Neurophysiology of stress urinary incontinence

Stress urinary incontinence (SUI) involves involuntary leakage of urine in response to abdominal pressure caused by activities such as sneezing and coughing. The condition affects millions of women worldwide, causing physical discomfort as well as social distress and even social isolation. Until recently, SUI was approached by clinicians as a purely anatomic problem requiring behavioral or surgical therapy. Over the past several years, extensive basic and clinical research in the field of neurourology has enhanced our understanding of the complex neural circuitry regulating normal function of the lower urinary tract. As a result, novel concepts have emerged regarding possible neurologic dysfunctions that might underlie the development of SUI, as well as potential novel strategies for pharmacologic therapy. This article reviews the normal neurophysiologic control of lower urinary tract function and considers potential pharmacologic approaches to correcting SUI.