Textbook of the neurogenic bladder by Corcos, Jacques; Ginsberg, David; Karsenty, Gilles

By Corcos, Jacques; Ginsberg, David; Karsenty, Gilles

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50 analyzed bladder muscle specimens from patients with neurogenic bladder dysfunction to determine whether the muscarinic receptor subtype mediating contraction shifts from M3 to M2 receptor subtype, as found in the denervated, hypertrophied rat bladder. They concluded that although normal detrusor contractions are mediated by the M3 receptor subtype, in patients with neurogenic bladder dysfunction, contractions can be mediated by the M2 receptors. Muscarinic receptors may also be located on the presynaptic nerve terminals and participate in the regulation of transmitter release.

ICs have been identified with antibodies against KIT, vimentin, and more recently, PDGFRα, using confocal microscopy. 123–125 The ultrastructural profile of the bladder ICs is comparable with that of the gastrointestinal ICs. 126,127 Myofibroblasts are considered to be smooth muscle–like fibroblasts found in many tissues of 15 the body, where they have functions in growth, repair, and wound healing. 128 Available data do not support a pacemaking role for detrusor-layer ICs, and it is possible that detrusor IC may act as a brake, preventing coordinated smooth muscle contraction during filling.

ATP) have been demonstrated in the bladder of both animals and humans, but their roles in the human bladder remain to be established. Urethra Sufficient contraction of the urethral smooth muscle is an important function to provide continence during the storage phase of the micturition cycle. Equally important is a coordinated and complete relaxation during the voiding phase. 13,230 The mechanism of this relaxant effect has not been definitely established, but several factors may contribute. One possibility is that the drop in intraurethral pressure is caused by the stimulation of muscarinic receptors on noradrenergic nerves, diminishing NA release and thereby tone in the proximal urethra.

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