Nordling J, Meyhoff H H, Hald T
Scand J Urol Nephrol. 1981;15(1):7-19. doi: 10.3109/00365598109181207.
Filling cystometry, urethral and anal sphincter electromyography, pressure-flow registration, urethral closure pressure profile at rest and after alpha-adrenoceptor blockade with phentolamine, evoked potential of the bulbocavernosus reflex and denervation supersensitivity to carbachol in a-reflexic bladders were performed in 57 consecutive patients with a localized neurological lesion, in order to evaluate the relative importance of the somatic, the parasympathetic and especially the sympathetic nervous system for the function of the lower urinary tract. In spinal lesions with detrusor hyperreflexia, dyscoordination between detrusor and striated urethral sphincter was dominant, while in cauda equina lesions and in lesions of the pelvic nerves the lack of parasympathetic bladder innervation dominated. It was not possible to identify specific spinal segments controlling sympathetic nervous regulation of the lower urinary tract. The only influence of the sympathetic nervous system was a control of urethral pressure, where a statistically significant smaller proportion of the maximal urethral pressure was affected after alpha-adrenergic blockade in patients with peripheral nerve lesions. All a-reflexic bladders exhibited denervation supersensitivity to carbachol, while carbachol did not change urethral pressure significantly indicating minimal influence of the parasympathetic nervous system on urethral pressure.
对57例连续性局部神经病变患者进行充盈性膀胱测压、尿道及肛门括约肌肌电图检查、压力-流率测定、静息时及酚妥拉明α-肾上腺素能受体阻滞后排尿期尿道闭合压测定、球海绵体肌反射诱发电位及无反射性膀胱对卡巴胆碱的去神经超敏反应，以评估躯体神经、副交感神经尤其是交感神经系统对下尿路功能的相对重要性。在逼尿肌反射亢进的脊髓病变中，逼尿肌与尿道横纹肌括约肌之间的不协调占主导地位，而在马尾神经病变和盆腔神经病变中，副交感神经对膀胱的支配缺失占主导地位。无法确定控制下尿路交感神经调节的特定脊髓节段。交感神经系统的唯一影响是对尿道压力的控制，在外周神经病变患者中，α-肾上腺素能阻滞后，最大尿道压力受影响的比例在统计学上显著降低。所有无反射性膀胱均表现出对卡巴胆碱的去神经超敏反应，而卡巴胆碱对尿道压力无明显影响，表明副交感神经系统对尿道压力的影响极小。
