The integrative physiology of the bladder

Area of Science:

• Urology
• Neuroscience
• Cell Biology

Background:

• Normal bladder function relies on complex interactions between regulatory cell types.
• The interstitial cells and peripheral neurones form the myovesical plexus, influencing bladder structure and function.
• The myovesical plexus shares characteristics with the gut, including functional modularity.

Purpose of the Study:

• To explore the role of the myovesical plexus in normal bladder function.
• To investigate the contribution of modular activity to bladder sensation and urgency.
• To understand the myovesical plexus's involvement in detrusor overactivity and voiding.

Main Methods:

• The study reviews existing literature on bladder physiology and the myovesical plexus.
• It analyzes the functional modularity and peristalsis-like movements within the bladder wall.
• It examines the coordination of modular activity during different physiological states like filling, urgency, and voiding.

Main Results:

• The myovesical plexus enables localized and propagating movements in the bladder wall.
• Localized modular activity contributes to normal sensation during filling; exaggerated activity may cause urinary urgency.
• Enhanced coordination of modular activity leads to contractions in detrusor overactivity, causing phasic pressure changes.

Conclusions:

• The bladder wall, via the myovesical plexus, acts as an effector in lower urinary tract regulation.
• Dysfunction within the myovesical plexus is a significant, underestimated factor in clinical bladder pathophysiology.
• Understanding the myovesical plexus is crucial for addressing various bladder problems.