Editing Functional: Neural Control of Storage and Voiding (section)

== Spinal ascending and descending influences ==

* '''Glutamate plays an important role in the spinal efferent circuitry supporting micturition'''.
* The spinal noradrenergic system, mediated by α1 adrenoceptors, has a modulatory role in controlling micturition by inhibiting afferent inputs from the bladder and facilitating the descending limb of the spinal micturition reflex to increase bladder contractility
* Glutamate appears to be involved as an excitatory transmitter in the supraspinal circuitry controlling micturition.
* Glutamate may also be a mediator of DO after neural injury
* Glycinergic and GABAergic projections to the lumbosacral cord inhibit the micturition reflex and also inhibit glutamatergic neurons. Clinically, DO can be inhibited by GABA receptor activation.
** GABA is the most widely distributed inhibitory neurotransmitter in the mammalian central nervous system.
* '''Activation of central serotonergic system can suppress voiding by inhibiting parasympathetic excitatory input to the urinary bladder'''
* '''Duloxetine'''
** '''MOA: combined norepinephrine and serotonin reuptake inhibitor'''
** '''Effects:'''
*** '''Increases neural activity of both the urethral sphincter and the bladder'''
** '''Uses:'''
*** '''Treatment of both stress incontinence and urgency incontinence.'''