Skip to main content
Log in

Neuronal circuitry of the lower urinary tract; central and peripheral neuronal control of the micturition cycle

  • Review Article
  • Published:
Anatomy and Embryology Aims and scope Submit manuscript

Abstract

A new presentation technique is introduced to describe the neuronal circuitry involved in the control of the uropoëtic system and its control mechanisms during the micturition cycle. This method is based on the preparation of flow charts and is applied to the discussion of four qualitative models which are derived from the literature. Opinions concerning the reflex arcs and supraspinal connections said to be involved in micturition and continence are different and sometimes contradictory. Little is known about how autonomic information from the lower urinary tract is relayed to supraspinal structures. Information about supraspinal (inter)connections and their function in micturition control is still fragmentary. The control mechanisms which terminate voiding are not totally clear. Moreover, the role of the pelvic floor musculature in the control of the lower urinary tract is probably underestimated. The flow charts presented in this paper contribute to the future design of a single complete qualitative model representing the general central and peripheral nervous connections and control mechanisms. Such a model would provide an approach for future research in neuromodulation and neurostimulation of the uropoëtic system and a reduced version could be used for quantitative modelling, e.g. in neural network simulations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Andersson KE (1986) Clinical relevance of some findings in neuroanatomy and neurophysiology of the lower urinary tract. Clin Sci 70 [Suppl 14]:21–32

    Google Scholar 

  • Awad SA, Bruce AW, Carro-Ciampi G, Downie JW, Lin M, Marks GS (1974) Distribution of alpha and beta adrenoceptors in human urinary bladder. Br J Pharmacol 50:525–529

    Google Scholar 

  • Baijet B (1981) The innervation of the abdominal, pelvic and adjoining viscera in the female. Thesis, University of Amsterdam

  • Baljet B, Drukker J (1979) The extrinsic innervation of the pelvic organs in the female rat. Acta Anat 107:241–267

    Google Scholar 

  • Blaivas JG (1982) The neurophysiology of micturition: a clinical study of 550 patients. J Urol 127:958–963

    Google Scholar 

  • Blaivas JG (1985) Pathophysiology of lower urinary tract dysfunction. Clin Obstet Gyneacol 12:295–309

    Google Scholar 

  • Blaivas JG (1990) Mechanisms of micturition. In: Chisholm GD, Fair WR (eds) Scientific foundations of urology, 3rd edn. Heinemann, Oxford, pp 273–286

    Google Scholar 

  • Bradley WE (1969a) Micturition reflex amplification. J Urol 101:403–407

    Google Scholar 

  • Bradley WE (1969b) Regulation of the micturition reflex by negative feedback. J Urol 101:400–402

    Google Scholar 

  • Bradley WE (1978) Innervation of the male urinary bladder. Urol Clin North Am 5:279–293

    Google Scholar 

  • Bradley WE, Conway CJ (1966) Bladder representation in the pontine-mesencephalic reticular formation. Exp Neurol 16:237–244

    Google Scholar 

  • Bradley WE, Teague CT (1968a) The pelvic ganglia. J Urol 100:649–652

    Google Scholar 

  • Bradley WE, Teague CT (1968b) Spinal cord organization of micturition reflex afferents. Exp Neurol 22:504–516

    Google Scholar 

  • Bradley WE, Teague CT (1969a) Cerebellar influence on the micturition reflex. Exp Neurol 23:399–411

    Google Scholar 

  • Bradley WE, Teague CT (1969b) Hypogastric and pelvic nerve activity during the micturition reflex. J Urol 102:438–440

    Google Scholar 

  • Bradley WE, Teague CT (1969c) Cerebellar regulation of the micturition reflex. J Urol 101:396–399

    Google Scholar 

  • Bradley WE, Teague CT (1969d) Spinal cord representation of the peripheral neural pathways of the micturition reflex. J Urol 101:220–223

    Google Scholar 

  • Bradley WE, Timm GW, Scott FB (1974) Innervation of the detrusor muscle and urethra. Urol Clin North Am 1:3–27

    Google Scholar 

  • Coote JH, Fleetwood-Walker SM, Gilbey MP, Peterson DF (1982) Possible role of oxytocin, vasopression and the paraventriculospinal pathway in the regulation of sympathetic preganglionic neurons. J Physiol 324:81P

    Google Scholar 

  • De Groat WC (1975) Nervous control of the urinary bladder of the cat. Brain Res 87:201–211

    Google Scholar 

  • De Groat WC, Booth AM, Krier J (1979a) Interaction between sacral parasympathetic and lumbar sympathetic inputs to pelvic ganglia. In: Brooks CMcC, Koizumi K, Sato A (eds) Integrative functions of the autonomic nervous system. Tokyo University Press, Tokyo, pp 234–247

    Google Scholar 

  • De Groat WC, Booth AM, Krier J, Milne RJ, Morgan C, Nadelhaft I (1979b) Neural control of the urinary bladder and large intestine. In: Brooks CMcC, Koizumi K, Sato A (eds) Integrative functions of the autonomic nervous system. Tokyo University Press, Tokyo, pp 50–67

    Google Scholar 

  • De Groat WC, Lalley PM (1972) Reflex firing in the lumbar sympathetic outflow to activation of vesical afferent fibres. J Physiol 226:289–309

    Google Scholar 

  • De Groat WC, Saum WR (1971) Adrenergic inhibition in mammalian para-sympathetic ganglia. Nature 231:188–189

    Google Scholar 

  • De Groat WC, Steers WD (1990) Autonomic regulation of the urinary bladder and sexual organs. In: Loewy AD, Spyer KM (eds) Central regulation of autonomic functions. University Press, Oxford, pp 310–323

    Google Scholar 

  • Dixon J, Gosling J (1987) Structure and innervation in the human. In: Torrens MJ, Morrison JFB (eds) The physiology of the lower urinary tract. Springer, Berlin Heidelberg New York, pp 3–22

    Google Scholar 

  • Donker PJ (1986) A study of myelinated fibres in the branches of the pelvic plexus. Neurourol Urodynamics 5:185–202

    Google Scholar 

  • Donker PJ, Dröes JTPM, Van Ulden BM (1982) Anatomy of the musculature and innervation of the bladder and urethra. In: Chisholm GD, Williams DI (eds) Scientific foundations of urology. Chicago Yearbook, Chicago, pp 404–411

    Google Scholar 

  • Dröes JTPM (1972) De musculatuur van blaas en urethra in de menselijke foetus. Thesis, Leiden University of Leiden

    Google Scholar 

  • Elbadawi A (1984) Ultrastructure of vesicourethral innervation. II. Postganglionic axoaxonal synapses in intrinsic innervation of the vesicourethral lissosphincter: a new structural and functional concept in micturition. J Urol 131:781–790

    Google Scholar 

  • Elbadawi A (1987a) Comparative neuromorphology in animals. In: Torrens MJ, Morrison JFB (eds) The physiology of the lower urinary tract. Springer, Berlin Heidelberg New York, pp 23–52

    Google Scholar 

  • Elbadawi A (1987b) Neuromuscular mechanisms of micturition. In: Yalla SV, McGuire EJ, Elbadawi A, Blaivas JG (eds) The principles and practice of neurourology and urodynamics. Macmillan, London, pp 3–35

    Google Scholar 

  • Elbadawi A (1991) Anatomy and innervation of the vesicourethral muscular unit of micturition. In: Krane RJ, Siroky MB (eds) Clinical neuro-urology, 2nd edn. Little, Brown & Co, Boston, pp 5–23

    Google Scholar 

  • Fletcher TF, Bradley WE (1978) Neuroanatomy of the bladderurethra. J Urol 119:153–160

    Google Scholar 

  • Fowler CJ, Fowler C (1987) Clinical neurophysiology. In: Torrens MJ, Morrison JFB (eds) The physiology of the lower urinary tract. Springer, Berlin Heidelberg New York, pp 89–131

    Google Scholar 

  • Gosling JA (1985) Structure of the lower urinary tract and pelvic floor. Clin Obstet Gynecol 12:285–301

    Google Scholar 

  • Gosling JA, Dixon JS, Humpherson JR (1983) Gross and microscopic anatomy of the urethra, I and II. In: Gosling JA, Dixon JS, Humpherson JR (eds) Functional anatomy of the urinary tract. Churchill Livingstone, Edinburgh London New York, pp 4.1–5.20

    Google Scholar 

  • Griffiths D, Holstege G, Dalm E, De Wall H (1990) Control and coordination of bladder and urethral function in the brain stem of the cat. Neurourol. Urodynamics 9:63–82

    Google Scholar 

  • Hald T, Bradley WE (1982a) Neuroanatomy. In: Hald T, Bradley WE (eds) The urinary bladder, neurology and dynamics. Williams & Wilkins, Baltimore, pp 5–21

    Google Scholar 

  • Hald T, Bradley WE (1982b) Neurophysiology of the urinary bladder. In: Hald T, Bradley WE (eds) The urinary bladder, neurology and dynamics. Williams & Wilkins, Baltimore, pp 22–36

    Google Scholar 

  • Hickey DS, Phillips JI, Hukins DWL (1982) Arrangements of collagen fibrils and muscle fibres in the female urethra and their implications for the control of micturition. Br J Urol 54:556–561

    Google Scholar 

  • Holstege G (1989) Neuronal organization of micturition. In: Lower urinary tract dysfunction: from all to clinical approach. Micro symposium Erasmus University Rotterdam, Rotterdam

    Google Scholar 

  • Holstege G, Griffiths D (1990) Neuronal organization of micturition. In: Paxinos G (ed) The human nervous system. Academic Press, New York London, pp 297–306

    Google Scholar 

  • Marani E, Pijl MEJ, Kraan MC, Lyckama à Nijeholt GAB, Videleer AC (1993) Interconnections of the upper ventral rami of the human sacral plexus: a reappraisal for dorsal rhizotomy in neurostimulation operations. Neurourol Urodynamics 12:585–598

    Google Scholar 

  • Morrison JFB (1987a) Neural connections between the lower urinary tract and the spinal cord. In: Torrens MJ, Morrison JFB (eds) The physiology of the lower urinary tract. Springer, Berlin Heidelberg New York, pp 53–85

    Google Scholar 

  • Morrison JFB (1987b) Sensations arising from the lower urinary tract. In: Torrens MJ, Morrison JFB (eds) The physiology of the lower urinary tract. Springer, Berlin Heidelberg New York, pp 89–131

    Google Scholar 

  • Morrison JFB (1987c) The functions of efferent nerves to the lower urinary tract. In: Torrens MJ, Morrison JFB (eds) The physiology of the lower urinary tract. Springer, Berlin Heidelberg New York, pp 133–159

    Google Scholar 

  • Morrison JFB (1987d) Reflex control of the lower urinary tract. In: Torrens MJ, Morrison JFB (eds) The physiology of the lower urinary tract. Springer, Berlin Heidelberg New York, pp 193–235

    Google Scholar 

  • Morrison JFB (1987e) Bladder control: role of higher levels of the central nervous system. In: Torrens MJ, Morrison JFB (eds) The physiology of the lower urinary tract. Springer, Berlin Heidelberg New York, pp 237–274

    Google Scholar 

  • Raz S (1978) Pathophysiology of male incontinence. Urol Clin North Am 5:295–304

    Google Scholar 

  • Sato A, Sato Y, Schmidt RF (1979) Somatic afferents and their effect on bladder function. In: Brooks CMcC, Koizumi K, Sato A (eds) Integrative functions of the autonomic nervous system. Tokyo University Press, Tokyo, pp 309–318

    Google Scholar 

  • Tanagho EA, Schmidt RA, Araujo GG de (1982) Urinary striated sphincter: what is its nerve supply? Urology 20:415–417

    Google Scholar 

  • Van Arsdalen K, Wein AJ (1991) Physiology of micturition and continence. In: Krane RJ, Siroky MB (eds) Clinical neurourology, 2nd edn. Little, Brown and Co, Boston, pp 25–82

    Google Scholar 

  • Van Ulden BM (1975) De musculatuur van de blaashals en de urethra posterior bij de man. Thesis, Leiden University, Leiden

    Google Scholar 

  • Venema (1988) De klinische betekenis van de instabiele urethra van de vrouw. Thesis, Leiden University, Leiden

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kinder, M.V., Bastiaanssen, E.H.C., Janknegt, R.A. et al. Neuronal circuitry of the lower urinary tract; central and peripheral neuronal control of the micturition cycle. Anat Embryol 192, 195–209 (1995). https://doi.org/10.1007/BF00184744

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00184744

Key words

Navigation