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2015 ; 5
(1
): 327-96
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Neural control of the lower urinary tract
#MMPMID25589273
de Groat WC
; Griffiths D
; Yoshimura N
Compr Physiol
2015[Jan]; 5
(1
): 327-96
PMID25589273
show ga
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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