New Understanding of Central and Peripheral Interaction between Bladder and Sphincter Function

Abstract

The lower urinary tract provides two functional modes of operation, the storage of urine over several hours and periodical micturition without residual urine. For appropriate urine storage and voluntary controlled voiding at socially accepted circumstances precise steering mechanisms are necessary which basically rely on the neuronal interaction of somatic and autonomic pathways in the peripheral and central nervous system. In normal condition, a close connection between afferent and efferent, spinal and supraspinal as well as somatic and autonomic pathways ensures a coordinated activation and deactivation of reflex pathways thus promoting continence during the storage phase and successful micturition. If neurological lesion damages pathways involved in lower urinary tract control, disturbance of interaction and coordination may occur and phenomenons like detrusor-sphincter dyssynergia may lead to impaired function of the entire urinary tract.