Bladder spontaneous activity: influence of mild heating and inert injectables

........................................................................................................................... 2 Author’s declaration. ...................................................................................................... 3 Acknowledgements. ......................................................................................................... 4 List of figures. ................................................................................................................ 12 List of tables. .................................................................................................................. 17 Abbreviations. ................................................................................................................ 18 CHAPTER 1. GENERAL INTRODUCTION. 20 1.1 Overview on the urinary tract system. .................................................................. 21 1.2 The anatomy of the lower urinary tract. ............................................................... 22 1.2.1 Urinary bladder. .................................................................................................. 22 1.2.1.1 Function and anatomy. ................................................................................. 22 1.2.1.2 Histology of the bladder wall. ...................................................................... 24 1.2.2 Urethra. ............................................................................................................... 27 1.2.2.1 Function and anatomy. ................................................................................. 27 1.2.2.2 Histology of the urethra. .............................................................................. 28 1.3 The micturition reflex. ............................................................................................ 30 1.3.1 Neural control of the LUT. ................................................................................. 30 1.3.1.1 Filling phase. ................................................................................................ 31 1.3.1.1.1 Adrenergic receptor signalling cascade. ............................................... 33 1.3.1.1.2 Urethral control during filling. ............................................................. 34 1.3.1.2 Voiding phase. ............................................................................................. 35 1.3.1.2.1 Muscarinic receptor signalling cascade. .............................................. 36 1.3.1.2.2 Purinergic receptor signalling cascade. ............................................... 40 1.4 The mucosa not just a passive barrier. ............................................................... 42 1.4.1 Mucosal barrier properties. ................................................................................. 42 1.4.2 Distribution and function of receptors in the bladder wall. ................................ 45 1.4.3 The sensory role of the mucosa. ......................................................................... 50 1.5 Spontaneous contractions. ...................................................................................... 55 1.5.1 Generation of spontaneous contractions. ............................................................ 55 1.5.2 The origin of spontaneous contractions. ............................................................. 57 1.5.2.1 Myogenic hypothesis. .................................................................................. 57 1.5.2.2 Urotheliogenic hypothesis. ........................................................................... 58 1.5.2.3 Neurogenic hypothesis. ................................................................................ 60