Pharmacology of the lower urinary tract

Abstract

The functions of the lower urinary tract, to store and periodically release urine, are dependent on the activity of smooth and striated muscles in the urinary bladder, urethra, and external urethral sphincter. This activity is in turn controlled by neural circuits in the brain, spinal cord, and peripheral ganglia. Various neurotransmitters, including acetylcholine, norepinephrine, dopamine, serotonin, excitatory and inhibitory amino acids, adenosine triphosphate, nitric oxide, and neuropeptides, both in the periphery and the central nervous system have been implicated in the neural regulation of the lower urinary tract. Injuries or diseases of the nervous system, as well as drugs and disorders of the peripheral organs, can produce lower urinary tract dysfunctions such as urinary frequency, urgency, pain and incontinence or inefficient voiding and urinary retention. This chapter will review recent advances in our understanding of the pharmacology in the control of lower urinary tract function and the targets for drug therapy.