ABSTRACT
The urinary symptoms of patients with neurogenic bladder usually result from either failure to store urine at low pressure with or without urinary incontinence, or failure to void by complete bladder emptying. They represent the two extremes of a complex functional mechanism relying on an intact neuroanatomic axis. Patients with more profound disturbances may require pharmacologic treatment to reinforce other forms of management, such as clean intermittent catheterization (CIC). Antimuscarinic drugs alone or in combination with CIC are currently the mainstay of conservative treatment of neurogenic bladders. Acetylcholine is a major neurotransmitter involved in detrusor contractions. There are five muscarinic receptor subtypes, each encoded by a different gene. All muscarinic receptor subtype mRNAs have been detected in the human bladder, including the urothelium, interstitial cells, nerve fibers, and detrusor layers. Structural differences divide urologic agents into tertiary and quaternary amines. They also differ in molecular size, charge, and lipophilicity.
