Influence of the sympathetic nervous system on the lower urinary tract and its clinical implications

Norlén, Lars

doi:10.1002/nau.1930010204

Cited by 20 publications

(5 citation statements)

References 101 publications

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“…DS was also confirmed in the refluxing ureter of spinal subjects confirming neural control in the function of UVJ [13]. All these clinical findings are compatible with contemporary basic studies which unfolded intricate innervation pattern of lower urinary tract distinctly different from the traditional one [14,15].…”

Section: Sympathetic Innervation Of the Lower Urinary Tractsupporting

confidence: 83%

A LIFE IN UROLOGY: Privilege, Obligation and Reward

2020

Integr J Nephro Urol Stud

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Section: Sympathetic Innervation Of the Lower Urinary Tractsupporting

confidence: 83%

A LIFE IN UROLOGY: Privilege, Obligation and Reward

2020

Integr J Nephro Urol Stud

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“…The cause for this spontaneous activity remains unclear; it may well be related to failure of autonomic control, evidenced by sudden losses of internal sphincter tone. 34,47 The study of vesical wall thickness helped to ascertain the existence of a progressive increase throughout the disease (Table IV), male patients being more affected than female patients (M:16; F:7). We also observed that patients with dysuria presented more frequent vesical wall thickening, which points to the existence of hypertrophy to balance the likely functional obstruction.…”

Section: Ultrasonographic Datamentioning

confidence: 99%

Lower urinary tract dysfunction in familial amyloidotic polyneuropathy, Portuguese Type

Andrade¹

2008

Neurourology and Urodynamics

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In addition to reduced sensation, underactive detrusor, opening of the vesical neck and external sphincter deficit, we found data suggesting failure of relaxation of the internal and external sphincter. The overdistention associated with an open vesical neck and external sphincter deficit justifies incontinence in those patients. The retention is due to inadequate contraction of the detrusor, probably associated with non-relaxing of the internal and external sphincter. These dysfunctions derive from deposition of amyloid substance in the detrusor, but overdistention is likely to play a role. Early therapeutic intervention in these patients is vital to avoid secondary injuries.

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“…They speculated that these changes lead to an adrenergically mediated hyperactivity of the detrusor smooth muscle. The reduction by phenoxybenzamine of autonomous bladder activity in patients provided further support for this hypothesis (Norlen, 1976(Norlen, , 1982Sundin et al 1977;Norlen & Sundin, 1978).…”

mentioning

confidence: 91%

“…Lumbar sympathetic pathways present in the hypogastric nerves ( Fig. 1) and sympathetic chain provide an inhibitory input to the detrusor muscle and bladder ganglia and an excitatory input to the bladder neck and urethra (Kuru, 1965;de Sy, Lacroix & Leusen, 1974;Norlen, 1982;Kuo, Hisamitsu & de Groat, 1984).…”

mentioning

confidence: 99%

“…In addition reinnervation of denervated parasympathetic ganglion cells by sympathetic preganglionic axons and sprouting of adrenergic and cholinergic postganglionic nerves (Carpenter, 1951;Carpenter & Root, 1951;Ekstr6m & Elmer, 1980;Yokota & Burnstock, 1983;Ekstrom & Malmberg, 1984; is also likely to be important. These changes would be expected to produce marked alterations in bladder activity and contribute to the development of the autonomous hyperactive bladder condition which is seen in patients with injuries or congenital abnormalities of the sacral autonomic pathways (Norlen, 1976;Sundin et al 1977;Norlen & Sundin, 1978;Norlen, 1982). In addition, the conversion of sympathetic efferent influences on the bladder from primarily inhibitory to excitatory would in turn convert spinal vesicosympathetic reflex mechanisms which mediate a negative feed-back control of bladder activity (de Groat & Lalley, 1972;de Groat & Theobald, 1976) to a positive feed-back mechanism that could increase detrusor activity and in turn increase baseline intravesical pressure.…”

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confidence: 99%

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Reorganization of sympathetic preganglionic connections in cat bladder ganglia following parasympathetic denervation.

Groat

Kawatani

1989

The Journal of Physiology

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SUMMARY1. Experiments were undertaken to examine the mechanisms involved in the reorganization of sympathetic efferent pathways to the urinary bladder of the cat following chronic unilateral, parasympathetic preganglionic denervation of the bladder.2. Electrical stimulation (10-30 Hz) of the hypogastric nerve in cats with an intact bladder innervation or on the normally irpnervated side of the bladder in unilaterally denervated preparations elicited low-amplitude (10-25 cmH20) transient (10-30 s) bladder contractions and non-synaptic axonal volleys on bladder postganglionic nerves. However, after chronic (3-22 months) sacral preganglionic denervation, hypogastric nerve stimulation on the side of the denervation elicited large (60-80 cmH2O) and more sustained (4-5 min) bladder contractions as well as synaptically mediated firing on bladder postganglionic nerves. 3. The vesicoexcitatory effects of hypogastric nerve stimulation on the chronically denervated side were not altered selectively by the adrenergic blocking agent, phenoxybenzamine, but were blocked by atropine and hexamethonium suggesting that the responses were mediated by muscarinic and nicotinic cholinergic synapses. These drugs did not influence the responses elicited by hypogastric nerve stimulation on the normally innervated side of the bladder.4. Following more extensive chronic unilateral denervation (transection of the pelvic and hypogastric nerves on one side of the bladder) stimulation of the contralateral intact pelvic nerve elicited postganglionic firing in vesical postganglionic nerves on the denervated side. This crossed excitatory pathway was not observed in normal animals or following sacral preganglionic denervation.5. It is concluded that parasympathetic preganglionic denervation of the bladder ganglia leads to a reinnervation of the denervated cholinergic ganglion cells by sympathetic preganglionic pathways in the ipsilateral hypogastric nerve. This reinnervation results in the conversion of sympathetic inhibitory pathways to excitatory pathways in the denervated bladder. This change may contribute to the development of the autonomous hyperactive bladder seen under conditions of peripheral nerve or conus medullaris lesions of the spinal cord.

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Influence of the sympathetic nervous system on the lower urinary tract and its clinical implications

Cited by 20 publications

References 101 publications

A LIFE IN UROLOGY: Privilege, Obligation and Reward

A LIFE IN UROLOGY: Privilege, Obligation and Reward

Lower urinary tract dysfunction in familial amyloidotic polyneuropathy, Portuguese Type

Reorganization of sympathetic preganglionic connections in cat bladder ganglia following parasympathetic denervation.

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