Neurophysiology of Micturition: a Narrative Review on Preventing Mismanagement

Abstract

ABSTRACT Introduction: The insidious interrelation between three key factors underscores the critical need to understand the neural control of the lower urinary tract (LUT): the complexity of its functioning, the epidemiology of conditions that can disrupt it, and the nonspecific presentation of related symptoms. This paper examines the importance of understanding neurophysiology of micturition to prevent mismanagement and reduce unnecessary procedures. Material and Methods: This review focuses on the neurophysiology of the micturition cycle, the epidemiology of major health conditions that affect it, and the nonspecific nature of lower urinary tract symptoms (LUTS) concerning underlying pathologies. The review was conducted in accordance with the guidelines of the Scale for Assessment of Narrative Review Articles (SANRA). Only articles in English were included, while case reports, editorials, and expert opinion pieces were excluded. Results: The ability of the LUT to store and release urine requires precise coordination and is mediated by a complex network involving the brain, spinal cord, peripheral ganglia, and nerves. Epidemiological data reveal a growing global burden of diseases that impact LUT functioning (LUTF). Moreover, the nonspecific nature of LUTS often leads to diagnostic challenges, and inappropriate treatment strategies. Conclusion: The interplay between the complexity of LUTF, the widespread prevalence of conditions that can disrupt it, and the nonspecific nature of related symptoms frequently complicate urological decision-making. Overlooking associated neurological factors can result in suboptimal outcomes, diminished quality of life, and serious adverse consequences. A systematic approach is crucial to minimizing the risk of misdiagnosis and mismanagement, especially when considering invasive interventions.

Keywords

• Urinary Bladder
• Neurophysiology
• Lower Urinary Tract Symptoms