A series of 36 patients with specific neurological lesions affecting those parts of the nervous system thought to be involved in the control of bladder function have been studied by urodynamic, electromyographic and neurohistochemical means and the results compared with those obtained in 20 control subjects. In patients with pelvic nerve injury urethral sphincter electromyography (EMG) revealed abnormal motor units and the density of bladder innervation was significantly reduced (P less than 0.01). By contrast, in patients with distal autonomic neuropathy the innervation of the striated muscle of the urethra was unaffected and although there was an almost total loss of nerves from the bladder muscularis, the subepithelial plexus of nerves was preserved. In patients with progressive autonomic failure and multiple system atrophy, the bladder neck was incompetent in every case and the striated muscle of the urethra was affected by a process of denervation and re-innervation. These findings serve to distinguish patients with autonomic failure from those with idiopathic Parkinson's disease and influence the selection of patients for transurethral surgery.
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