Neurourology and Urodynamics

Cover: The cover image is from the Invited Review Article How does the lower urinary tract contribute to bladder sensation? ICI-RS 2023 by Grundy L, Wyndaele JJ, Hashitani H, et al. Neurourol Urodyn. 2024;43(6):1293-1302. https://doi.org/10.1002/nau.25316. Figure 1. Sensory innervation of the bladder. Afferent nerves innervate throughout the bladder wall. Detrusor innervating afferents (muscular afferents) detect bladder stretch. Afferent nerves innervating the urothelium (mucosal afferents) do not respond to stretch, but may have a crucial role in detecting bladder inflammation, cell destruction, and neurotransmitters released from the urothelium. The urothelium releases an array of neurotransmitters during bladder stretch, including ATP, ACh, and NO, which can interact with bladder afferents, interstitial cells of the lamina propria, and urothelial cells. Muscular mucosal afferents respond to both bladder stretch and urothelial stroking. Sensory signals are relayed to the central nervous system via the hypogastric, pelvic, and pudendal nerves, which project to the dorsal horn of the thoracic, lumbar, and sacral spinal cord, respectively. Second-order neurons activated within the spinal cord synapse in the thalamus or the periaqueductal gray of the midbrain. Thalamic projections provide input into limbic and cortical structures to provide the emotional affective and conscious component of the voiding reflex pathway. Alterations in the intensity of sensory signals from the bladder can therefore have profound impacts on bladder sensation. ACh, acetylcholine; ATP, adenosine triphosphate; GAG, glycosaminoglycan; HGN, hypogastric nerve; NO, nitric oxide; PN, pelvic nerve; PP, pelvic plexus.

Cover: The cover image is from the Invited Review Article Exploring lifelong overactive bladder: transitions, evidence, and clinical implications; a modified Delphi process. Neurourol Urodyn by Bou Kheir G, Verbakel I, Vande Walle J, et al. Neurourol Urodyn. 2024;43(5): 1040-1057. https://doi.org/10.1002/nau.25307. Figure 1. Schematic representation of the OAB lifelong concept, where the overactive bladder is regarded as a persistent and continuous condition. Its subjective perception by individuals may differ from birth (as represented by examples 1 and 2) and evolves over time. A threshold or level of clinical perception (dotted line) defines its subclinical or overt/bothersome in nature, this threshold itself may vary over time. Its course of evolution is influenced by modifying factors during transition periods. OAB, overactive bladder.

Cover: The cover image is from the Basic Science Article Statin administration ameliorates ischemia-induced overactive bladder with improvement of blood flow and anti-inflammatory effects in rats by Ishizuka Y, Satake Y, Kimura S, et al. Neurourol Urodyn. 2024;43(4):991-1002. https://doi.org/10.1002/nau.25433. Figure 2. Bladder blood flow is decreased in the AI group, and statin administration improves bladder blood flow. Blood flow measurement was performed following cystometry. (A) Typical images of bladder blood flow. Since the flow in the bladder dome tends to decrease in the vesicostomy part in all groups, blood flow was measured in the anterior bladder body. (B) Blood flow is measured at the 2-points of saline infusion volume (0-1.0 mL) and adjusted by arterial blood pressure; *p < 0.05.