ABSTRACT
Non-Obstructive Urinary Retention To allow for complete bladder emptying, detrusor contractions must be coordinated with urethral sphincteric relaxation. When the suprasacral pathways, which coordinate sphincteric activity, are altered, the guarding and urethral reflexes, which allow for urine storage without leakage still exist and cannot be turned off. This may result in urinary retention and is seen in certain patients with spinal cord injury and detrusor sphincter dyssynergia. These patients have functional detrusor contractions but are unable to coordinate this with a relaxed urethral sphincter resulting in urinary retention. Inhibition of the guarding reflexes may improve urinary retention. SNM is postulated to turn off excitatory flow to the urethral outlet and facilitate bladder emptying. In order to help both patients with urge-frequency and urge incontinence and non-obstructive urinary retention, it makes sense to believe that SNM works at the level of the pelvic floor and concomitant stimulation of afferent nerve fibers that feedback inhibits the detrusor muscle. This stimulation at the level of the pelvic floor may in turn also result in emptying improvement in patients with voiding dysfunction. Thus, pelvic floor spasticity may be thought of as a continuum that affects the bladder and SNM, at least, may impart its effects at regulation of this area.
