Recent advances in our understanding of the neurophysiology and neuropharmacology of the lower urinary tract have improved our ability to treat disorders of bladder and urethral function. Similarly, many classes of drugs currently used in treating various medical conditions can cause lower urinary tract symptoms and dysfunction. Based on objective modern techniques of urodynamic evaluation, the clinician is able to sort out bladder and urethral abnormalities and scientifically choose appropriate pharmacologic regimens to treat these conditions. This paper reviews lower urinary tract physiology, the neurophysiology of voiding mechanisms and provides the clinician with a rational, objective, current neuropharmacologic approach to lower urinary tract disorders.