Neural control of the urethra and development of pharmacotherapy for stress urinary incontinence
- 17 April 2003
- journal article
- review article
- Published by Wiley in BJU International
- Vol. 91 (8), 743-748
- https://doi.org/10.1046/j.1464-410x.2003.04161.x
Abstract
This review discusses the control of the urethra by the central nervous system, emphasizing the importance of nervous system control and the role of serotonin and noradrenaline in storage, micturition and sphincter reflexes. The concept of pharmacological neuromodulation and the use of pharmacological therapy as first‐line therapy for stress urinary incontinence (SUI) is presented. Coordination between the urinary bladder and urethra is mediated by many reflex pathways organized in the brain and spinal cord. During bladder filling, activation of mechanoreceptor afferent nerves in the bladder wall triggers firing in the cholinergic efferent pathways to the external urethral sphincter and in sympathetic adrenergic pathways to the urethral smooth muscle. These storage reflexes depend on interneuronal circuitry in the spinal cord and are modulated by descending pathways. It would therefore seem that neurotransmission in the central nervous system and periphery may be important in SUI, and moreover that pharmacological agents affecting these neurotransmitter pathways may be used to treat SUI. The central and peripheral mechanisms of action of duloxetine affect serotonin and noradrenaline neurotransmission in ways that may ameliorate the symptoms of SUI.Keywords
This publication has 47 references indexed in Scilit:
- The effects of birth on urinary continence mechanisms and other pelvic-floor characteristics*1Obstetrics & Gynecology, 1998
- Sympathetic efferent pathways projecting to the bladder neck and proximal urethra in the ratJournal of the Autonomic Nervous System, 1997
- Neurons in the rat brain and spinal cord labeled after pseudorabies virus injected into the external urethral sphincterJournal of Comparative Neurology, 1996
- Transneuronal labeling of neurons in the adult rat brainstem and spinal cord after injection of pseudorabies virus into the urethraJournal of Comparative Neurology, 1995
- Topographical Relation between Serotonin-Containing Paraneurons and Peptidergic Neurons in the Intestine and UrethraNeurosignals, 1994
- Unmasking of a neonatal somatovesical reflex in adult cats by the serotonin autoreceptor agonist 5-methoxy-N,N-dimethyltryptamineDevelopmental Brain Research, 1990
- Organization of afferent and efferent pathways in the pudendal nerve of the female catJournal of Comparative Neurology, 1989
- The role of pudendal nerve damage in the aetiology of genuine stress incontinence in womenBJOG: An International Journal of Obstetrics and Gynaecology, 1989
- Perineal Nerve Damage in Genuine Stress Urinary Incontinence; An Electrophysiological StudyBritish Journal of Urology, 1985
- Central distribution of afferent and efferent components of the pudendal nerve in catJournal of Comparative Neurology, 1984