[Neurogenic bladder disorders]

The past 15 years have witnessed an explosion of new knowledge concerning the anatomy, neurophysiology, and pharmacology of the lower urinary tract. Knowledge of the localization of a neurologic lesion-suprapontine, suprasacral, cauda equina, or peripheral nerves-rather than the type of disease allows a more "rational approach" to the diagnosis and therapy of neurogenic voiding disorders. More specifically, advances in pharmacological understanding enable us, at least in theory, to treat voiding disorders according to their types of dysfunction: drugs to promote bladder emptying that exert their predominant effect on bladder and bladder outlet respectively, and those promoting bladder storage with the corresponding objectives. We discuss the problem that many theoretically sound drugs are, in fact, not clinically efficacious, probably due to incomplete understanding of the physiology of normal micturition and its neurogenic disorders.