Pathophysiology of the lower urinary tract and CNS

A number of aspects of neural control are potentially important inthe control of bladder function, including both sensory and motorand peripheral and central pathways. It is likely that a combinationof disorders of both central and peripheral neural mechanisms isimportant in the genesis of urgency and the other symptoms of theoveractive bladder (OAB). Given the number of potential pathwaysinvolved, potential pharmacologic targets for OAB exist in the CNS(central nervous system; cerebral cortex, midbrain, spinal cord)and periphery (LUT; lower urinary tract). Antimuscarinics are stillthe mainstay of OAB treatment, but there are also a number ofother potentially efficacious drugs that may also provide benefitagainst the neurologic components of OAB. This review discussesthe impact of neurological abnormalities on lower urinary tractsymptoms and the potential for treatments targeting these pathwaysto improve symptoms.