Innervation of the proximal urethra of ovariectomized and estrogen-treated female rats

The proximal urethra plays a central role in maintaining urinary continence, and sympathetic excitatory innervation to urethral smooth muscle is a major factor in promoting tonic contraction of this organ. Elevated estrogen levels are often associated with incontinence in humans. Because elevated estrogen levels result in degeneration of sympathetic nerves from the closely related uterine smooth muscle, we examined the effects of chronic estrogen administration on proximal urethral innervation. Ovariectomized virgin female rats received either vehicle or 17 beta-estradiol for 1 week, and smooth muscle size and parasympathetic, sensory and sympathetic nerve densities were assessed quantitatively throughout the first 3 mm of the proximal urethral smooth muscle. In vehicle-infused ovariectomized rats, parasympathetic nerves immunoreactive for vesicular acetylcholine transporter were most abundant, while calcitonin gene-related peptide-immunoreactive sensory nerves and tyrosine hydroxylase-immunoreactive sympathetic nerves were less numerous. The densities of parasympathetic and sensory nerves remained constant along the proximal urethra, while sympathetic nerves showed a significant increase along a proximal-distal gradient. Administration of 17beta-estradiol for 7 days via subcutaneous osmotic pump did not change smooth muscle area in sections, and neither densities nor total innervation of any nerve population was altered. These findings reveal a rich cholinergic innervation of the proximal urethra, and a pronounced gradient in sympathetic innervation. Unlike the embryologically similar uterine smooth muscle, estrogen does not influence muscle size or composition of innervation, indicating that estrogen's actions on innervation are highly target-specific. Thus, estrogen's effects on urinary continence apparently occur independently of any significant remodeling of smooth muscle or resident innervation.