The sensory bladder (1): An update on the different sensations described in the lower urinary tract and the physiological mechanisms behind them

Impact of Intravesical Cold Sensation on Functional Network Connectivity Estimated Using ICA at Rest & During Interoceptive Task

Afferent nerves that carry interoceptive signals from the viscera to the brain include Aδ and C-fibers. Previously, we examined the effects of detrusor distention (conveyed mainly by Aδ fibers) on the static functional network connectivity (FNC) of the brain using independent component analysis (ICA) of fMRI time series. In the present study, we investigate the impact of intravesical cold sensation (thought to be conveyed by C-fibers) on brain FNC using similar ICA approach. Thirteen healthy women were scanned on a 3.0T MRI scanner during a resting state scan and an intravesical cold sensation task fMRI. High dimensional ICA (n = 75) were used to decompose the fMRI data into several intrinsic connectivity networks (ICNs) including the default-mode (DMN), subcortical (SCN; amygdala, thalamus), salience (SN), central executive (CEN), sensorimotor (SMN), and cerebellar/brainstem (CBN) networks. Results demonstrate significant FNC differences in several ICN pairs primarily between the SCN and cognitive networks such as CEN, as well as between SN and CBN and DMN when intravesical cold water condition was compared to rest (FDR-corrected p-value of 0.05). Significant increases in FNC between CBN and between SMN were also observed during interoceptive condition. The results indicate significant impact of Aδ and C-fiber-originated interoceptive signals on the brain connectivity when compared to the baseline rest.

Acute bladder decentralization in hound dogs: Preliminary results of effects on hypogastric nerve electroneurograms and detrusor pressure responses to spinal root and hypogastric nerve stimulation

OBJECTIVE

We aimed to refine electroneurogram techniques for monitoring hypogastric nerve activity during bladder filling, and then examined nerve activity in normal intact versus acutely decentralized bladders.

METHODS

Effects of electrical stimulation of hypogastric nerves or lumbar ventral roots on detrusor pressure were examined, as were effects of isoflurane versus propofol anesthetics on hypogastric nerve stimulation evoked pressure. Hypogastric nerve activity was then recorded using custom-made bipolar cuff electrodes during bladder filling before and after its transection between the spinal cord and electrode to eliminate efferent nerve signals.

RESULTS

Electrical stimulation of hypogastric nerves evoked low amplitude detrusor pressures that did not differ between the two anesthetics. Upper lumbar (L2) ventral root stimulation evoked detrusor pressures were suppressed, yet not eliminated, after transection of hypogastric nerves and all spinal roots below L5. Afferent and efferent hypogastric nerve activity did not change with bladder filling in neuronally intact bladders yet decreased in decentralized bladders. No change in afferent activity was observed during bladder filling in either intact or decentralized bladders.

CONCLUSIONS

These findings indicate that a more complete decentralized bladder model should include transection of lumbosacral spinal roots innervating the bladder as well as hypogastric nerves. These refined electroneurogram recording methods may be suitable for evaluating the effectiveness of nerve transfer surgeries for bladder reinnervation by monitoring sensory activity in the transferred nerve.

[The ice water test and bladder cooling reflex. Physiology, pathophysiology and clinical importance]

BACKGROUND

Urodynamic studies are utilised for identification and follow-up of functional disorders of the lower urinary tract. Provocation tests are used to determine disorders which could not be revealed in standard cystometry. The ice water test is a simple test to identify neurogenic bladder dysfunction and to screen the integrity of the upper motor neuron in neurogenic bladder dysfunction.

OBJECTIVES

Development and significance of the ice water test is presented in this review against the background of physiology and pathophysiology of the lower urinary tract.

MATERIALS AND METHODS

A systematic review of PubMed and ScienceDirect databases was performed in April 2015. No language or time limitation was applied. The following key words and Medical Subject Heading terms were used to identify relevant studies: "ice water test", "bladder cooling reflex", "micturition" and "neuronal control". Review articles and bibliographies of other relevant studies identified were hand searched to find additional studies.

RESULTS

The ice water test is performed by rapid instillation of 4-8 °C cold fluid into the urinary bladder. Hereby, afferent C fibers are activated by cold receptors in the bladder leading to the bladder cooling reflex. It is a spinal reflex which causes an involuntarily contraction of the urinary bladder. The test is normally positive in young infants during the first 4 years of life and become negative with maturation of the central nervous system afterwards by inhibition of the reflex. The damage of the upper motor neuron causes the recurrence of the reflex in the adulthood and indicates spinal and cerebral lesions.

DISCUSSION

The ice water test is utilised to identify lesions of the upper motor neuron. However, in the case of detrusor acontractility the test will always be negative and can not be utilized to distinguish between neurogenic or muscular causes. Furthermore, the test is also positive in a small percentage of cases of non-neurogenic diseases, e.g. in prostate-related bladder outlet obstruction or idiopathic overactive bladder. Although no clear explanation exists, a positive ice water test could be the first sign of an otherwise asymptomatic neurological disease.

CONCLUSIONS

Due to the simple procedure, the ice water test is a reliable possibility to identify neurologic bladder hyperactivity subsequent to standard cystometry.

The supraspinal neural correlate of bladder cold sensation--an fMRI study

In recent years, functional imaging studies have revealed a supraspinal network, which is involved in perception and processing of bladder distention. Very little information exists on the cortical representation of C-fiber transmitted temperature sensation of the human bladder, although C-fibers seem to be involved in the pathomechanisms of bladder dysfunctions. Our aim was, therefore, to evaluate the outcome of bladder cold stimulation on supraspinal activity using functional magnetic resonance imaging (fMRI). A block design fMRI study was performed in 14 healthy females at the MR-center of the University of Zurich. After catheterization, all subjects were investigated in a 3.0-Tesla Scanner. The scanning consisted of 10 repetitive cycles. Each cycle consisted of five conditions: REST, INFUSION, SENSATION, DRAIN 1, and DRAIN 2. Cold saline was passively infused at 4-8°C during scanning. Not more than 100 ml were infused per cycle. Blood-oxygen-level-dependent (BOLD) signal analysis of the different conditions was compared to REST. All activations were evaluated on a random effects level at P = 0.001. Activation of brain regions for bladder cold stimulation (DRAIN 1 period) was found bilaterally in the inferior parietal lobe [Brodmann area (BA) 40], the right insula (BA 13), the right cerebellar posterior lobe, the right middle temporal gyrus (BA 20), and the right postcentral gyrus (BA 3). In conclusion, bladder cooling caused a different supraspinal activation pattern compared to what is known to occur during bladder distention. This supports our hypothesis that cold sensation is processed differently from bladder distension at the supraspinal level.

Changes in bladder innervation in a mouse model of Alzheimer's disease

AIM

The aims of this study were to compare the structure of bladders from a transgenic mouse model of Alzheimer's disease with age matched control animals and to explore the idea that any structural differences might be related to functional bladder changes associated with the condition.

MATERIALS AND METHODS

Two groups of mice were used. Transgenic animals in which the murine Amyloid Precursor Protein (APP) gene has been partly replaced by the human APP including both the Swedish and London mutations and that overexpress a mutant of the human Presenilin 1 gene (PS1M146L) driven by the PDGF promoter. The transgenic mice (App(SL)/PS1(M146L)) aged 24+/-3 months were used. The second group was an age matched control group of C57 black mice. The bladders from each group were isolated, fixed in 4% paraformaldehyde and prepared for immunohistochemistry. Antibodies to the vesicular acetylcholine transporter (VAChT) and neuronal nitric oxide synthase (nNOS) were used to identify neural structures.

RESULTS

Cholinergic nerves (VAChT(+)) were observed in the inner and outer muscle bundles of App(SL)/PS1(M146L) and control mice. No major differences were noted in the distribution of these fibres. In contrast, there was a distinct difference in the innervation of the sub-urothelial layer. In App1(SL)/PS1(M146L) mice there were numerous VAChT and nNOS positive fibres in sharp contrast to the paucity of similar nerves in control animals. VAChT and nNOS did not appear to co-localise in the same nerve fibres within the lamina propria. Pairs of nerve fibres, nNOS(+) and VAChT(+), were observed to be intertwined and run in close proximity. A particularly unusual feature of the App(SL)/PS1(M146L) mouse bladder was the presence of neurones within the bladder wall. These nerve cell bodies were seen in all App(SL)/PS1(M146L) mouse bladders. The neurones could be found singly or in small ganglion like groups of cells and were located in all layers of the bladder wall (sub-urothelium, in the lamina propria adjacent to the inner muscle and within the inner muscle and outer muscle layers). No nerve cells or small ganglia were noted in any of the control bladders studied.

CONCLUSIONS

There are structural differences in the bladders of App(SL)/PS1(M146L) mice compared to control animals. These differences are associated with sub-urothelial nerves which, because of their location, are likely to be sensory fibres. This may lead to a changed sensory processing from the App(SL)/PS1(M146L) bladders. The physiological role of the intra-mural neurones and ganglia is not known. It is speculated that they may be associated with peripheral motor/sensory mechanisms linked to the generation and modulation of sensation.