The purpose of this presentation is to describe the distribution of noradrenergic nerves in the human genitourinary system. The techniques which have been employed include formaldehyde-induced fluorescence and immunocytochemical methods to demonstrate dopamine β-hydroxylase and tyrosine hydroxylase. These methods have been applied to human fetal, neonatal, infant, child and adult tissues removed either at post mortem examination or by surgical excision. The innervation of the fetal urinary bladder is well established by 13 weeks and, as in older specimens, the detrusor receives a sparse noradrenergic nerve supply. In contrast the smooth muscle of the terminal ureter is well supplied by this type of autonomic nerve. An additional incomplete muscle layer has been identified as a nomal component of the terminal ureter which is richly innervated by noradrenergic nerves. In some cases this muscle forms a complete collar which may be responsible for ureteric obstruction. By comparison with the detrusor, bladder neck smooth muscle receives a dense noradrenergic nerve supply particularly in the male. Unlike the detrusor, the structure and innervation of the vas deferens, seminal vesicle and prostate are poorly differentiated in the fetus. In the infant and child, the structure of the intramural smooth muscle of these organs remains immature although a rich noradrenergic nerve supply resembing the adult has been established in the fetus by 30 weeks. In the fetus, autonomic ganglia occur in association with noradrenaline rich paraganglia and surprisingly, with sensory nerve endings resembling pacinian corpuscles. Shortly after birth paraganglia are no longer associated with the autonomic ganglia of the genitourinary system. On the basis of size at least two types of autonomic neuron populate these autonomic ganglia. One type is relatively large and devoid of catecholamines but is closely associated with pericellular noradrenergic nerve fibres. The second type of neuron is small, contains noradrenaline and is arranged in clusters closely related to the capsule of the prostate gland. The significance of these observations will be considered with respect to the neurological control of the genitourinary system.

Keywords:
Noradrenaline, Human, Urinary tract, Pelvic plexus, Autonomic ganglia, Paraganglia
1.
Ek A, Alm P, Andersson K-E, Persson CGA: Adrenergic and cholinergic nerves of the human urethra and urinary bladder. A histochemical study. Acta Physiol Scand 1977;99:345–352.
2.
Gosling JA, Dixon JS, Lendon RG: The autonomic innervation of the human male and female bladder neck and proximal urethra. J Urol 1977;118:302–305.
3.
Sundin T, Dahlström A, Norlén L, Svedmyr N: The sympathetic innervation and adrenoreceptor function of the human lower urinary tract in the normal state and after parasympathetic denervation. Invest Urol 1977;14:322–328.
4.
Benson GS, McConnell JA, Wood JG: Adrenergic innervation of the human bladder body. J Urol 1979;122:189–191.
5.
Klück P: The autonomic innervation of the human urinary bladder, bladder neck and urethra. A histochemical study. Anat Rec 1980;198:439–447.
6.
McConnell J, Benson GS, Wood JG: Autonomic innervation of the urogenital system. Adrenergic and cholinergic elements. Brain Res Bull 1982;9:679–694.
7.
Sjöstrand NO: The adrenergic innervation of the vas deferens and accessory male genital glands. Acta Physiol Scand 1965;Suppl 257:1–82.
8.
Owman C, Alm P, Sjöberg NO: Pelvic autonomic ganglia: structure, transmitters, function and steroid influence; in Elfvin L-G (ed): Autonomic Ganglia. New York, John Wiley & Sons Ltd, 1983, pp 125–143.
9.
Gilpin CJ, Dixon JS, Gilpin SA, Gosling JA: The fine structure of autonomic neurons in the wall of the human urinary bladder. J Anat 1983;137:705–713.
10.
Smet PJ, Edyvane KA, Jonavicius J, Marshall VR: Neuropeptides and neurotransmitter-synthesizing enzymes in intrinsic neurons of the human urinary bladder. J Neurocytol 1996;25:112–124.
11.
De Groat WC, Booth AM: Inhibition and facilitation in parasympathetic ganglia of the urinary bladder. Fed Proc 1980;39:2990–2996.
12.
Chai TC, Steers WD: Neurophysiology of micturition and continence. Urol Clin N Amer 1996;23:221–236.
13.
Gary T, Robertson D: Lessons learned from dopamine β-hydroxylase deficiency in humans. News Physiol Sci 1994;9:35–39.
14.
Dohkita S, Nishimoto T, Morita T: Noradrenaline content in canine lower urinary tract tissue. Tohoku J Exp Med 1987;151:117–119.
15.
Lincoln J, Burnstock G: Autonomic innervation of the urinary bladder and urethra; in Maggi CA (ed): Nervous control of the urogenital system. Chur, Harwood Academic Publishers, 1993, vol 3, pp 33–68.
16.
Krane RJ, Olsson CA: Phenoxy-benzamine in neurogenic bladder dysfunction. A theory of micturition. J Urol 1973;110:650–652.
17.
Elbadawi A: Functional anatomy of the organs of micturition. Urol Clin N Amer 1996;23:177–210.
18.
Awad SA, Bruce AW, Carro-Ciampi G, Downie JW, Lin M: Distribution of α- and β-adrenoceptors in human urinary bladder. Br J Pharmac 1974;50:525–529.
19.
Nergardh A, Boreus LO: Autonomic receptor function in the lower urinary tract of man and cat. Scand J Urol Nephrol 1972;6:32–36.
20.
Edyvane KA, Smet PJ, Jonavicius J, Marshall VR: Regional differences in the innervation of the human ureterovesical junction by tyrosine hydroxylase-, vasoactive intestinal peptide- and neuropeptide Y-like immunoreactive nerves. J Urol 1995;154:262–266.
21.
Gearhart P, Canning DA, Gilpin SA, Lam EE, Gosling JA: Histological and histochemical study of the vesicoureteric junction in infancy and childhood. Br J Urol 1993;72:648–654.
22.
Dixon JS, Canning DA, Gearhart JP, Gosling JA: An immunohistochemical study of the innervation of the ureterovesical junction in infancy and childhood. Br J Urol 1994;73:292–297.
23.
Dixon JP, Jen PYP, Yeung CK, Gosling JA: The vesico-ureteric junction in three cases of primary obstructive megaureter associated with ectopic ureteric insertion. Br J Urol 1998;81:580–584.
24.
Onufrowicz B: Notes on the arrangement and function of cell groups in the sacral region of the spinal cord. J Nerv Ment Dis 1899;26:498–504.
25.
Elbadawi A, Schenk EA: A new theory of the innervation of bladder musculature. Part 4. Innervation of the vesicourethral junction and external urethral sphincter. J Urol 1974;111:613–615.
26.
Kumagai A, Koyanagi T, Takahashi Y: The innervation of the extemal urethral sphincter; an ultrastructural study in male human subjects. Urol Res 1987;15:39–43.
27.
Crowe R, Chapple CR, Burnstock G: The human prostate gland: a histological and immunohistological study of neuropeptides, serotonin, dopamine β-hydroxylase and acetylcholinesterase in autonomic nerves and ganglia. Br J Urol 1991;68:53–61.
28.
Baumgarten HG, Falck B, Holstein A-F, Owman CH, Owman T: Adrenergic innervation of human testis, epididymis, ductus deferens and prostate. A fluorescence, microscopic and fluorimetric study. Z Zellforsch 1968;90:81–95.
29.
Gosling JA, Dixon JS: The intramural innervation of the human vas deferens and seminal vesiele in infants and children. Scand J Urol Nephrol 1994;Suppl 157:75–81.
30.
Baumgarten HG, Holstein A-F, Rosengren E: Arrangement, ultra-structure and adrenergic innervation of smooth musculature of ductuli efferenti, ductus epididymis and ductus deferens of man. Z Zellforsch 1971;120:37–79.
31.
Jen PYP, Dixon JS, Gosling JA: Immunohistochemical localisation of neuromarkers and neuropeptides in human fetal and neonatal urinary bladder. Br J Urol 1995;75:230–235.
32.
Jen PYP, Dixon JS, Gosling JA: Development of peptide-containing nerves in the human fetal vas deferens and seminal vesicle. Br J Urol 1995;75:378–385.
33.
Kirulata HG, Fraser K, Owen L: The significance of the adrenergic nerves in the etiology of vesicoureteral reflux. J Urol 1986;136:232–235.
34.
Dixon JS, Jen PYP, Yueng CK, Chow LTC, Mathews R, Gearhart JP, Gosling JA: The structure and autonomic innervation of the vesicoureteric junction in cases of primary ureteric reflux. Br J Urol 1998;81:146–151.
35.
Gosling JA, Thompson SA: Morphological and histochemical studies on developing human pelvic autonomic nerve cells and paraganglia; in Coupland RE, Forsmann WG (eds): Peripheral Neuroendocrine Interaction. London, Springer, 1978, pp 37–47.
36.
Phillips M: Fetal catecholamines. Am J Obs Gyn 1983;146:840–855.
37.
Thompson SA, Gosling JA: Histochemical light microscopic study of catecholamine-containing paraganglia in the human pelvis. Cell Tiss Res 1976;170:539–548.
38.
Dixon JS, Gosling JA, Canning DA, Gearhart JP: An immunohistochemical study of human postnatal paraganglia associated with the urinary bladder. J Anat 1992;181:431–436.
39.
Hervonen A, Vaalasti A, Vaalasti T, Partanen M, Kanerva L: Paraganglia in the urogenital tract of man. Histochem 1976;48:307–313.
40.
Dixon JS, Jen PYP, Gosling JA: Immunohistochemical characteristies of human paraganglion cells and sensory corpuscles associated with the urinary bladder. A developmental study in the male fetus, neonate and infant. J Anat 1998;192:407–415.
1999
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.