Focus on afferent sensory nervous pathways of the lower urinary tract after SCI. Tribute to Sir Ludwig Guttmann.

Abstract

Study design: Narrative Review.

Objectives: To focus on the knowledge on afferent sensory nervous pathways related to the lower urinary tract (LUT), in individuals with spinal cord injury (SCI).

Methods: We made a narrative review in which are summarized different primary studies from which conclusions may be drawn in a systematic way and from a holistic point of view, contributed by researcher's own experience and existing theories.

Results: The knowledge on sensation in the LUT has grown during the last decade: advances in the basic science of bladder sensing relating to (a) the bladder wall-urothelial cells, sensory nerves, interstitial cells, and smooth muscle cells and (b) putative chemo/mechanosensors in the urethra-paraneurons or "brush cells" have helped to enlighten the different sensations related to bladder filling and voiding. Clinically there are diverse ways to evaluate the sensory function after SCI. After SCI, most patients retain the ability to be aware of the LUT, through bladder filling sensations, the feeling of passage through the urethra, pain and feeling unstable bladder contractions. They relate to different spinal afferent pathways, and their investigations permit valuable information on the spinal cord's condition and the completeness of its disruption. Therapeutic advantages to be explored may be to train the sensation awareness, to guide the frequency of CIC, to better determine the role of sacral stimulation.

Conclusion: The knowledge on pelvic afferent sensory nervous pathways of the LUT after SCI, offers important diagnostic and therapeutic data.