal compared to control contraction. CONCLUSION This study suggests the existence of sensitive pathways inhibition by perineal contraction through a sensitive perineo-vesical inhibitory reflex. LEVEL OF EVIDENCE 3.
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Barbe MF, Gomez-Amaya SM, Salvadeo DM, Lamarre NS, Tiwari E, Cook S, Glair CP, Jang DH, Ragheb RM, Sheth A, Braverman AS, Ruggieri MR. Clarification of the Innervation of the Bladder, External Urethral Sphincter and Clitoris: A Neuronal Tracing Study in Female Mongrel Hound Dogs. Anat Rec (Hoboken) 2018; 301:1426-1441. [PMID: 29575690 DOI: 10.1002/ar.23808] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/30/2017] [Accepted: 01/16/2018] [Indexed: 12/18/2022]
Abstract
Many studies examining the innervation of genitourinary structures focus on either afferent or efferent inputs, or on only one structure of the system. We aimed to clarify innervation of the bladder, external urethral sphincter (EUS) and clitoris. Retrograde dyes were injected into each end organ in female dogs. Spinal cord, mid-bladder, and spinal, caudal mesenteric, sympathetic trunk and pelvic plexus ganglia were examined for retrograde dye-labeled neurons. Neurons retrogradely labeled from the bladder were found primarily in L7-S2 spinal ganglia, spinal cord lateral zona intermedia at S1-S3 levels, caudal mesenteric ganglia, T11-L2 and L6-S2 sympathetic trunk ganglia, and pelvic plexus ganglia. The mid-bladder wall contained many intramural ganglia neurons labeled anterogradely from the pelvic nerve, and intramural ganglia retrogradely labeled from dye labeling sites surrounding ureteral orifices. Neurons retrogradely labeled from the clitoris were found only in L7 and S1 spinal ganglia, L7-S3 spinal cord lateral zona intermedia, and S1 sympathetic trunk ganglia, and caudal mesenteric ganglia. Neurons retrogradely labeled from the EUS were found in primarily at S1 and S2 spinal ganglia, spinal cord lamina IX at S1-S3, caudal mesenteric ganglia, and S1-S2 sympathetic trunk ganglia. Thus, direct inputs from the spinal cord to each end organ were identified, as well as multisynaptic circuits involving several ganglia, including intramural ganglia in the bladder wall. Knowledge of this complex circuitry of afferent and efferent inputs to genitourinary structures is necessary to understand and treat genitourinary dysfunction. Anat Rec, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Mary F Barbe
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, 19140
| | - Sandra M Gomez-Amaya
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, 19140
| | - Danielle M Salvadeo
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, 19140
| | - Neil S Lamarre
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, 19140
| | - Ekta Tiwari
- Department of Electrical and Computer Engineering, College of Engineering, Temple University, Philadelphia, Pennsylvania, 19140
| | - Shalonda Cook
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, 19140
| | - Connor P Glair
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, 19140
| | - Daniel H Jang
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, 19140
| | - Rachel M Ragheb
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, 19140
| | - Akaash Sheth
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, 19140
| | - Alan S Braverman
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, 19140
| | - Michael R Ruggieri
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, 19140.,Department of Electrical and Computer Engineering, College of Engineering, Temple University, Philadelphia, Pennsylvania, 19140.,Shriners Hospitals for Children of Philadelphia, Philadelphia, Pennsylvania, 19140
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Cruz Y, Lucio RA, Palacios JL. Neural and Endocrine Factors Contribute to the Comorbidity of Urinary and Sexual Dysfunctions. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0129-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Subramanian HH, Huang ZG, Silburn PA, Balnave RJ, Holstege G. The physiological motor patterns produced by neurons in the nucleus retroambiguus in the rat and their modulation by vagal, peripheral chemosensory, and nociceptive stimulation. J Comp Neurol 2017; 526:229-242. [DOI: 10.1002/cne.24318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Hari H. Subramanian
- Queensland Brain Institute, Asia-Pacific Centre for Neuromodulation, The University of Queensland; Brisbane 4072 Australia
- Discipline of Biomedical Science, The University of Sydney; Lidcombe NSW 1825 Australia
| | - Zheng-Gui Huang
- Discipline of Biomedical Science, The University of Sydney; Lidcombe NSW 1825 Australia
- Department of Pharmacology; Wannan Medical College; Wuhu City Anhui Province 241002 People's Republic of China
| | - Peter A. Silburn
- Queensland Brain Institute, Asia-Pacific Centre for Neuromodulation, The University of Queensland; Brisbane 4072 Australia
| | - Ron J. Balnave
- Discipline of Biomedical Science, The University of Sydney; Lidcombe NSW 1825 Australia
| | - Gert Holstege
- The University of Queensland; Brisbane 4072 Australia
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Ahmed Z. Effects of cathodal trans-spinal direct current stimulation on lower urinary tract function in normal and spinal cord injury mice with overactive bladder. J Neural Eng 2017; 14:056002. [DOI: 10.1088/1741-2552/aa76f2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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31
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Verstegen AMJ, Vanderhorst V, Gray PA, Zeidel ML, Geerling JC. Barrington's nucleus: Neuroanatomic landscape of the mouse "pontine micturition center". J Comp Neurol 2017; 525:2287-2309. [PMID: 28340519 PMCID: PMC5832452 DOI: 10.1002/cne.24215] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 03/16/2017] [Accepted: 03/17/2017] [Indexed: 12/12/2022]
Abstract
Barrington's nucleus (Bar) is thought to contain neurons that trigger voiding and thereby function as the "pontine micturition center." Lacking detailed information on this region in mice, we examined gene and protein markers to characterize Bar and the neurons surrounding it. Like rats and cats, mice have an ovoid core of medium-sized Bar neurons located medial to the locus coeruleus (LC). Bar neurons express a GFP reporter for Vglut2, develop from a Math1/Atoh1 lineage, and exhibit immunoreactivity for NeuN. Many neurons in and around this core cluster express a reporter for corticotrophin-releasing hormone (BarCRH ). Axons from BarCRH neurons project to the lumbosacral spinal cord and ramify extensively in two regions: the dorsal gray commissural and intermediolateral nuclei. BarCRH neurons have unexpectedly long dendrites, which may receive synaptic input from the cerebral cortex and other brain regions beyond the core afferents identified previously. Finally, at least five populations of neurons surround Bar: rostral-dorsomedial cholinergic neurons in the laterodorsal tegmental nucleus; lateral noradrenergic neurons in the LC; medial GABAergic neurons in the pontine central gray; ventromedial, small GABAergic neurons that express FoxP2; and dorsolateral glutamatergic neurons that express FoxP2 in the pLC and form a wedge dividing Bar from the dorsal LC. We discuss the implications of this new information for interpreting existing data and future experiments targeting BarCRH neurons and their synaptic afferents to study micturition and other pelvic functions.
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Affiliation(s)
- Anne M. J. Verstegen
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Division of Endocrinology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine & Neurology, Harvard Medical School, Boston, Massachusetts
| | - Veronique Vanderhorst
- Department of Medicine & Neurology, Harvard Medical School, Boston, Massachusetts
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Paul A. Gray
- Department of Anatomy & Neurobiology, Washington University School of Medicine, Saint Louis, Missouri
- Indigo Ag, Inc., Charlestown, Massachusetts
| | - Mark L. Zeidel
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine & Neurology, Harvard Medical School, Boston, Massachusetts
| | - Joel C. Geerling
- Department of Medicine & Neurology, Harvard Medical School, Boston, Massachusetts
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Pasquet T, Durigneux J, Anselmetti A, Tessiot C, Beaumesnil M, Delion M, Dinomais M. Voiding dysfunction after isolated cerebellum stroke in a teenager. Ann Phys Rehabil Med 2017; 60:270-273. [PMID: 28438563 DOI: 10.1016/j.rehab.2017.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Thibault Pasquet
- Physical Medicine and Rehabilitation Department, Pontchaillou University Hospital, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France.
| | - Julien Durigneux
- Department of Pediatric Physical and Rehabilitation Medicine, Centre des Capucins, 49933 Angers, France; LUNAM, University of Angers, Department of Pediatric Neurology, 49933 Angers, France
| | - Amélie Anselmetti
- Department of Pediatric Physical and Rehabilitation Medicine, Centre des Capucins, 49933 Angers, France
| | - Chantal Tessiot
- Department of Pediatric Physical and Rehabilitation Medicine, Centre des Capucins, 49933 Angers, France
| | - Marion Beaumesnil
- Department of Pediatric Physical and Rehabilitation Medicine, Centre des Capucins, 49933 Angers, France
| | - Matthieu Delion
- LUNAM, University of Angers, Department of Neurosurgery, 49933 Angers, France; LUNAM, University of Angers, Anatomy Laboratory, 49045 Angers, France
| | - Mickael Dinomais
- Department of Pediatric Physical and Rehabilitation Medicine, Centre des Capucins, 49933 Angers, France; LUNAM; University of Angers, Department of Physical and Rehabilitation Medicine, CHU Angers, 49933 Angers, France
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Arya NG, Weissbart SJ. Central control of micturition in women: Brain-bladder pathways in continence and urgency urinary incontinence. Clin Anat 2017; 30:373-384. [PMID: 28276096 DOI: 10.1002/ca.22840] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 02/03/2017] [Indexed: 12/30/2022]
Abstract
Urinary incontinence disproportionately affects women. Anatomical textbooks typically describe continence mechanisms in women in the context of the pelvic floor support of the urinary bladder and the urethral sphincters. However, the urinary bladder and urethral sphincters are under the central control of the brain through a complex network of neurons that allow storage of urine followed by voiding when socially appropriate. Recent studies suggest that the most common type of urinary incontinence in women, urgency urinary incontinence, involves significant dysfunction of the central control of micturition. In this paper, we review the anatomy and functional connectivity of the nervous system structures involved in the control of micturition. Clinical application of this anatomy in the context of urgency urinary incontinence is also discussed. Understanding the anatomy of the neural structures that control continence will allow clinicians to better understand the underlying pathology of urge incontinence and consider new ways of treating this distressing condition. Clin. Anat. 30:373-384, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Nisha G Arya
- Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven J Weissbart
- Department of Urology, Stony Brook University School of Medicine, Stony Brook, New York
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Central Control Circuit for Context-Dependent Micturition. Cell 2016; 167:73-86.e12. [PMID: 27662084 DOI: 10.1016/j.cell.2016.08.073] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/28/2016] [Accepted: 08/23/2016] [Indexed: 01/23/2023]
Abstract
Urine release (micturition) serves an essential physiological function as well as a critical role in social communication in many animals. Here, we show a combined effect of olfaction and social hierarchy on micturition patterns in adult male mice, confirming the existence of a micturition control center that integrates pro- and anti-micturition cues. Furthermore, we demonstrate that a cluster of neurons expressing corticotropin-releasing hormone (Crh) in the pontine micturition center (PMC) is electrophysiologically distinct from their Crh-negative neighbors and sends glutamatergic projections to the spinal cord. The activity of PMC Crh-expressing neurons correlates with and is sufficient to drive bladder contraction, and when silenced impairs micturition behavior. These neurons receive convergent input from widespread higher brain areas that are capable of carrying diverse pro- and anti-micturition signals, and whose activity modulates hierarchy-dependent micturition. Taken together, our results indicate that PMC Crh-expressing neurons are likely the integration center for context-dependent micturition behavior.
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35
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Cohn JA, Kowalik CG, Kaufman MR, Reynolds WS, Milam DF, Dmochowski RR. Evaluation of the axonics modulation technologies sacral neuromodulation system for the treatment of urinary and fecal dysfunction. Expert Rev Med Devices 2016; 14:3-14. [PMID: 27915486 DOI: 10.1080/17434440.2017.1268913] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Sacral neuromodulation (SNM) remains one of the few effective treatments for refractory bladder and bowel dysfunction. However, SNM is associated with frequent need for surgical intervention, in many cases because of a failed battery. A rechargeable SNM system, with a manufacturer-reported battery life of 15 years or more, has entered post-market clinical testing in Europe but has not yet been approved for clinical testing in the United States. Areas covered: We review existing neuromodulation technologies for the treatment of lower urinary tract and bowel dysfunction and explore the limitations of available technology. In addition, we discuss implantation technique and device specifications and programming of the rechargeable SNM system in detail. Lastly, we present existing evidence for the use of SNM in bladder and bowel dysfunction and evaluate the anticipated trajectory of neuromodulation technologies over the next five years. Expert commentary: A rechargeable system for SNM is a welcome technological advance. However surgical revision not related to battery changes is not uncommon. Therefore, while a rechargeable system would be expected to reduce costs, it will not eliminate the ongoing maintenance associated with neuromodulation. No matter the apparent benefits, all new technologies require extensive post-market monitoring to ensure safety and efficacy.
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Affiliation(s)
- Joshua A Cohn
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Casey G Kowalik
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Melissa R Kaufman
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - W Stuart Reynolds
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Douglas F Milam
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Roger R Dmochowski
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
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36
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Holstege G. How the Emotional Motor System Controls the Pelvic Organs. Sex Med Rev 2016; 4:303-328. [DOI: 10.1016/j.sxmr.2016.04.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/29/2016] [Accepted: 04/29/2016] [Indexed: 11/27/2022]
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Ishida H, Yamauchi H, Ito H, Akino H, Yokoyama O. α1D-Adrenoceptor blockade increases voiding efficiency by improving external urethral sphincter activity in rats with spinal cord injury. Am J Physiol Regul Integr Comp Physiol 2016; 311:R971-R978. [PMID: 27605559 DOI: 10.1152/ajpregu.00030.2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 08/22/2016] [Accepted: 08/31/2016] [Indexed: 12/11/2022]
Abstract
Ideal therapy for lower urinary tract dysfunction in patients with spinal cord injury (SCI) should decrease detrusor overactivity, thereby promoting urine storage at low intravesical pressure and promoting efficient voiding at low pressure by decreasing detrusor-sphincter dyssynergia. Here we investigated blockade of various α-adrenoceptors to determine the subtype that was principally responsible for improving the voiding dysfunction. The effects of the intravenous α-blocker naftopidil, the α-blocker BMY 7378, and the α-blocker silodosin were evaluated using cystometrography and external urethral sphincter-electromyography (EMG) in decerebrated, unanesthetized female Sprague-Dawley rats with chronic SCI following transection at Th8. Parameters measured included the voided volume, residual volume, voiding efficiency, and burst and silent periods on EMG. Compared with values in decerebrated non-SCI rats, EMG of decerebrated SCI rats revealed more prominent tonic activity, significantly shorter periods of bursting activity, and a reduced ratio of the silent to active period during bursting. Compared with the value before drug administration (control), the voiding efficiency was significantly increased by naftopidil (1 and 3 mg/kg) (<0.05 each), and the burst (<0.01 and <0.05, respectively) and silent periods (<0.01 each) on EMG were significantly lengthened. BMY 7378 (1 mg/kg) significantly increased voiding efficiency and lengthened the burst periods (<0.05 each). Silodosin did not affect any parameters. These results suggest that α-blockade reduces the urethral resistance associated with detrusor-sphincter dyssynergia, thus improving voiding efficiency in SCI rats.
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Affiliation(s)
- Hirokazu Ishida
- Department of Urology, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Hiroki Yamauchi
- Department of Urology, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Hideaki Ito
- Department of Urology, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Hironobu Akino
- Department of Urology, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Osamu Yokoyama
- Department of Urology, Faculty of Medical Science, University of Fukui, Fukui, Japan
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38
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Wang Z, Liao L. Effect of urethral wall injection of replication-defective herpes simplex virus-mediated gene transfer of kynurenine aminotransferase on urethral pressure in spinal cord-injured rats. Neurourol Urodyn 2016; 36:1046-1051. [PMID: 27391207 DOI: 10.1002/nau.23067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/22/2016] [Indexed: 11/08/2022]
Abstract
AIMS We determined whether or not replication-defective herpes simplex virus vector-mediated kynurenine aminotransferase II (HSVrd-KAT II) suppressed the tonic activity of the urethral sphincter in spinal cord-injured (SCI) rats. METHODS Thirty-six adult female Sprague-Dawley rats were used to produce a spinal cord injury model. One week after spinalization, HSVrd-KAT II was injected into the urethral wall of rats and another two groups of SCI rats were treated with saline and HSVrd as controls. Three weeks after viral injection, the urethral pressure profile (UPP), continuous cystometry, and gene expression in the L6-S1 spinal cords were evaluated in all three groups. RESULTS In the HSVrd-KAT II group, the maximum urethral closure pressure (Pclo.max) and maximum voiding pressure were significantly decreased (23.6-24.9% and 31.6-30.9%, respectively), in addition to an increase in voiding efficiency(48.8-76%), compared with the sham and HSVrd groups. The KAT II protein and mRNA levels were significantly increased in HSV-KAT II group compared with the HSVrd group. CONCLUSION KAT II gene therapy effectively reduced the urethral pressure, improving detrusor-sphincter dyssynergia (DSD), and detrusor overactivity (DO), probably by blocking the N-methyl-D-aspartate receptor (NMDAr) in the L6-S1 spinal cord. Neurourol. Urodynam. 36:1046-1051, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Zhaoxia Wang
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University (CMU), Beijing, China.,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University (CMU), Beijing, China.,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
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Arya NG, Weissbart SJ, Xu S, Rao H. Brain activation in response to bladder filling in healthy adults: An activation likelihood estimation meta-analysis of neuroimaging studies. Neurourol Urodyn 2016; 36:960-965. [PMID: 27367364 DOI: 10.1002/nau.23058] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/30/2016] [Indexed: 01/23/2023]
Abstract
AIMS Recent studies have used different neuroimaging techniques and identified various brain regions that are activated during bladder filling. However, there is a lack of consensus regarding which of these brain regions regulate the process of urine storage. The aim of this meta-analysis is to identify brain regions that are commonly activated during bladder filling in healthy adults across different studies. METHODS PubMed was searched for neuroimaging studies investigating the effects of bladder filling on regional brain activation. Studies were excluded if they did not report brain activation differences from whole-brain group analysis by comparing the state of bladder filling with the state of bladder rest. The current version of the activation likelihood estimation (ALE) approach was used for meta-analysis. RESULTS We identified 14 neuroimaging studies examining brain activation in response to experimental bladder filling in 181 healthy subjects, which reported 89 foci for ALE analysis. The meta-analysis revealed significant activation in multiple brain regions including thalamus (bilaterally), right insula, cerebellum, and brainstem (bilaterally). CONCLUSIONS Several key brain regions involved in sensory processing are commonly activated during bladder filling in healthy adults across different studies. Neurourol. Urodynam. 36:960-965, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Nisha G Arya
- Division of Urogynecology, Department of Obstetrics and Gynecology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven J Weissbart
- Division of Urogynecology, Department of Obstetrics and Gynecology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sihua Xu
- Laboratory of Applied Brain and Cognitive Sciences, Shanghai International Studies University, Shanghai, China.,Center for Functional Neuroimaging, Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hengyi Rao
- Laboratory of Applied Brain and Cognitive Sciences, Shanghai International Studies University, Shanghai, China.,Center for Functional Neuroimaging, Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
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Cafarchio EM, da Silva LA, Auresco LC, Ogihara CA, Almeida RL, Giannocco G, Luz MCB, Fonseca FLA, Sato MA. Cholinergic activation of neurons in the medulla oblongata changes urinary bladder activity by plasma vasopressin release in female rats. Eur J Pharmacol 2016; 776:116-23. [PMID: 26879866 DOI: 10.1016/j.ejphar.2016.02.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/11/2016] [Accepted: 02/11/2016] [Indexed: 12/15/2022]
Abstract
The central control of the micturition is dependent on cortical areas and other ascending and descending pathways in the brain stem. The descendent pathways from the pons to the urinary bladder (UB) can be direct or indirect through medullary neurons (MN). Chemical stimulation with l-glutamate of MN known for their involvement in cardiovascular regulation evokes changes in pelvic nerves activities, which innervate the urinary bladder. Different neurotransmitters have been found in medullary areas; nevertheless, their involvement in UB control is few understood. We focused to investigate if cholinergic activation of neurons in the medulla oblongata changes the urinary bladder activity. Carbachol (cholinergic agonist) or atropine (cholinergic antagonist) was injected into the 4thV in anesthetized female Wistar rats and the intravesical pressure (IP), mean arterial pressure (MAP), heart rate (HR) and renal conductance (RC) were recorded for 30 min. Carbachol injection into the 4thV increased IP with peak response at 30 min after carbachol and yielded no changes in MAP, HR and RC. Atropine injection into the 4thV decreased IP and elicited no changes in MAP, HR and RC. Plasma vasopressin levels evaluated by ELISA kit assay increased after carbachol into the 4th V. Intravenous blockade of V1 receptors prior to carbachol into the 4thV abolished the increase in IP evoked by carbachol. Therefore, our findings suggest that cholinergic activation of neurons in the medulla oblongata by carbachol injections into the 4thV increases IP due to plasma vasopressin release, which acts in V1 receptors in the UB.
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Affiliation(s)
- Eduardo M Cafarchio
- Dept. Morphology and Physiology, Faculdade de Medicina do ABC, Santo Andre, SP 09060-650, Brazil
| | - Luiz A da Silva
- Dept. Morphology and Physiology, Faculdade de Medicina do ABC, Santo Andre, SP 09060-650, Brazil
| | - Luciana C Auresco
- Dept. Morphology and Physiology, Faculdade de Medicina do ABC, Santo Andre, SP 09060-650, Brazil
| | - Cristiana A Ogihara
- Dept. Morphology and Physiology, Faculdade de Medicina do ABC, Santo Andre, SP 09060-650, Brazil
| | - Roberto L Almeida
- Dept. Morphology and Physiology, Faculdade de Medicina do ABC, Santo Andre, SP 09060-650, Brazil
| | - Gisele Giannocco
- Dept. Morphology and Physiology, Faculdade de Medicina do ABC, Santo Andre, SP 09060-650, Brazil
| | - Maria C B Luz
- Clinical Laboratory Analysis, Faculdade de Medicina do ABC, Santo Andre, SP 09060-650, Brazil
| | - Fernando L A Fonseca
- Clinical Laboratory Analysis, Faculdade de Medicina do ABC, Santo Andre, SP 09060-650, Brazil
| | - Monica A Sato
- Dept. Morphology and Physiology, Faculdade de Medicina do ABC, Santo Andre, SP 09060-650, Brazil.
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41
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Central control of visceral pain and urinary tract function. Auton Neurosci 2016; 200:35-42. [PMID: 26905459 DOI: 10.1016/j.autneu.2016.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 08/17/2015] [Accepted: 02/01/2016] [Indexed: 12/21/2022]
Abstract
Afferent input from Aδ and C-fibres innervating the urinary bladder are processed differently by the brain, and have different roles in signaling bladder sensation. Aδ fibres that signal bladder filling activate a spino-bulbo-spinal loop, which relays in the midbrain periaqueductal grey (PAG) and pontine micturition centre (PMC). The excitability of this circuitry is regulated by tonic GABAergic inhibitory processes. In humans and socialised animals micturition is normally under volitional control and influenced by a host of psychosocial factors. Higher nervous decision-making in a social context to 'go now' or 'do not go' probably resides in frontal cortical areas, which act as a central control switch for micturition. Exposure to psychosocial stress can have profoundly disruptive influence on the process and lead to maladaptive changes in the bladder. During sleeping the voiding reflex threshold appears to be reset to a higher level to promote urinary continence. Under physiological conditions C-fibre bladder afferents are normally silent but are activated in inflammatory bladder states and by intense distending pressure. Following prolonged stimulation visceral nociceptors sensitise, leading to a lowered threshold and heightened sensitivity. In addition, sensitization may occur within the central pain processing circuitry, which outlasts the original nociceptive insult. Visceral nociception may also be influenced by genetic and environmental influences. A period of chronic stress can produce increased sensitivity to visceral pain that lasts for months. Adverse early life events can produce even longer lasting epigenetic changes, which increase the individual's susceptibility to developing visceral pain states in adulthood.
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Abstract
Results from functional brain scanning have shown that neural control of the bladder involves many different regions. Yet, many aspects of this complex system can be simplified to a working model in which a few forebrain circuits, acting mainly on the midbrain periaqueductal grey (PAG), advance or delay the triggering of the voiding reflex and generate bladder sensations according to the volume of urine in the bladder, the safety of voiding and the emotional and social propriety of doing so. Understanding these circuits seems to offer a route to treatment of conditions, such as urgency incontinence or overactive bladder, in patients without overt neurological disease. Two of these circuits include, respectively, the medial prefrontal cortex and the parahippocampal complex, as well as the PAG. These circuits belong to a well-known network that is active at rest and deactivated when attention is required. Another circuit, comprising the insula and the midcingulate or dorsal anterior cingulate cortex, is activated by bladder filling and belongs to a salience network that generates sensations such as the desire to void. Behavioural treatments of urgency incontinence lead to changes in brain function that support the working model and suggest the mechanism of this type of treatment.
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Smith PP, Kuchel GA, Griffiths D. Functional Brain Imaging and the Neural Basis for Voiding Dysfunction in Older Adults. Clin Geriatr Med 2015; 31:549-65. [DOI: 10.1016/j.cger.2015.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Lee HS, Choi JG, Shin JH. Urological disturbance and its neuroanatomical correlate in patients with chronic brainstem stroke. Neurourol Urodyn 2015; 36:136-141. [PMID: 26397818 DOI: 10.1002/nau.22889] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/03/2015] [Indexed: 11/12/2022]
Abstract
AIMS Few studies have depicted urological disturbances among patients with chronic brainstem stroke, and little is known about the exact location of the micturition center or its role in humans. The aim of the present study was to retrospectively investigate urological disturbances and their neuroanatomical correlates among consecutively admitted patients with chronic brainstem stroke. METHODS Urodynamic studies, brain images, and urological symptoms questionnaires were reviewed from consecutive patients suffering from brainstem stroke, who had been admitted to a stroke unit at a rehabilitation hospital between June 1, 2013 and January 31, 2015. For further comparison, consecutive data from urodynamic studies of patients with upper cervical spinal cord injury (admitted to a hospital between January 1, 2008 and January 31, 2015) were reviewed. RESULTS Patients with chronic pontine stroke manifested more frequent detrusor underactivity, lower maximal detrusor pressure, and higher compliance than patients with upper cervical spinal cord injury. The most frequently involved lesions associated with detrusor underactivity were located around the central portion of the bilateral pons along the entire sagittal level. Urinary incontinence and symptoms associated with lower urinary tract dysfunction were reported in 10% and 95% of patients with brainstem stroke, respectively. No difference was found between genders or stroke subtypes in patients with brainstem stroke. CONCLUSIONS The present study identified a relationship between chronic pontine stroke and detrusor underactivity. Thus, detrusor underactivity might be associated with lesions localized to central portions of the bilateral pons. The prevalence of lower urinary tract symptoms was also revealed to be high among patients with chronic brainstem stroke. Neurourol. Urodynam. 36:136-141, 2017. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Hye-Sun Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Gangbuk-gu, Seoul, Korea
| | - Jeong Gue Choi
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Gangbuk-gu, Seoul, Korea
| | - Joon-Ho Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Gangbuk-gu, Seoul, Korea
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de Groat WC, Yoshimura N. Anatomy and physiology of the lower urinary tract. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:61-108. [PMID: 26003239 DOI: 10.1016/b978-0-444-63247-0.00005-5] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain, spinal cord, and peripheral autonomic ganglia that coordinates the activity of smooth and striated muscles of the bladder and urethral outlet. Neural control of micturition is organized as a hierarchic system in which spinal storage mechanisms are in turn regulated by circuitry in the rostral brainstem that initiates reflex voiding. Input from the forebrain triggers voluntary voiding by modulating the brainstem circuitry. Many neural circuits controlling the lower urinary tract exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. The major component of the micturition switching circuit is a spinobulbospinal parasympathetic reflex pathway that has essential connections in the periaqueductal gray and pontine micturition center. A computer model of this circuit that mimics the switching functions of the bladder and urethra at the onset of micturition is described. Micturition occurs involuntarily during the early postnatal period, after which it is regulated voluntarily. Diseases or injuries of the nervous system in adults cause re-emergence of involuntary micturition, leading to urinary incontinence. The mechanisms underlying these pathologic changes are discussed.
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Affiliation(s)
- William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Naoki Yoshimura
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Cho HJ, Kang TH, Chang JH, Choi YR, Park MG, Choi KD, Sung SM, Park KP, Jung DS. Neuroanatomical correlation of urinary retention in lateral medullary infarction. Ann Neurol 2015; 77:726-33. [PMID: 25627980 DOI: 10.1002/ana.24379] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 01/14/2015] [Accepted: 01/21/2015] [Indexed: 02/05/2023]
Abstract
We prospectively recruited 10 patients who presented with urinary retention as a neurological deficit that was attributable to lateral medullary infarction. Of these, 9 patients underwent a urodynamic study, which demonstrated detrusor underactivity of the bladder in 7 patients. Urinary retention developed mainly when the lesions involved the lateral tegmentum of the middle or caudal medulla. We concluded that interruption of the descending pathway from the pontine micturition center to the sacral spinal cord in the lateral medulla was responsible for the development of urinary retention.
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Affiliation(s)
- Han-Jin Cho
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan
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Kitta T, Mitsui T, Kanno Y, Chiba H, Moriya K, Shinohara N. Brain-bladder control network: The unsolved 21st century urological mystery. Int J Urol 2015; 22:342-8. [DOI: 10.1111/iju.12721] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 12/13/2014] [Accepted: 12/30/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Takeya Kitta
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine; Hokkaido University; Sapporo Hokkaido Japan
| | - Takahiko Mitsui
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine; Hokkaido University; Sapporo Hokkaido Japan
| | - Yukiko Kanno
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine; Hokkaido University; Sapporo Hokkaido Japan
| | - Hiroki Chiba
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine; Hokkaido University; Sapporo Hokkaido Japan
| | - Kimihiko Moriya
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine; Hokkaido University; Sapporo Hokkaido Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine; Hokkaido University; Sapporo Hokkaido Japan
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Abstract
This article summarizes anatomical, neurophysiological, pharmacological, and brain imaging studies in humans and animals that have provided insights into the neural circuitry and neurotransmitter mechanisms controlling the lower urinary tract. The functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain, spinal cord, and peripheral autonomic ganglia that coordinates the activity of smooth and striated muscles of the bladder and urethral outlet. The neural control of micturition is organized as a hierarchical system in which spinal storage mechanisms are in turn regulated by circuitry in the rostral brain stem that initiates reflex voiding. Input from the forebrain triggers voluntary voiding by modulating the brain stem circuitry. Many neural circuits controlling the lower urinary tract exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. The major component of the micturition switching circuit is a spinobulbospinal parasympathetic reflex pathway that has essential connections in the periaqueductal gray and pontine micturition center. A computer model of this circuit that mimics the switching functions of the bladder and urethra at the onset of micturition is described. Micturition occurs involuntarily in infants and young children until the age of 3 to 5 years, after which it is regulated voluntarily. Diseases or injuries of the nervous system in adults can cause the re-emergence of involuntary micturition, leading to urinary incontinence. Neuroplasticity underlying these developmental and pathological changes in voiding function is discussed.
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Affiliation(s)
- William C. de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
| | - Derek Griffiths
- Department of Medicine (Geriatrics), University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
| | - Naoki Yoshimura
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
- Department of Urology, University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
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Griffiths D. Functional imaging of structures involved in neural control of the lower urinary tract. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:121-33. [PMID: 26003241 DOI: 10.1016/b978-0-444-63247-0.00007-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Recent functional brain imaging studies, building on earlier observations, suggest a working model of brain control of the lower urinary tract. It comprises a few cerebral neural circuits that, during the storage phase, act on the midbrain periaqueductal gray to inhibit the long-loop, spinobulbospinal voiding reflex, thus promoting continence. Circuit 1, centered on the medial prefrontal cortex, appears to be concerned with conscious control of both continence and voiding. Circuit 2, centered on the dorsal anterior cingulate (midcingulate) and supplementary motor area, is concerned with emotional aspects of bladder control: desire to void or urgency with concomitant urethral sphincter activation to delay leakage. A subcortical circuit 3 has been less well studied. Circuit 1 is bilateral with a right-sided preference. Scattered studies of the connectivity of the control network suggest that white-matter damage may contribute to urinary incontinence. A few studies confirm that isolated cerebral lesions, if in the medial prefrontal cortex or its connecting pathways, may lead to incontinence. Lower urinary tract dysfunction in other neurologic diseases (normal-pressure hydrocephalus, Parkinson's disease, and multiple systems atrophy) appears consistent with the working model, and even spinal or peripheral lesions have central effects. However, this model omits the contributions of brain regions already observed in some imaging studies and therefore is certainly oversimplified.
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Affiliation(s)
- Derek Griffiths
- Formerly Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Ferrero SL, Brady TD, Dugan VP, Armstrong JE, Hubscher CH, Johnson RD. Effects of lateral funiculus sparing, spinal lesion level, and gender on recovery of bladder voiding reflexes and hematuria in rats. J Neurotrauma 2014; 32:200-8. [PMID: 25137571 DOI: 10.1089/neu.2013.3247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Deficits in bladder function are complications following spinal cord injury (SCI), severely affecting quality of life. Normal voiding function requires coordinated contraction of bladder and urethral sphincter muscles dependent upon intact lumbosacral reflex arcs and integration of descending and ascending spinal pathways. We previously reported, in electrophysiological recordings, that segmental reflex circuit neurons in anesthetized male rats were modulated by a bilateral spino-bulbo-spinal pathway in the mid-thoracic lateral funiculus. In the present study, behavioral measures of bladder voiding reflexes and hematuria (hemorrhagic cystitis) were obtained to assess the correlation of plasticity-dependent recovery to the degree of lateral funiculus sparing and mid-thoracic lesion level. Adult rats received mid-thoracic-level lesions at one of the following severities: complete spinal transection; bilateral dorsal column lesion; unilateral hemisection; bilateral dorsal hemisection; a bilateral lesion of the lateral funiculi and dorsal columns; or a severe contusion. Voiding function and hematuria were evaluated by determining whether the bladder was areflexic (requiring manual expression, i.e., "crede maneuver"), reflexive (voiding initiated by perineal stroking), or "automatic" (spontaneous voiding without caretaker assistance). Rats with one or both lateral funiculi spared (i.e., bilateral dorsal column lesion or unilateral hemisection) recovered significantly faster than animals with bilateral lateral funiculus lesions, severe contusion, or complete transection. Bladder reflex recovery time was significantly slower the closer a transection lesion was to T10, suggesting that proximity to the segmental sensory and sympathetic innervation of the upper urinary tract (kidney, ureter) should be avoided in the choice of lesion level for SCI studies of micturition pathways. In addition, hematuria duration was significantly longer in males, compared to females, despite similar bladder reflex onset times. We conclude that the sparing of the mid-thoracic lateral funiculus on one side is required for early recovery of bladder reflex voiding function and resolution of hematuria.
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Affiliation(s)
- Sunny L Ferrero
- 1 Department of Physiological Sciences, University of Florida College of Veterinary Medicine , Gainesville, Florida
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