Van Koeveringe Gommert, McCloskey Karen D, Kanai Anthony J, de Rijk Mathijs M, Tyagi Pradeep, Speich John E, Fry Christopher H, Wein Alan J
Department of Urology, Research Institute for Mental Health and Neuroscience, Maastricht University and Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.
Patrick G. Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK.
Neurourol Urodyn. 2025 Mar;44(3):568-576. doi: 10.1002/nau.25638. Epub 2024 Dec 18.
To answer the question of whether the bladder itself can to any extent control or modulate the initiation of voiding.
This subject was discussed at the International Consultation on Incontinence-Research Society (ICI-RS) 2024 conference in Bristol, UK in a proposal session.
Cells in the bladder wall sense the local environment via a diverse array of ion channels and receptors which together provide input to motor-sensory and signal transduction mechanisms. A purinergic signal transduction system provides a high-gain mucosal chemosensitive transduction pathway between bladder wall stretch during filling and graded afferent activation. Recent studies established cross-species similarities in the regulation of urine storage which include the upregulation of aquaporin (water) channels during bladder filling/wall stretch, in the bladder. In addition to the endocrine hypothalamus/pituitary axis production, urothelial production of arginine vasopressin acts on urothelial vasopressin receptors in a paracrine manner causing aquaporin channel upregulation, reducing the bladder volume and delaying sensation of fullness. Bladder shape influences the sensory systems involved in the perception of bladder volume; moreover irregular bladder shapes may correlate with overactive bladder.
Volume measuring and signaling threshold-determining mechanisms in the bladder along with shape and permeability act to influence the timing and type of signaling to the CNS; although this is not always followed by a consecutive action. The hierarchical grading of the signals originating from the bladder among other peripheral bodily or central signals are crucial factors that determine whether the bladder is "allowed" to initiate voiding.
回答膀胱自身是否能在一定程度上控制或调节排尿起始的问题。
该主题在英国布里斯托尔举行的2024年国际尿失禁咨询会——研究学会（ICI-RS）会议的一个提案环节中进行了讨论。
膀胱壁中的细胞通过多种离子通道和受体感知局部环境，这些离子通道和受体共同为运动感觉和信号转导机制提供输入。嘌呤能信号转导系统在充盈期膀胱壁伸展与分级传入激活之间提供了一条高增益的黏膜化学敏感转导途径。最近的研究确定了跨物种在尿液储存调节方面的相似性，包括膀胱在充盈/壁伸展时水通道蛋白（水）通道的上调。除了内分泌下丘脑/垂体轴的产生外，尿路上皮产生的精氨酸加压素以旁分泌方式作用于尿路上皮加压素受体，导致水通道蛋白通道上调，减少膀胱容量并延迟饱腹感。膀胱形状会影响参与膀胱容量感知的感觉系统；此外，不规则的膀胱形状可能与膀胱过度活动症相关。
膀胱中的容量测量和信号阈值确定机制以及形状和通透性会影响向中枢神经系统发送信号的时间和类型；尽管这并不总是会引发后续行动。源自膀胱的信号在其他外周身体信号或中枢信号中的分级是决定膀胱是否“被允许”开始排尿的关键因素。
