Uro-physiology Research Group; The Dental and Medical School; Newcastle University; Newcastle upon Tyne, England.
Organogenesis. 2013 Jul-Sep;9(3):224-33. doi: 10.4161/org.25895. Epub 2013 Aug 5.
It is recognized that, as the bladder fills, there is a corresponding increase in sensation. This awareness of the volume in the bladder is then used in a complex decision making process to determine if there is a need to void. It is also part of everyday experience that, when the bladder is full and sensations strong, these sensations can be suppressed and the desire to void postponed. The obvious explanation for such altered perceptions is that they occur centrally. However, this may not be the only mechanism. There are data to suggest that descending neural influences and local factors might regulate the sensitivity of the systems within the bladder wall generating afferent activity. Specifically, evidence is accumulating to suggest that the motor-sensory system within the bladder wall is influenced in this way. The motor-sensory system, first described over 100 years ago, appears to be a key component in the afferent outflow, the afferent "noise," generated within the bladder wall. However, the presence and possible importance of this complex system in the generation of bladder sensation has been overlooked in recent years. As the bladder fills the motor activity increases, driven by cholinergic inputs and modulated, possibly, by sympathetic inputs. In this way information on bladder volume can be transmitted to the CNS. It can be argued that the ability to alter the sensitivity of the mechanisms generating the motor component of this motor-sensory system represents a possible indirect way to influence afferent activity and so the perception of bladder volume centrally. Furthermore, it is emerging that the apparent modulation of sensation by drugs to alleviate the symptoms of overactive bladder (OAB), the anti-cholinergics and the new generation of drugs the β 3 sympathomimetics, may be the result of their ability to modulate the motor component of the motor sensory system. The possibility of controlling sensation, physiologically and pharmacologically, by influencing afferent firing at its point of origin is a "new" concept in bladder physiology. It is one that deserves careful consideration as it might have wider implications for our understanding of bladder pathology and in the development of new therapeutic drugs. In this overview, evidence for the concept peripheral modulation of bladder afferent outflow is explored.
人们认识到，随着膀胱充盈，感觉相应增加。这种对膀胱容量的意识然后被用于一个复杂的决策过程，以确定是否需要排空。人们也有日常经验，即当膀胱充盈且感觉强烈时，这些感觉可以被抑制，排尿的欲望可以推迟。对于这种改变的感知，明显的解释是它们发生在中枢。然而，这可能不是唯一的机制。有数据表明，下行神经影响和局部因素可能调节膀胱壁内系统的敏感性，产生传入活动。具体来说，有证据表明，膀胱壁内的运动感觉系统就是以这种方式受到影响的。这个运动感觉系统早在 100 多年前就被首次描述，它似乎是膀胱壁内传入传出的关键组成部分，即膀胱壁内产生的传入“噪音”。然而，近年来，这个复杂系统在膀胱感觉产生中的存在和可能的重要性被忽视了。随着膀胱充盈，运动活动增加，由胆碱能输入驱动，并可能由交感输入调节。通过这种方式，可以将膀胱容量的信息传递到中枢神经系统。可以说，改变产生运动感觉系统运动成分的机制敏感性代表了一种可能的间接方式来影响传入活动，从而影响中枢对膀胱容量的感知。此外，越来越明显的是，用于缓解膀胱过度活动症（OAB）症状的药物、抗胆碱能药物和新一代药物——β3 拟交感神经药物对感觉的明显调节，可能是它们调节运动感觉系统运动成分的结果。通过影响传入活动的起源点来生理和药理学地控制感觉是膀胱生理学中的一个“新概念”。这是一个值得仔细考虑的概念，因为它可能对我们理解膀胱病理学和开发新的治疗药物有更广泛的影响。在这篇综述中，探讨了外周调节膀胱传入传出的概念的证据。
