Nervous lesions affecting the innervation of the lower urinary tract (LUT) cause different dysfunctions depending mainly on the location of the lesion, its extent, the underlying neurological pathology and the changes in the LUT occurring during the course of the neurological disease. Lesions are categorized into (1) cerebral, suprapontine and pontine lesions; (2) spinal suprasacral lesions; and (3) subsacral, peripheral nerve lesions.
The net effect of the suprapontine areas of the brain on the micturition reflex is inhibitory. Lesions in the relevant areas cause symptoms of the overactive bladder. If the lesion is localized above the pontine micturition center (PMC)/periaqueductal grey (PAG), voiding remains coordinated.
A spinal cord lesion above the lumbosacral level, depending on completeness of the lesion, may eliminate (complete lesions) or at least reduce (incomplete lesions) voluntary control of micturition leading to neurogenic spinal detrusor overactivity mediated by spinal reflex pathways with important disadvantages.
Patients with complete conus/cauda equina or pelvic plexus injury are neurologically decentralized but may not be completely denervated as afferent and efferent neuron interconnections at the level of the intramural ganglia in the detrusor muscle are possible.
Therefore, lesions of the innervation of the LUT, detrusor and sphincter may become overactive or underactive (acontractile) depending on the location and extent of the lesion. Mostly the detrusor and sphincter are affected, mostly of the same type, but also differently, even normal function of the counterpart is possible. The same urodynamic pattern may have different clinical implications.
Cerebral lesions and LUTS Spinal cord lesions and LUTS Peripheral nerve lesions and LUTS Neuropathology of LUTS
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