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Urothelial mucosal signaling and the overactive bladder-ICI-RS 2013

Authors

  • Lori A. Birder,

    Corresponding author
    1. Departments of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    2. Departments of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    • Correspondence to: Lori A. Birder, University of Pittsburgh School of Medicine, A 1217 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261 E-mail: lbirder@pitt.edu

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  • Karl-Erik Andersson,

    1. Aarhus Institute for Advanced Studies, Aarhus University, Aarhus, Denmark
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  • Anthony J. Kanai,

    1. Departments of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    2. Departments of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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  • Ann T. Hanna-Mitchell,

    1. Departments of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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  • Chris H. Fry

    1. Department of Physiology, University of Surrey, Guilford, United Kingdom
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  • Conflict of interest: none.
  • Karl-Erik Andersson led the peer-review process as the Associate Editor responsible for the paper.

Abstract

There is abundant evidence that the lower urinary tract (LUT) mucosal layer is involved both in mechanosensory functions that regulate bladder contractile activity and in urethral sensation. Changes to the mucosa can be associated with a number of bladder pathologies. For example, alterations of the urothelium and underlying lamina propria at both the molecular and structural levels have been reported in both patients and animals associated with disorders such as bladder pain syndrome and diabetic cystopathy. In contrast to the urinary bladder, much less is known about the urothelium/lamina propria of the bladder neck/proximal urethra. There are important gender differences in the outflow region both anatomically and with respect to innervation, hormonal sensitivity, and location of the external urethral sphincter. There is reasonable evidence to support the view that the mucosal signaling pathway in the proximal urethra is important for normal voiding, but it has also been speculated that the proximal urethra can initiate bladder overactivity. When dysfunctional, the proximal urethra may be an interesting target, for example, botulinum toxin injections aiming at eliminating both urgency and incontinence due to detrusor overactivity. Neurourol. Urodynam. 33:597–601, 2014. © 2014 Wiley Periodicals, Inc.

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