Neurourologic Findings with Applicability to Incontinence and Urethral Function*

Neurourology is applicable to urinary incontinence and obstructive uropathy in the general population. In most neurogenic conditions, incontinence is related to a loss of coordination of the bladder with the urethral sphincter mechanism. This article discusses possible causes and risk factors for stress incontinence and gives several clinical examples of patients with incontinence of varying causes. No medications have been approved by the US Food and Drug Administration for the treatment of stress incontinence. Alpha receptor agonists, tricyclic antidepressants, and estrogen have all been used to treat the condition, with varying degrees of success. A new pharmaceutical agent targeting the unique motor neurons in Onuf’s nucleus, which specifically innervate the striated urethral sphincter, shows promise as an effective treatment for motor urge incontinence and possibly certain types of stress incontinence. The types of stress incontinence for which the agent may be effective, however, must be carefully defined. (Advanced Studies in Medicine. 2002;2(19):681-689) N eurourology, especially the video urodynamic study of urinary tract function and dysfunction in patients with known neural lesions, is applicable to urinary incontinence and obstructive uropathy in the general urologic population. It was first established in neurogenic conditions that risk is related to abnormal bladder compliance or the ability of the bladder to store urine at low pressure. This abnormality is the result of bladder outlet obstruction. In most neurogenic conditions, this obstruction is related to a loss of coordination between the bladder and the urethral sphincter mechanism. Abnormal bladder storage function also results from any significant obstructive process involving the bladder outlet, such as benign prostatic hypertrophy or urethral obstruction after stress incontinence surgery (Figure 1). Obstruction, structural or neurogenic, has the same effect on compliance, which in turn determines risk.