Ciba Foundation Symposium 151 - Neurobiology of Incontinence by CIBA Foundation Symposium

By CIBA Foundation Symposium

Incontinence is a truly universal and sometimes devastating challenge, yet one who is going mostly unacknowledged. as a way to elucidate the underlying mechanisms of this significant medical situation, this symposium introduced jointly neuroscientists engaged on the fundamental biology of the bladder and bowel and clinicians facing many of the manifestations of urinary and fecal incontinence. The ensuing assurance is huge and contains papers at the innervation and useful anatomy of the urinary tract and anorectal zone, and the principal neural keep watch over of those components. different contributions speak about the practical review of the anorectum and bladder, pressure incontinence and the neurogenic speculation of incontinence, detrusor-external sphincter dyssynergia, and pharmacological and surgical ways to remedy.

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During urine elimination a high level of afferent activity activates efferent input to the bladder. 30 de Groat as incontinence. This paper will review anatomical and physiological studies in animals that have provided insights into the reflex pathways and transmitters involved in the neural control of micturition. Anatomy and innervation of the lower urinary tract The storage and periodic elimination of urine are dependent upon the activity of two functional units in the lower urinary tract: (1) a reservoir (the urinary bladder) and (2) an outlet consisting of bladder neck, urethra and striated muscles of the urethral sphincter.

De Groat: Yes. That implies that the mechanism described by Dr Fowler is probably important, and probably the first event; but these experiments by Lapides suggest that there may also be a cerebral voluntary control of the visceral pathways but that this control may be slower. Fowler: Surely in the curarized patients one simply did not see the effect in the periphery, because neuromuscular transmission was blocked? This doesn’t mean that an inhibitory drive on the anterior horn cells didn’t initiate the whole reflex arc.

Afferent axons innervating the urinary tract are present in the three sets of nerves (de Groat 1986, Janig & Morrison 1986). The most important afferents for initiating micturition are those passing in the pelvic nerve to the sacral spinal cord (Kuru 1965). These afferents are small myelinated (Ah) and unmyelinated ( C ) fibres which convey impulses from tension receptors in the bladder wall to neurons in laminae I, V, VII and X of the spinal cord (Figs. 4 & 5) (Morgan et a1 1981). Ad bladder afferents in the cat respond in a graded manner to passive distension as well as active contraction of the bladder (Janig & Morrison 1986) and exhibit pressure thresholds in the range of 5-15 mmHg, which are similar to those pressures at which humans report the first sensation of bladder filling.

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