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Neurogenic lower urinary tract dysfunction—the so-called neurogenic bladder—can result from many neurological conditions. The importance of this problem to patient health and quality of life is now better recognised, particularly as these days many of the symptoms can be treated.
The lower urinary tract and its neurological control
Optimal patient management requires an understanding of the physiology of the lower urinary tract, and its derangement in neurological disease. The lower urinary tract consists of the bladder and urethra and has just two roles: storage of urine and voiding at appropriate times. To regulate this, a complex neural control system acts like a switching circuit to maintain a reciprocal relationship between the reservoir (storage) function of the bladder and the continence (voiding) function of the urethra (figure 1). The pontine micturition centre is responsible for switching between the ‘storage’ phase and ‘voiding’ phase. It in turn receives input from other centres, particularly the periaqueductal grey of the midbrain, hypothalamus and cortical areas such as the prefrontal cortex.
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