Fundamentals of the Neuroanatomy of the Lower Urinary Tract

Abstract

The lower urinary tract receives exitatory and inhibitory input from sympathetic, parasympathetic and somatic efferent nerve fibres. Furthermore, afferent C- and A-delta fibres ensure the flow of sensory information from the periphery to the central nervous system. The control of urine storage and voiding is hierarchically organised and is implemented at various levels. Cortical and diencephal influences on the pontine micturition centre control continence and micturition via sympathetic and parasympathetic or somatic spinal reflex arcs. Feedback is ensured by sensory nerve fibres reacting to stretch condition (A fibres) and noxious substances (C fibres) in the area of the detrusor and the urethra. Fine regulation of the central nervous activity is effected in the visceral autonomous ganglia, the ganglion mesentericum inferius and the plexus pelvicus, as well as in the intramural ganglia in the urinary bladder wall.