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Nature Reviews. Neuroscience Jun 2008Micturition, or urination, occurs involuntarily in infants and young children until the age of 3 to 5 years, after which it is regulated voluntarily. The neural... (Review)
Review
Micturition, or urination, occurs involuntarily in infants and young children until the age of 3 to 5 years, after which it is regulated voluntarily. The neural circuitry that controls this process is complex and highly distributed: it involves pathways at many levels of the brain, the spinal cord and the peripheral nervous system and is mediated by multiple neurotransmitters. Diseases or injuries of the nervous system in adults can cause the re-emergence of involuntary or reflex micturition, leading to urinary incontinence. This is a major health problem, especially in those with neurological impairment. Here we review the neural control of micturition and how disruption of this control leads to abnormal storage and release of urine.
Topics: Animals; Humans; Nervous System Diseases; Nervous System Physiological Phenomena; Neural Pathways; Neurotransmitter Agents; Trauma, Nervous System; Urinary Incontinence; Urination
PubMed: 18490916
DOI: 10.1038/nrn2401 -
Pediatric Nephrology (Berlin, Germany) Jul 2021Urinary tract infection is a commonly occurring paediatric infection associated with significant morbidity. Diagnosis is challenging as symptoms are non-specific and... (Review)
Review
Urinary tract infection is a commonly occurring paediatric infection associated with significant morbidity. Diagnosis is challenging as symptoms are non-specific and definitive diagnosis requires an uncontaminated urine sample to be obtained. Common techniques for sampling in non-toilet-trained children include clean catch, bag, pad, in-out catheterisation and suprapubic aspiration. The pros and cons of each method are examined in detail in this review. They differ significantly in frequency of use, contamination rates and acceptability to parents and clinicians. National guidance of which to use differs significantly internationally. No method is clearly superior. For non-invasive testing, clean catch sampling has a lower likelihood of contamination and can be made more efficient through stimulation of voiding in younger children. In invasive testing, suprapubic aspiration gives a lower likelihood of contamination, a high success rate and a low complication rate, but is considered painful and is not preferred by parents. Urine dipstick testing is validated for ruling in or out UTI provided that leucocyte esterase (LE) and nitrite testing are used in combination.
Topics: Child; Child, Preschool; Humans; Infant; Parents; Specimen Handling; Urinalysis; Urinary Tract Infections; Urination; Urine; Urine Specimen Collection
PubMed: 32918601
DOI: 10.1007/s00467-020-04742-w -
Journal of Smooth Muscle Research =... Jun 2005The micturition reflex is one of the autonomic reflexes, but the release of urine is regulated by voluntary neural mechanisms that involve centers in the brain and... (Review)
Review
The micturition reflex is one of the autonomic reflexes, but the release of urine is regulated by voluntary neural mechanisms that involve centers in the brain and spinal cord. The micturition reflex is a bladder-to-bladder contraction reflex for which the reflex center is located in the rostral pontine tegmentum (pontine micturition center: PMC). There are two afferent pathways from the bladder to the brain. One is the dorsal system and the other is the spinothalamic tract. Afferents to the PMC ascend in the spinotegmental tract, which run through the lateral funiculus of the spinal cord. The efferent pathway from the PMC also runs through the lateral funiculus of the spinal cord to inhibit the thoracolumbar sympathetic nucleus and the sacral pudendal nerve nucleus, while promoting the activity of the sacral parasymapathetic nucleus. Inhibition of the sympathetic nucleus and pudendal nerve nucleus induces relaxation of the bladder neck and the external urethral sphincter, respectively. There are two centers that inhibit micturition in the pons, which are the pontine urine storage center and the rostral pontine reticular formation. In the lumbosacral cord, excitatory glutamatergic and inhibitory glycinergic/GABAergic neurons influence both the afferent and efferent limbs of the micturition reflex. The activity of these neurons is affected by the pontine activity. There are various excitatory and inhibitory areas co-existing in the brain, but the brain has an overall inhibitory effect on micturition, and thus maintains continence. For micturition to occur, the cerebrum must abate its inhibitory influence on the PMC.
Topics: Animals; Central Nervous System; Humans; Urinary Bladder; Urination; Urine
PubMed: 16006745
DOI: 10.1540/jsmr.41.117 -
American Family Physician Apr 2013Urinary incontinence is common, increases in prevalence with age, and affects quality of life for men and women. The initial evaluation occurs in the family physician's...
Urinary incontinence is common, increases in prevalence with age, and affects quality of life for men and women. The initial evaluation occurs in the family physician's office and generally does not require urologic or gynecologic evaluation. The basic workup is aimed at identifying possible reversible causes. If no reversible cause is identified, then the incontinence is considered chronic. The next step is to determine the type of incontinence (urge, stress, overflow, mixed, or functional) and the urgency with which it should be treated. These determinations are made using a patient questionnaire, such as the 3 Incontinence Questions, an assessment of other medical problems that may contribute to incontinence, a discussion of the effect of symptoms on the patient's quality of life, a review of the patient's completed voiding diary, a physical examination, and, if stress incontinence is suspected, a cough stress test. Other components of the evaluation include laboratory tests and measurement of postvoid residual urine volume. If the type of urinary incontinence is still not clear, or if red flags such as hematuria, obstructive symptoms, or recurrent urinary tract infections are present, referral to a urologist or urogynecologist should be considered.
Topics: Adult; Aged; Aged, 80 and over; Child; Clinical Laboratory Techniques; Diagnosis, Differential; Female; Humans; Male; Medical History Taking; Physical Examination; Quality of Life; Severity of Illness Index; Surveys and Questionnaires; Symptom Assessment; Urinary Incontinence; Urinary Tract; Urination; Urine; Urodynamics
PubMed: 23668444
DOI: No ID Found -
Journal of Visualized Experiments : JoVE Feb 2023Normal voiding behavior is the result of the coordinated function of the bladder, the urethra, and the urethral sphincters under the proper control of the nervous...
Normal voiding behavior is the result of the coordinated function of the bladder, the urethra, and the urethral sphincters under the proper control of the nervous system. To study voluntary voiding behavior in mouse models, researchers have developed the void spot assay (VSA), a method that measures the number and area of urine spots deposited on a filter paper lining the floor of an animal's cage. Although technically simple and inexpensive, this assay has limitations when used as an end-point assay, including a lack of temporal resolution of voiding events and difficulties quantifying overlapping urine spots. To overcome these limitations, we developed a video-monitored VSA, which we call real-time VSA (RT-VSA), and which allows us to determine voiding frequency, assess voided volume and voiding patterns, and make measurements over 6 h time windows during both the dark and light phases of the day. The method described in this report can be applied to a wide variety of mouse-based studies that explore the physiological and neurobehavioral aspects of voluntary micturition in health and disease states.
Topics: Mice; Animals; Urination; Urinary Bladder; Urethra; Disease Models, Animal; Biological Assay
PubMed: 36847378
DOI: 10.3791/64621 -
Journal of Applied Microbiology Dec 2021The goal of good toilet hygiene is minimizing the potential for pathogen transmission. Control of odours is also socially important and believed to be a societal measure... (Review)
Review
The goal of good toilet hygiene is minimizing the potential for pathogen transmission. Control of odours is also socially important and believed to be a societal measure of cleanliness. Understanding the need for good cleaning and disinfecting is even more important today considering the potential spread of emerging pathogens such as SARS-CoV-2 virus. While the flush toilet was a major advancement in achieving these objectives, exposure to pathogens can occur from failure to clean and disinfect areas within a restroom, as well as poor hand hygiene. The build-up of biofilm within a toilet bowl/urinal including sink can result in the persistence of pathogens and odours. During flushing, pathogens can be ejected from the toilet bowl/urinal/sink and be transmitted by inhalation and contaminated fomites. Use of automatic toilet bowl cleaners can reduce the number of microorganisms ejected during a flush. Salmonella bacteria can colonize the underside of the rim of toilets and persist up to 50 days. Pathogenic enteric bacteria appear in greater numbers in the biofilm found in toilets than in the water. Source tracking of bacteria in homes has demonstrated that during cleaning enteric bacteria are transferred from the toilet to the bathroom sinks and that these same bacteria colonize cleaning tools used in the restroom. Quantitative microbial risk assessment has shown that significant risks exist from both aerosols and fomites in restrooms. Cleaning with soaps and detergents without the use of disinfectants in public restrooms may spread bacteria and viruses throughout the restroom. Odours in restrooms are largely controlled by ventilation and flushing volume in toilet/urinals. However, this results in increased energy and water usage. Contamination of both the air and surfaces in restrooms is well documented. Better quantification of the risks of infection are needed as this will help determine what interventions will minimize these risks.
Topics: Bathroom Equipment; COVID-19; Humans; Hygiene; SARS-CoV-2; Toilet Facilities
PubMed: 33899991
DOI: 10.1111/jam.15121 -
Autonomic Neuroscience : Basic &... Nov 2021The storage and elimination of urine requires coordinated activity between muscles of the bladder and the urethra. This coordination is orchestrated by a complex system... (Review)
Review
The storage and elimination of urine requires coordinated activity between muscles of the bladder and the urethra. This coordination is orchestrated by a complex system containing spinal, midbrain and forebrain networks. Normally there is a reciprocity between patterns of activity in urinary bladder sacral parasympathetic efferents and somatic motoneurons innervating the striatal external urethral sphincter muscle. At the spinal level this reciprocity is mediated by ensembles of excitatory and inhibitory interneurons located in the lumbar-sacral segments. In this review I will present an overview of currently identified spinal interneurons and circuits relevant to the lower urinary tract and will discuss their established or hypothetical roles in the cycle of micturition. In addition, a recently discovered auxiliary spinal neuronal ensemble named lumbar spinal coordinating center will be described. Sexual dimorphism and developmental features of the lower urinary tract which may play a significant role in designing treatments for patients with urine storage and voiding dysfunctions are also considered. Spinal cord injuries seriously damage or even eliminate the ability to urinate. Treatment of this abnormality requires detailed knowledge of supporting neural mechanisms, therefore various experiments in normal and spinalized animals will be discussed. Finally, a possible intraspinal mechanism will be proposed for organization of external urethral sphincter (EUS) bursting which represents a form of intermittent EUS relaxation in rats and mice.
Topics: Animals; Humans; Interneurons; Male; Mice; Motor Neurons; Rats; Spinal Cord; Spinal Cord Injuries; Urethra; Urinary Bladder; Urination
PubMed: 34391124
DOI: 10.1016/j.autneu.2021.102861 -
Nursing ResearchLimited information on the normal range of urination frequencies in women is available to guide bladder health promotion efforts.
BACKGROUND
Limited information on the normal range of urination frequencies in women is available to guide bladder health promotion efforts.
OBJECTIVES
This study used data from the Boston Area Community Health (BACH) Survey to (a) estimate normative reference ranges in daytime and nighttime urination frequencies in healthy women based on two operational definitions of "healthy" and (b) compare urination frequencies by age, race/ethnicity, and fluid intake.
METHODS
A secondary analysis of cross-sectional interview data collected from female participants was performed using less restrictive ("healthy") and strict ("elite healthy") inclusion criteria. All analyses were weighted to account for the BACH sampling design. Normative reference values corresponding to the middle 95% of the distribution of daytime and nighttime urination frequencies were calculated overall and stratified by age, race/ethnicity, and fluid intake. Generalized linear regression with a log-link was used to estimate rate ratios of daytime and nighttime urination frequencies by age, race/ethnicity, and fluid intake.
RESULTS
Of the 2,534 women who completed the BACH follow-up interviews, 1,505 women met healthy eligibility criteria, and 300 met elite healthy criteria. Overall, reference ranges for urination frequencies were 2-10 times/day and 0-4 times/night in healthy women and 2-9 times/day and 0-2 times/night in elite healthy women. Women ages 45-64 years, but not 65+ years, reported a greater number of daytime urination than those aged 31-44 years, whereas women 65+ years reported a greater number of nighttime urination. Black women reported fewer daytime urination and more nighttime urinations than White women. Women who consumed less than 49 oz daily reported fewer daytime and nighttime urinations than those who drank 50-74 oz; drinking 75+ oz had only a small effect on urination frequencies.
DISCUSSION
Normative reference values for daytime and nighttime urination frequencies were similar in women using strict and relaxed definitions of health. These results indicate a wide range of "normal" urination frequencies, with some differences by age, race/ethnicity, and fluid intake. Future research is needed to examine urination frequencies in minority women and whether fluid intake amount and type influence the development of lower urinary tract symptoms.
Topics: Black People; Cross-Sectional Studies; Ethnicity; Female; Humans; Surveys and Questionnaires; Urination
PubMed: 35319538
DOI: 10.1097/NNR.0000000000000595 -
Clinical Journal of the American... Mar 2015Urine differs greatly in ion and solute composition from plasma and contains harmful and noxious substances that must be stored for hours and then eliminated when it is... (Review)
Review
Urine differs greatly in ion and solute composition from plasma and contains harmful and noxious substances that must be stored for hours and then eliminated when it is socially convenient to do so. The urinary tract that handles this output is composed of a series of pressurizable muscular compartments separated by sphincteric structures. With neural input, these structures coordinate the delivery, collection, and, ultimately, expulsion of urine. Despite large osmotic and chemical gradients in this waste fluid, the bladder maintains a highly impermeable surface in the face of a physically demanding biomechanical environment, which mandates recurring cycles of surface area expansion and increased wall tension during filling, followed by rapid wall compression during voiding. Afferent neuronal inflow from mucosa and submucosa communicates sensory information about bladder fullness, and voiding is initiated consciously through coordinated central and spinal efferent outflow to the detrusor, trigonal internal sphincter, and external urethral sphincter after periods of relative quiescence. Provocative new findings suggest that in some cases, lower urinary tract symptoms, such as incontinence, urgency, frequency, overactivity, and pain may be viewed as a consequence of urothelial defects (either urothelial barrier breakdown or inappropriate signaling from urothelial cells to underlying sensory afferents and potentially interstitial cells). This review describes the physiologic and anatomic mechanisms by which urine is moved from the kidney to the bladder, stored, and then released. Relevant clinical examples of urinary tract dysfunction are also discussed.
Topics: Humans; Interstitial Cells of Cajal; Muscle Contraction; Muscle, Smooth; Neural Pathways; Ureter; Urethra; Urinary Bladder; Urination; Urothelium
PubMed: 24742475
DOI: 10.2215/CJN.04520413 -
Anesthesiology Clinics Sep 2012Decreased urine output and acute kidney injury (also known as acute renal failure) are among the most important complications that may develop in the postanesthetic... (Review)
Review
Decreased urine output and acute kidney injury (also known as acute renal failure) are among the most important complications that may develop in the postanesthetic period. In this article, the authors present definitions of decreased urine output, oliguria, and acute kidney injury. They review the epidemiology, pathophysiology, and prevention of postoperative acute kidney injury. Finally, the article offers approaches to diagnosis and management of the postsurgical patient with decreased urine output or acute kidney injury.
Topics: Acute Kidney Injury; Anesthesia; Anesthesia Recovery Period; Hospital Units; Humans; Oliguria; Postoperative Care; Postoperative Complications; Risk Factors; Urination; Urine
PubMed: 22989592
DOI: 10.1016/j.anclin.2012.07.004