Pathophysiology of the lower urinary tract and CNS.

A number of aspects of neural control are potentially important in the control of bladder function, including both sensory and motor and peripheral and central pathways. It is likely that a combination of disorders of both central and peripheral neural mechanisms is important in the genesis of urgency and the other symptoms of the overactive bladder (OAB). Given the number of potential pathways involved, 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 still the mainstay of OAB treatment, but there are also a number of other potentially efficacious drugs that may also provide benefit against the neurologic components of OAB. This review discusses the impact of neurological abnormalities on lower urinary tract symptoms and the potential for treatments targeting these pathways to improve symptoms.