Non-Neurogenic Bladder Dysfunctions

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Overactive bladder syndrome (OAB) is a common disorder with significant impact on quality of life, defined in 2002 by the International Continence Society (ICS) as a syndrome characterized by urgency, with or without urge incontinence, usually with frequency and nocturia. To be consistent with the individual component of lower urinary tract symptoms (LUTS), it is preferable to use the terms “urgency incontinence” and “increased daytime frequency” instead of “urge incontinence” and “frequency,” respectively. Thus, the current definition of OAB is urgency, with or without urgency urinary incontinence, usually with increased daytime frequency and nocturia, in the absence of proven infection or other obvious pathology.  The ICS established standardized definitions for the single OAB components.  “Urgency” is the complaint of a sudden compelling desire to pass urine, which is difficult to defer; this is the pivotal symptom of OAB, with the greatest impact on quality of life. Urge incontinence (UUI) is defined as involuntary Urinary incontinence or just before urine leakage. "more 'Daytime repetition' is a self-reflection complaint. It is disabled frequently depending on the day. There is no minimum number of blanks in a normal space Identification and research data are currently insufficient The criteria are used to determine the increase in daytime frequency. "Nocturia" complaint The individual must wake up at least once in the night to turn it off. Sympathetic outflow from the lumbar spinal cord ensures relaxation of the bladder The walls and contractions of the internal urethral sphincter that contribute to urination storage. The peripheral sympathetic pathway follows a complex pathway. Through the sympathetic nerve chain to reach the inferior mesenteric artery It then reaches the pelvic ganglion through the inferior abdominal nerve. The external urethral sphincter motoneurons are located along the lateral border of the sacral ventral horn, commonly referred to as the Onuf’s nucleus. The stimulation of stretch-sensitive receptors during the filling phase activates afferent pathways, informing the brain that the bladder is reaching capacity. There are two different types of bladder afferent pathways: the first type (Aδ-fibers, composed by myelinated axons), mechanosensitive, activated by intravesical pressures (non-nociceptive or nociceptive); the second type (C-fibers, composed by unmyelinated axons), activated by cold, heat, or chemical irritation of the bladder mucosa.. During neuropathic conditions (spinal cord injury) and possibly inflammatory conditions, there is recruitment of C-fibers that form a new functional afferent pathway that can cause urgency incontinence and possibly bladder pain. The C-fibers signalling pathway can be blocked by some drugs (capsaicin, resiniferatoxin): this is the rationale for intravesical neurotoxin therapy of OAB. Positron-emission tomography (PET) and functional magnetic resonance imaging (fMRI) studies that investigated which brain areas are involved in the regulation of micturition reveals that thalamus, insula, prefrontal cortex, anterior cingulate gyrus, periaqueductal gray (PAG), pons, medulla and supplementary motor area (SMA) are activated during urinary storage. There is a general consensus that bladder control is modulated in an inhibitory fashion by the diencephalic and cerebral cortex functions, while the influence of the brainstem is facilitatory.  Input from the pons acts as “on–off” switches to shift the LUT between the two modes of storage and voiding . The pontine micturition center (PMC, also known as Barrington’s nucleus or M-region, because of its medial location) is a pontine region involved in the supraspinal control of micturition: neurons in the PMC send descending excitatory projections to spinally located parasympathetic neurons controlling the detrusor muscle of the bladder and inhibitory interneurons regulating Onuf’s nucleus: this activation results in relaxation of external urethral sphincter and contraction of the bladder. Another region within the pontine located laterally has been identified as the pontine continence center (PCC or L-region, because of its lateral location), which has been suggested to suppress bladder contraction and to regulate the striated urethral sphincter muscle activity during the storage phase. These two pons regions can represent separate functional systems. Act independently. The social control of this area is by no means clear and has a lot to do with it. Brain regions: cerebral cortex (middle frontal lobe) and basal ganglia intended to suppress the emptying reflex; Other areas (prefrontal cortex, islets The cortex (the anterior cingulate gyrus) is believed to be responsible for the sense of consciousness, will and emotional response

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