Physiology and Pathophysiology

and Apichana Kovindha²

(1)

University of Antwerp, Antwerp, Belgium

(2)

Rehabilitation Medicine, Chiang Mai University, Chiang Mai, Thailand

An overview of the physiology of the LUT function is indispensable to understand how changes occur after SCI. It will help us interpret data from urodynamic tests correctly. The innervations and functions of the LUT are given in Table 2.1 and Fig. 2.1. One should acquire this basic knowledge to be able to understand what follows.

Table 2.1

Overview of functions of the sympathetic, the parasympathetic and the somatic nerves in the LUT, and the spinal cord level which they relate to

	Sympathetic Spinal cord T10–L2	Parasympathetic Spinal cord S2–S4	Somatic Spinal cord S3–S5
Neurotransmitters	Noradrenaline	Acetylcholine
Bladder (β3 receptors)	−
Bladder (M3 receptors)		+
Bladder neck (α1)	+
External US	Exp	Exp	+
Sensation in LUT	+	+	+

US urethral sphincter, Exp mostly from animal experiments. − = inhibition; + = stimulation

Fig. 2.1

Innervation of the LUT and central control mechanisms. From T10 to L2 the sympathetic control runs through the hypogastric nerves. From S2 to S5 the innervation runs through the pelvic (parasympathetic control) and the pudendal nerves (somatic innervation of the external sphincter and pelvic floor muscles). Sensory information runs through all peripheral nerves and the spinal cord

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