Management of lower urinary tract symptoms in men with progressive neurological disease.

Purpose Of Review: Progressive neurological disease can cause lower urinary tract symptoms similar to those seen in bladder outflow obstruction. Increasingly common with age, these two groups of conditions often coexist. The complex pathophysiology of men with this combination of problems is often poorly understood and suboptimally managed, mostly with long-term indwelling catheters.

The perspective of a neurologist on treatment-related research in fecal and urinary incontinence.

Afferent innervation is important in sensing the degree of bladder fullness and in forming the input limb to involuntary detrusor contractions in neurogenic and probably also non-neurogenic detrusor overactivity. It is likely that homologous mechanisms are involved in control of the bowel. Accumulating evidence now suggests that in conditions of bladder hypersensitivity as well as non-neurogenic detrusor overactivity, there is up-regulation of unmyelinated nerve fibers expressing both the vanilloid receptor and purinergic receptors.

Neurological disorders of micturition and their treatment.

An overview of the current concepts of the neurological control of the bladder is given, based on laboratory experiments and PET scanning studies in human subjects. This is followed by a description of the various causes of the neurogenic bladder, discussed in a hierarchical order starting with cortical lesions and descending through the basal ganglia and brainstem, spinal cord, conus and cauda equina to disorders of peripheral innervation. Then follows a description of the condition of isolated urinary retention in young women.