ABSTRACT
I. INTRODUCTION Medical treatment for sphincteric pathology is often pursued as a first-line approach for the patient with either incontinence or obstructive voiding. The decision to pursue medical therapy may be patient-driven and based on the desire to avoid more aggressive invasive procedures. Alternatively, the decision may be physician-driven and possibly prompted by these same desires. The basis for the medical approach stems from the qualities that the sphincter possesses, both as an autonomically innervated organ (internal sphincter) and a skeletal muscle (external sphincter). The distinction should be made when approaching therapy between whether the target of treatment is the smooth internal sphincter (bladder neck) or the striated external sphincter. The medical approach to the treatment of the dysfunctional sphincter may be divided practically into medications to either enhance sphincteric function (as in stress incontinence) or weaken sphincteric function (as in dyssynergia or voiding dysfunction) and promote bladder emptying. The knowledge of these types of therapies, their benefits and risks, therefore, is essential for the clinician who cares for any patient with incontinence, voiding dysfunction, or neurogenic bladder.
