Urogenix, Inc., Durham, North Carolina, USA.
Am J Physiol Regul Integr Comp Physiol. 2010 Aug;299(2):R416-38. doi: 10.1152/ajpregu.00111.2010. Epub 2010 May 19.
The urethral rhabdosphincter and pelvic floor muscles are important in maintenance of urinary continence and in preventing descent of pelvic organs [i.e., pelvic organ prolapse (POP)]. Despite its clinical importance and complexity, a comprehensive review of neural control of the rhabdosphincter and pelvic floor muscles is lacking. The present review places historical and recent basic science findings on neural control into the context of functional anatomy of the pelvic muscles and their coordination with visceral function and correlates basic science findings with clinical findings when possible. This review briefly describes the striated muscles of the pelvis and then provides details on the peripheral innervation and, in particular, the contributions of the pudendal and levator ani nerves to the function of the various pelvic muscles. The locations and unique phenotypic characteristics of rhabdosphincter motor neurons located in Onuf's nucleus, and levator ani motor neurons located diffusely in the sacral ventral horn, are provided along with the locations and phenotypes of primary afferent neurons that convey sensory information from these muscles. Spinal and supraspinal pathways mediating excitatory and inhibitory inputs to the motor neurons are described; the relative contributions of the nerves to urethral function and their involvement in POP and incontinence are discussed. Finally, a detailed summary of the neurochemical anatomy of Onuf's nucleus and the pharmacological control of the rhabdosphincter are provided.
尿道横纹括约肌和盆底肌对于维持尿控和防止盆腔器官下降（即盆腔器官脱垂[POP]）非常重要。尽管其具有临床重要性和复杂性，但对横纹括约肌和盆底肌的神经控制的全面综述仍缺乏。本综述将神经控制的历史和近期基础科学发现置于盆底肌的功能解剖学背景下，并将其与内脏功能协调，并在可能的情况下将基础科学发现与临床发现相关联。本文简要描述了骨盆的横纹肌，然后详细介绍了其周围神经支配，特别是阴部神经和肛提肌神经对各种骨盆肌功能的贡献。提供了位于 Onuf 核中的横纹括约肌运动神经元以及位于骶骨腹角弥散分布的肛提肌运动神经元的位置和独特的表型特征，以及来自这些肌肉的感觉信息的初级传入神经元的位置和表型。描述了介导运动神经元兴奋性和抑制性输入的脊髓和脊髓上通路；讨论了神经对尿道功能的相对贡献及其在 POP 和尿失禁中的作用。最后，详细总结了 Onuf 核的神经化学解剖和横纹括约肌的药理学控制。
