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The familiar functions of the bladder and lower urinary tract the storage and intermittent evacuation of urine are served by three structural components: the bladder itself, the main component of which is the large detrusor (transitional type) muscle; a functional internal sphincter composed of similar muscle; and the striated external sphincter or urogenital diaphragm The sphincters assure continence; in the male, the internal sphincter also prevents the re ux of semen from the urethra during ejaculation For micturition to occur, the sphincters must relax, allowing the detrusor to expel urine from the bladder into the urethra This is accomplished by a complex mechanism involving mainly the parasympathetic nervous system (the sacral peripheral nerves derived from the second, third, and fourth sacral segments of the spinal cord and their somatic sensorimotor bers) and to a lesser extent, sympathetic bers derived from the thorax The brainstem micturition centers, with their spinal and suprasegmental connections, may contribute (Fig 26-5) The detrusor muscle receives motor innervation from nerve cells in the intermediolateral columns of gray matter, mainly from the third and also from the second and fourth sacral segments of the spinal cord (the detrusor center ) These neurons give rise to preganglionic bers that synapse in parasympathetic ganglia within the bladder wall Short postganglionic bers end on muscarinic acetylcholine receptors of the muscle bers There are also betaadrenergic receptors in the dome of the bladder, which are activated by sympathetic bers that arise in the intermediolateral nerve cells of T10, T11, and T12 segments These preganglionic bers pass via inferior splanchnic nerves to the inferior mesenteric ganglia (Figs 26-1 and 26-4); pre- and postganglionic sympathetic axons are conveyed by the hypogastric nerve to the pelvic plexus and the bladder dome The internal sphincter and base of the bladder (trigone), consisting of smooth muscle, are also innervated to some extent by the sympathetic bers of the hypogastric nerves; their receptors are mainly of alpha-adrenergic type, which makes it possible to therapeutically manipulate the function of the sphincter.

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