Diseases and conditions affecting the bladder and associated structures of the lower urinary tract are a leading cause of urinary incontinence, pelvic pain, and kidney failure, and they often contribute to poor quality of life. It has been estimated that 35 million Americans suffer from bladder disease and most have chronic conditions.Benjamin Franklin documented the poor quality of life for people with bladder problems in 1752. He invented the first flexible urethral catheter, made of silver and covered with gut, to help his brother empty his bladder. Franklin's brother suffered from bladder outlet obstruction caused by bladder stones. Years later, Franklin, who suffered from the same problem, was forced to catheterize himself intermittently with his own invention. Although technology now provides better instrumentation, medical science has not solved many cases of urinary retention-or other problems related to the bladder-and intermittent catheterization much as Franklin described is still used. Bladder diseases and problems affect people of all ages, races, and ethnic groups. Strides have been taken to improve diagnosis, management, and treatment of bladder diseases, but many primary questions about bladder formation, function, and disease remain. The Bladder Research Progress Review Group (BRPRG) was formed by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) of the National Institutes of Health (NIH) to examine the state of bladder research in the United States and to develop a plan for future research in this area. The members of the BRPRG are a multidisciplinary group of recognized experts in bladder research. Their task was a complex one because many diseases and conditions of the urinary tract such as incontinence, obstruction, interstitial cystitis, and spina bifida affect the bladder's structure and function. Bladder diseases such as bladder cancer or urinary tract infections affect specific tissues such as bladder epithelium; thus, research on these tissues will contribute directly to overall progress in cancer and infectious diseases research and not to research on bladder alone. From early 2000 to July 2001, members of the BRPRG had discussions and intensive meetings to examine all areas of bladder-related problems categorized by diseases and by organ or tissue in an attempt to develop a strategic bladder research plan. This plan is provided in this document. Overwhelmingly, the BRPRG has concluded that bladder research in the United States is inadequate, fraught with a number of impediments, and lags behind research in other areas that affect the health of Americans to a similar degree. The extent of health problems associated with the bladder emphasizes the urgent need to expand rapidly bladder health-related research not only to diagnose, manage, and treat bladder diseases, but also to discover the risk and preventive factors that will ultimately improve overall health. Recent discoveries and technological advances in biomedical science have provided a unique opportunity to make rapid and important advances in bladder research that might improve diagnosis, management, and prevention of bladder problems. This report outlines future critical research on the basic science of the lower urinary tract and clinical studies of bladder diseases and conditions. It also makes specific recommendations for focused inclusion of biotechnologies that offer opportunities for bladder research. In addition, the report describes the kinds of programs that will provide a pipeline of new researchers through training, new collaborations, and infrastructure to support this work. The potential consequences of rapid progress in bladder research could save many children, women, and men from the physical and emotional consequences of bladder diseases and conditions.