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Neuroanatomy, neurophysiology, and dysfunction of the female lower urinary tract: a review.

Publication ,  Journal Article
Unger, CA; Tunitsky-Bitton, E; Muffly, T; Barber, MD
Published in: Female Pelvic Med Reconstr Surg
2014

The 2 major functions of the lower urinary tract are the storage and emptying of urine. These processes are controlled by complex neurophysiologic mechanisms and are subject to injury and disease. When there is disruption of the neurologic control centers, dysfunction of the lower urinary tract may occur. This is sometimes referred to as the "neurogenic bladder." The manifestation of dysfunction depends on the level of injury and severity of disruption. Patients with lesions above the spinal cord often have detrusor overactivity with no disruption in detrusor-sphincter coordination. Patients with well-defined suprasacral spinal cord injuries usually present with intact reflex detrusor activity but have detrusor sphincter dyssynergia, whereas injuries to or below the sacral spinal cord usually lead to persistent detrusor areflexia. A complete gynecologic, urologic, and neurologic examination should be performed when evaluating patients with neurologic lower urinary tract dysfunction. In addition, urodynamic studies and neurophysiologic testing can be used in certain circumstances to help establish diagnosis or to achieve better understanding of a patient's vesicourethral functioning. In the management of neurogenic lower urinary tract dysfunction, the primary goal is improvement of a patient's quality of life. Second to this is the prevention of chronic damage to the bladder and kidneys, which can lead to worsening impairment and symptoms. Treatment is often multifactorial, including behavioral modifications, bladder training programs, and pharmacotherapy. Surgical procedures are often a last resort option for management. An understanding of the basic neurophysiologic mechanisms of the lower urinary tract can guide providers in their evaluation and treatment of patients who present with lower urinary tract disorders. As neurologic diseases progress, voiding function often changes or worsens, necessitating a good understanding of the underlying physiology in question.

Duke Scholars

Published In

Female Pelvic Med Reconstr Surg

DOI

EISSN

2154-4212

Publication Date

2014

Volume

20

Issue

2

Start / End Page

65 / 75

Location

United States

Related Subject Headings

  • Urologic Diseases
  • Urinary Tract
  • Spinal Cord Injuries
  • Neurophysiology
  • Neuroanatomy
  • Humans
  • Female
  • 3215 Reproductive medicine
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Unger, C. A., Tunitsky-Bitton, E., Muffly, T., & Barber, M. D. (2014). Neuroanatomy, neurophysiology, and dysfunction of the female lower urinary tract: a review. Female Pelvic Med Reconstr Surg, 20(2), 65–75. https://doi.org/10.1097/SPV.0000000000000058
Unger, Cécile A., Elena Tunitsky-Bitton, Tyler Muffly, and Matthew D. Barber. “Neuroanatomy, neurophysiology, and dysfunction of the female lower urinary tract: a review.Female Pelvic Med Reconstr Surg 20, no. 2 (2014): 65–75. https://doi.org/10.1097/SPV.0000000000000058.
Unger CA, Tunitsky-Bitton E, Muffly T, Barber MD. Neuroanatomy, neurophysiology, and dysfunction of the female lower urinary tract: a review. Female Pelvic Med Reconstr Surg. 2014;20(2):65–75.
Unger, Cécile A., et al. “Neuroanatomy, neurophysiology, and dysfunction of the female lower urinary tract: a review.Female Pelvic Med Reconstr Surg, vol. 20, no. 2, 2014, pp. 65–75. Pubmed, doi:10.1097/SPV.0000000000000058.
Unger CA, Tunitsky-Bitton E, Muffly T, Barber MD. Neuroanatomy, neurophysiology, and dysfunction of the female lower urinary tract: a review. Female Pelvic Med Reconstr Surg. 2014;20(2):65–75.

Published In

Female Pelvic Med Reconstr Surg

DOI

EISSN

2154-4212

Publication Date

2014

Volume

20

Issue

2

Start / End Page

65 / 75

Location

United States

Related Subject Headings

  • Urologic Diseases
  • Urinary Tract
  • Spinal Cord Injuries
  • Neurophysiology
  • Neuroanatomy
  • Humans
  • Female
  • 3215 Reproductive medicine
  • 3202 Clinical sciences