[Noxious stimuli and neurogenic overactive bladder]

Abstract

Objectives: Describe the relationships between neurogenic overactive bladder and noxious stimuli.

Methods: Relevant data from the literature were identified primarily through a Medline search of articles published through July 2014. The search terms included overactive bladder, central nervous system, noxious visceral and cutaneous stimuli.

Results: Overactive bladder often due to overactive detrusor is the most common symptom observed in central neurogenic bladder (70 to 80% in case of spinal cord injury). Pathophysiological mechanisms are various and numerous. Noxious cutaneous stimuli may determine, or maintain, these symptoms by increased afferent inputs in segmental levels, particularly S2S3 levels, determining exaggerated visceral, muscle and bladder responses depending on this considered medullary level. These modifications are only observed in case of central neurogenic lesions secondary to spinal cord involvement. Animal researches have precised the role of lack of the supra-segmental inhibition.

Conclusions: In presence of neurogenic overactive bladder, it is always necessary to track down noxious stimuli particularly in case of modifications of clinical or urodynamic status or when the usual treatments, generally anticholinergic drugs, have a reduced efficacy. Treatment is first focused on the suppression of these noxious cutaneous stimuli.

Keywords: Hyperactivité du detrusor; Hyperactivité vésicale; Inhibition; Neuro-modulation; Neurogenic overactive bladder; Overactive detrusor; Reflex; Réflexe.