Shah Adarsh P, Mevcha Amit, Wilby Daniel, Alatsatianos Anton, Hardman John C, Jacques Steven, Wilton Joanne C
Department of Anatomy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom.
Clin Anat. 2014 Nov;27(8):1275-83. doi: 10.1002/ca.22388. Epub 2014 Mar 10.
Urinary incontinence remains an important clinical problem worldwide, having a significant socio-economic, psychological, and medical burden. Maintaining urinary continence and coordinating micturition are complex processes relying on interaction between somatic and visceral elements, moderated by learned behavior. Urinary viscera and pelvic floor must interact with higher centers to ensure a functionally competent system. This article aims to describe the relevant anatomy and neuronal pathways involved in the maintenance of urinary continence and micturition. Review of relevant literature focusing on pelvic floor and urinary sphincters anatomy, and neuroanatomy of urinary continence and micturition. Data obtained from both live and cadaveric human studies are included. The stretch during bladder filling is believed to cause release of urothelial chemical mediators, which in turn activates afferent nerves and myofibroblasts in the muscosal and submucosal layers respectively, thereby relaying sensation of bladder fullness. The internal urethral sphincter is continuous with detrusor muscle, but its arrangement is variable. The external urethral sphincter blends with fibers of levator ani muscle. Executive decisions about micturition in humans rely on a complex mechanism involving communication between several cerebral centers and primitive sacral spinal reflexes. The pudendal nerve is most commonly damaged in females at the level of sacrospinous ligament. We describe the pelvic anatomy and relevant neuroanatomy involved in maintaining urinary continence and during micturition, subsequently highlighting the anatomical basis of urinary incontinence. Comprehensive anatomical understanding is vital for appropriate medical and surgical management of affected patients, and helps guide development of future therapies.
尿失禁在全球范围内仍是一个重要的临床问题，具有重大的社会经济、心理和医学负担。维持尿失禁和协调排尿是复杂的过程，依赖于躯体和内脏因素之间的相互作用，并受习得行为调节。泌尿内脏和盆底必须与高级中枢相互作用，以确保系统功能正常。本文旨在描述维持尿失禁和排尿所涉及的相关解剖结构和神经通路。综述了有关盆底和尿道括约肌解剖结构以及尿失禁和排尿神经解剖学的相关文献。纳入了来自活体和尸体人体研究的数据。膀胱充盈时的牵张被认为会导致尿路上皮化学介质的释放，进而分别激活黏膜层和黏膜下层的传入神经和成肌纤维细胞，从而传递膀胱充盈的感觉。尿道内括约肌与逼尿肌连续，但其排列方式可变。尿道外括约肌与肛提肌纤维融合。人类排尿的执行决策依赖于一种复杂的机制，涉及多个脑中枢与原始骶髓反射之间的沟通。女性阴部神经最常在骶棘韧带水平受损。我们描述了维持尿失禁和排尿过程中涉及的盆腔解剖结构和相关神经解剖学，随后强调了尿失禁的解剖学基础。全面的解剖学理解对于对受影响患者进行适当的医学和手术管理至关重要，并有助于指导未来治疗方法的开发。
