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Cannabinoids and the endocannabinoid system in lower urinary tract function and dysfunction

Authors

  • Petter Hedlund

    Corresponding author
    1. Urological Research Institute, San Raffaele Scientific Institution, Milan, Italy
    2. Department of Clinical Pharmacology, Linköping, Sweden
    • Correspondence to: Petter Hedlund, M.D., Ph.D., Urological Research Institute, San Raffaele University, Via Olgettina 45, 20132 Milan, Italy. E-mail: petter.hedlund@liu.se

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  • Lori Birder led the peer-review process as the Associate Editor responsible for the paper.
  • Conflict of interest: none.

Abstract

Aims

To review knowledge on cannabinoids and the endocannabinoid system in lower urinary tract function and dysfunction.

Methods

Review of MEDLINE using defined search terms, and manual analysis. Articles published in English were included.

Results and Discussion

Components of the endocannabinoid system—cannabinoid (CB) receptor types 1 and 2, anandamide, and fatty acid amide hydrolase (FAAH), which degrades anandamide and related fatty-acid amides—have been located to lower urinary tract tissues of mice, rats, monkeys, and humans. Studies have located CB receptors in urothelium and sensory nerves and FAAH in the urothelium. CB receptor- and FAAH-related activities have also been reported in the lumbosacral spinal cord. Data on supraspinal CB functions in relation to micturition are lacking.

Cannabinoids are reported to reduce sensory activity of isolated tissues, cause antihyperalgesia in animal studies of bladder inflammation, affect urodynamics parameters reflecting sensory functions in animals models, and appear to have effects on storage symptoms in humans. FAAH inhibitors have affected sensory bladder functions and reduced bladder overactivity in rat models. Cannabinoids may modify nerve-mediated functions of isolated lower urinary tract tissues.

Conclusions

Evidence suggests components of the endocannabinoid system are involved in regulation of bladder function, possibly at several levels of the micturition pathway. It is unclear if either CB receptor has a dominant role in modification of sensory signals or if differences exist at peripheral and central nervous sites. Amplification of endocannabinoid activity by FAAH inhibitors may be an attractive drug target in specific pathways involved in LUTS. Neurourol. Urodynam. 33:46–53, 2014. © 2013 Wiley Periodicals, Inc.

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