Current Knowledge and Novel Frontiers in Lower Urinary Tract Dysfunction after Spinal Cord Injury: Basic Research...

Area of Science:

• Neuroscience
• Urology
• Regenerative Medicine

Background:

• Lower urinary tract dysfunction (LUTD) is a common complication following spinal cord injury (SCI).
• Understanding the neurophysiologic mechanisms of LUT control and SCI-induced alterations is crucial for developing effective treatments.
• Animal models provide valuable insights into the complex changes in micturition control after SCI.

Purpose of the Study:

• To review recent advancements in basic research on LUTD following SCI.
• To elucidate the neurophysiologic mechanisms underlying LUT function and SCI-induced changes in micturition control.
• To identify potential therapeutic targets for neurogenic LUTD.

Main Methods:

• Review of current literature on SCI and LUTD.
• Focus on neurophysiologic mechanisms in animal models of SCI.
• Analysis of changes in bladder and outlet coordination, and afferent neuron properties.

Main Results:

• SCI disrupts the neural control of urine storage and voiding, leading to impaired bladder emptying and coordination.
• Following SCI, the bladder transitions from areflexic to hyperreflexic states due to altered spinal reflex pathways.
• Hyperexcitability of C-fiber bladder afferents is a key factor in neurogenic LUTD, particularly detrusor overactivity.
• Reflex plasticity involving neuropeptides and neurotrophic factors contributes to LUTD.
• Aδ-fibers may also play a role in conditions like detrusor sphincter dyssynergia.

Conclusions:

• Animal research is vital for understanding LUTD pathophysiology after SCI.
• Identifying contributing factors like C-fiber hyperexcitability and reflex plasticity can guide the development of novel treatments for SCI-related LUTD.