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A Decentralized Ex Vivo Murine Bladder Model with the Detrusor Muscle Removed for Direct Access to the Suburothelium during Bladder Filling
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A brief physiology and pathophysiology of the bladder
Jörgen Quaghebeur1, Mark Bush2, Dmitry Shkarupa3
1Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium.
Annals of Translational Medicine
|May 9, 2024
Summary
The integral theory proposes female urinary incontinence and overactive bladder stem from weak pelvic ligaments, not bladder issues. Ligament repair offers a potential cure for these common conditions.
Area of Science:
- Urology
- Gynecology
- Pelvic Floor Disorders
Background:
- The prevailing view attributes overactive bladder (OAB) pathogenesis to unknown causes, with no definitive cure.
- The integral theory (IT) posits bladder control is a binary cortical-peripheral system, challenging existing paradigms.
- Female urinary incontinence (UI) and OAB symptoms are linked to peripheral structures, specifically pelvic ligaments and vaginal support.
Purpose of the Study:
- To review experimental works supporting the integral theory of female urinary incontinence (IT).
- To elucidate the IT's explanation for the pathogenesis of overactive bladder (OAB) and urinary incontinence.
- To explore the potential for cure through treatments targeting ligamentous support.
Main Methods:
- Review of experimental publications relevant to the integral theory of female urinary incontinence.
- Analysis of the IT's proposed mechanism of bladder control involving cortical and peripheral feedback loops.
- Examination of the role of collagen deficiency, childbirth, and aging in ligamentous weakening and UI.
Main Results:
- The IT attributes UI and OAB to weakened pelvic ligaments (pubourethral, uterosacral) and vaginal support, primarily due to collagen deficiency.
- Weakened ligaments impair urethral closure (stress incontinence), evacuation (retention), and vaginal support, leading to premature urothelial stretch receptor firing (urge incontinence).
- Treatments aimed at strengthening these ligaments show promise in curing or improving stress urinary incontinence (SUI), OAB, and emptying dysfunctions.
Conclusions:
- Bladder control is a peripheral mechanism dependent on ligamentous and vaginal integrity, regulated by cortical input.
- Reconceptualizing OAB as 'overactivated' rather than 'overactive' aligns with the IT and suggests a higher probability of cure.
- The IT provides a unified explanation for various forms of female urinary incontinence and overactive bladder, highlighting ligament repair as a therapeutic target.
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