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Past, Present, and Future in the Study of Neural Control of the Lower Urinary Tract

International Neurourology Journal 2020년 24권 3호 p.191 ~ 199
김진욱, 김수진, 박종목, Na Yong-Gil, 김계환,
소속 상세정보
김진욱 ( Kim Jin-Wook ) - Chung-Ang University College of Medicine Department of Urology
김수진 ( Kim Su-Jin ) - Yonsei University Wonju College of Medicine Department of Urology
박종목 ( Park Jong-Mok ) - Chungnam National University College of Medicine Department of Urology
 ( Na Yong-Gil ) - Chungnam National University College of Medicine Department of Urology
김계환 ( Kim Khae-Hawn ) - Chungnam National University College of Medicine Department of Urology

Abstract


The neurological coordination of the lower urinary tract can be analyzed from the perspective of motor neurons or sensory neurons. First, sensory nerves with receptors in the bladder and urethra transmits stimuli to the cerebral cortex through the periaqueductal gray (PAG) of the midbrain. Upon the recognition of stimuli, the cerebrum carries out decision-making in response. Motor neurons are divided into upper motor neurons (UMNs) and lower motor neurons (LMNs) and UMNs coordinate storage and urination in the brainstem for synergic voiding. In contrast, LMNs, which originate in the spinal cord, cause muscles to contract. These neurons are present in the sacrum, and in particular, a specific neuron group called Onuf’s nucleus is responsible for the contraction of the external urethral sphincter and maintains continence in states of rising vesical pressure through voluntary contraction of the sphincter. Parasympathetic neurons originating from S2?S4 are responsible for the contraction of bladder muscles, while sympathetic neurons are responsible for contraction of the urethral smooth muscle, including the bladder neck, during the guarding reflex. UMNs are controlled in the pons where various motor stimuli to the LMNs are directed along with control to various other pelvic organs, and in the PAG, where complex signals from the brain are received and integrated. Future understanding of the complex mechanisms of micturition requires integrative knowledge from various fields encompassing these distinct disciplines.

키워드

Periaqueductal gray; Pons; Urination; Nervous system

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