Peripheral neuropathies of the lower urinary tract following pelvic surgery and radiation therapy

Introduction Though control and coordination of micturition is relegated to higher centers in the brain and spinal cord, the lower urinary tract is ultimately innervated by the 'hard wiring' of peripheral nerves, conveying essential neurotransmission of the autonomic and somatic nervous systems. Iatrogenic damage to peripheral nerves of the bladder, urethra, and pelvic floor during the course of surgical endeavors or radiotherapy may result in significant patient morbidity in terms of resultant vesicourethral dysfunction. Voiding dysfunction resulting from extirparative or ablative therapies aimed at the treatment of cancer may be physically and socially devastating for a patient. It is important for the pelvic surgeon and radiotherapist alike to be familiar with the complex innervation of the bladder and urethra in order to reduce the likelihood of injury to peripheral nerves during the course of therapy. In addition, the urologist must be familiar with the signs, symptoms, and typical urodynamic manifestations of peripheral nerve injury in order to facilitate precise physiologic diagnosis and optimize treatment strategies. It is appropriate to begin our discussion with a review of the anatomy of the peripheral nervous system as it pertains to innervation and neural control of the lower urinary tract.