Innervation of the detrusor muscle bundle in neurogenic detrusor overactivity

OBJECTIVE To evaluate the peripheral anatomical distribution of innervation within muscle bundles of the detrusor and the changes arising in neurogenic detrusor overactivity (DO). PATIENTS AND METHODS Full‐thickness samples from the bladder dome of three cadaveric transplant organ donors and four people with neurogenic DO caused by spinal cord injury were compared. Systematic serial cryostat sections were stained using Masson trichrome and elastin techniques, and vimentin immunohistochemistry. A coherent image stack was generated for three‐dimensional image reconstructions, which were displayed using mixed rendering (i.e. differing graphics for separate tissue components) to show peri‐ and intra‐bundle innervation against the muscle fascicle framework. RESULTS Control specimens had a dense nerve supply. Muscle bundle innervation was derived by dichotomous branching from peri‐bundle nerve trunks in the inter‐bundle connective tissue. Transverse interfascicular branches entered bundles perpendicular to the long axis at the midpoint of the bundle. They gave rise to axial interfascicular branches, which distributed to the pre‐terminal and terminal nerve fibres. All samples from patients with neurogenic DO had patchy denervation. The primary deficit was predominantly at the level of the terminal axial innervation and was cross‐sectionally consistent along the longitudinal axis of the muscle bundle. CONCLUSION Patchy denervation may reflect a deficit at the level of the peripheral ganglia. Any contraction in the areas of denervation either occurs out of co‐ordination with the rest of the bladder, or is co‐ordinated by means of non‐neural structures. The observation of fine muscle strands running between fascicles, and connective tissue anchoring structures, represent two hypothetical mechanisms by which such co‐ordination might be effected.