Skip to main content

Lower Urinary Tract Symptoms

  • Chapter
  • First Online:

Abstract

The lower urinary tract consists of interrelated structures including the bladder, urethra, smooth, and striated sphincters, pelvic floor muscles, and the prostate gland in men with a common function of providing effective urinary storage and voluntary urinary expulsion. These functions are achieved in two discrete phases of micturition [1].

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Wein AJ, Levin RM, Barrett DM. Voiding function: relevant anatomy, physiology, and pharmacology. In: Duckett JW, Howards ST, Grayhack JT, Gillenwater JY, editors. Adult and pediatric urology. St. Louis: Mosby; 1991. p. 933–99.

    Google Scholar 

  2. Wein AJ. Pathophysiology and classification of lower urinary tract dysfunction: overview. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology. 10th ed. Philadelphia: Elsevier Saunders; 2011. p. 1834–46.

    Google Scholar 

  3. Abrams P. New words for old: lower urinary tract symptoms for “prostatism”. BMJ. 1994;308(6934):929–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, Hunt TL, Wein AJ. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20(6):327–36.

    CAS  PubMed  Google Scholar 

  5. Irwin DE, Milsom I, Hunskaar S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006;50(6):1306–14. discussion 1314–5.

    Article  PubMed  Google Scholar 

  6. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. International Urogynecological Association, International Continence Society. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.

    PubMed  Google Scholar 

  7. Wein AJ, Lee DI. Benign prostatic hyperplasia and related entities. In: Hanno PH, Malkokwicz SB, Wein AJ, editors. Penn clinical manual of urology. Philadelphia: Elsevier; 2007. p. 479–521.

    Chapter  Google Scholar 

  8. Guess HA, Arrighi HM, Metter EJ, Fozard JL. Cumulative prevalence of prostatism matches the autopsy prevalence of benign prostatic hyperplasia. Prostate. 1990;17(3):241–6.

    Article  CAS  PubMed  Google Scholar 

  9. Oishi K, Boyle P, Barry M, et al. Epidemiology and natural history of benign prostatic hyperplasia. In: 4th International consultation on benign prostatic hyperplasia. Plymouth: Plymbridge Distributors Ltd; 1998. p. 23–59.

    Google Scholar 

  10. Blaivas JG. The bladder is an unreliable witness. Neurourol Urodyn. 1996;15(5):443–5.

    Article  CAS  PubMed  Google Scholar 

  11. Cg R. The utility of serum prostatic-specific antigen in the management of men with benign prostatic hyperplasia. Int J Impot Res. 2008;20 Suppl 3:S19–26.

    Google Scholar 

  12. Bohnen AM, Groeneveld FP, Bosch JL. Serum prostate-specific antigen as a predictor of prostate volume in the community: the Krimpen study. Eur Urol. 2007;51(6):1645–52. discussion 1652–3.

    Article  PubMed  Google Scholar 

  13. Cg R. BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU Int. 2008;101 Suppl 3:17–21.

    Google Scholar 

  14. Lieber MM, Roberts RO. Prostate volume and prostate specific antigen in the absence of prostate cancer: a review of the relationship and prediction of long-term outcomes. Prostate. 2001;49(3):208–12.

    Article  CAS  PubMed  Google Scholar 

  15. Marion G. Surgery of the neck of the bladder. Br J Urol. 1933;5:351–7.

    Article  Google Scholar 

  16. Turner-Warwick R, Whiteside CG, Worth PHL, et al. A urodynamic view of the clinical problems associated with bladder neck dysfunction and its treatment by endoscopic incision and transtrigonal posterior prostatectomy. Br J Urol. 1973;45:44–59.

    Article  CAS  PubMed  Google Scholar 

  17. Diokno AC, Hollander J, Bennett CJ. Bladder neck obstruction in women: a real entity. J Urol. 1984;132:294–8.

    CAS  PubMed  Google Scholar 

  18. Smey P, King LR, Firlit CF. Dysfunctional voiding in children secondary to internal sphincter dyssynergia: treatment with phenoxybenzamine. Urol Clin North Am. 1980;7:337–47.

    CAS  PubMed  Google Scholar 

  19. Westney OL. Salvage surgery for bladder outlet obstruction after prostatectomy or cystectomy. Curr Opin Urol. 2008;18(6):570–4.

    Article  PubMed  Google Scholar 

  20. Beard DE, Goodyear WE. Urethral stricture: a pathological study. J Urol. 1948;59:619–26.

    CAS  PubMed  Google Scholar 

  21. Mundy AR, Andrich DE. Urethral strictures. BJU Int. 2011;107(1):6–26.

    Article  PubMed  Google Scholar 

  22. Romero Perez P, Mira Llinaries A. Complications of the lower urinary tract secondary to urethral stenosis. Actas Urol Esp. 1996;20:786–93.

    CAS  PubMed  Google Scholar 

  23. Harriss DR, Beckingham IJ, Lemberger RJ, Lawrence WT. Long-term results of intermittent low-friction selfcathetersation in patients with recurrent urethral strictures. Br J Urol. 1994;74:790–2.

    Article  CAS  PubMed  Google Scholar 

  24. Smith AL, Ferlise VJ, Rovner ES. Female urethral strictures: successful management with long-term clean intermittent catheterization after urethral dilatation. BJU Int. 2006;98(1):96–9.

    Article  PubMed  Google Scholar 

  25. Palminteri E. Stents and urethral strictures: a lesson learned? Eur Urol. 2008;54:498–500.

    Article  PubMed  Google Scholar 

  26. Kavia RB, Datta SN, Dasgupta R, Elneil S, Fowler CJ. Urinary retention in women: its causes and management. BJU Int. 2006;97(2):281–7.

    Article  PubMed  Google Scholar 

  27. Wein AJ. Lower urinary tract dysfunction in neurologic injury and disease. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology. Philadelphia: Saunders; 2007. p. 2011–44.

    Google Scholar 

  28. Wein AJ, Moy ML. Voiding function and dysfunction; urinary incontinence. In: Hanno PH, Malkokwicz SB, Wein AJ, editors. Penn clinical manual of urology. Philadelphia: Elsevier; 2007. p. 341–478.

    Chapter  Google Scholar 

  29. Andersson K-E, Chapple CR, Cardozo L, et al. Pharmacological treatment of urinary incontinence. In: Abrams P, Cardozo L, Khoury S, et al., editors. Incontinence. 4th ed. Paris: Health Publications Ltd; 2009. p. 631–99.

    Google Scholar 

  30. Abrams P, Drake M. Overactive bladder. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology. Philadelphia: Saunders; 2007. p. 2079–90.

    Google Scholar 

  31. Hirayama A, Torimoto K, Yamada A, Tanaka N, Fujimoto K, Yoshida K, Hirao Y. Relationship between nocturnal urine volume, leg edema, and urinary antidiuretic hormone in older men. Urology. 2011;77(6):1426–31.

    Article  PubMed  Google Scholar 

  32. Hanno PM, Burks DA, Clemens JQ, Dmochowski RR, Erickson D, Fitzgerald MP, et al. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2011;185(6):2162–70.

    Article  PubMed  Google Scholar 

  33. Serati M, Cattoni E, Braga A, Siesto G, Salvatore S. Coital incontinence: relation to detrusor overactivity and stress incontinence. A controversial topic. Neurourol Urodyn. 2011;30(8):1415.

    Article  PubMed  Google Scholar 

  34. Resnick NM, Tadic SD, Yalla SV. Geriatric incontinence and voiding dysfunction. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology. 10th ed. Philadelphia: Elsevier Saunders; 2011. p. 2204–22.

    Google Scholar 

  35. Griebling TL. Aging and geriatric urology. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology. 11th ed. Philadelphia: Elsevier Saunders; 2016. p. 2083–102.

    Google Scholar 

  36. Tyagi P, et al. Association of inflammaging (inflammation + aging) with higher prevalence of OAB in elderly population. Int Urol Nephrol. 2014;46(5):871–7.

    Article  CAS  PubMed  Google Scholar 

  37. Yamaguchi O, Nomiya M, Andersson KE. Functional consequences of chronic bladder ischemia. Neurolurol Urodyn. 2014;33(1):54–8.

    Article  Google Scholar 

  38. Young JS, et al. The passive and active contractile properties of the neurogenic, underactive bladder. BJU Int. 2014;111(2):355–61.

    Article  Google Scholar 

  39. Nomiya M, et al. The effect of atherosclerosis-induced chronic bladder ischemia on bladder function in the rat. Neurourol Urodyn. 2012;31(1):195–200.

    Article  CAS  PubMed  Google Scholar 

  40. Azadzoi KM, Tarcan T, Siroky MB, Krane RJ. Atherosclerosis-induced chronic ischemia causes bladder fibrosis and non-compliance in the rabbit. J Urol. 1999;161(5):1626–35.

    Article  CAS  PubMed  Google Scholar 

  41. Yoshida M, MAsunaga K, Nagata T, Satoji Y, Shiomi M. The effects of chronic hyperlipidemia on bladder function in myocardial infarction-prone Watanabe heritable hyperlipidemic (WHHLMI) rabbits. Neurourol Urodyn. 2010;29(7):1350–4.

    Article  PubMed  Google Scholar 

  42. Levin RM, et al. Studies on experimental bladder outlet obstruction in the cat: long-term functional effects. J Urol. 1992;148(3):939–43.

    CAS  PubMed  Google Scholar 

  43. Xiao N, Wang Z, Huang Y, Daneshgari F, Liu G. Roles of polyuria and hyperglycemia in bladder dysfunction in diabetes. J Urol. 2013;189(3):1130–6.

    Article  CAS  PubMed  Google Scholar 

  44. Christ GJ, et al. Effects of streptozotocin-induced diabetes on bladder and erectile (dys)function in the same rat in vivo. BJU Int. 2006;97(5):1076–82.

    Article  PubMed  Google Scholar 

  45. Elbadawi A, Yalla SV, Resnick NM. Structural basis of geriatric voiding dysfunction. II. Aging detrusor: normal versus impaired contractility. J Urol. 1993;150(5 Pt 2):1657–67.

    CAS  PubMed  Google Scholar 

  46. Elbadawi A, Yalla SV, Resnick NM. Structural basis of geriatric voiding dysfunction. III. Detrusor overactivity. J Urol. 1993;150(5 Pt 2):1668–80.

    CAS  PubMed  Google Scholar 

  47. Elbadawi A, Hailemariam S, Yalla SV, Resnick NM. Structural basis of geriatric voiding dysfunction. VI. Validation and update of diagnostic criteria in 71 detrusor biopsies. J Urol. 1997;157(5):1802–13.

    Article  CAS  PubMed  Google Scholar 

  48. Holm NR, Horn T, Hald T. Detrusor in ageing and obstruction. Scand J Urol Nephrol. 1995;29(1):45–9.

    Article  CAS  PubMed  Google Scholar 

  49. Lepor H, Sunaryadi I, Hartanto V, Shapiro E. Quantitative morphometry of the adult human bladder. J Urol. 1992;148(2 Pt 1):414–7.

    CAS  PubMed  Google Scholar 

  50. Susset JG, Servot-Viguier D, Lamy F, Madernas P, Black R. Collagen in 155 human bladders. Invest Urol. 1978;16(3):204–6.

    CAS  PubMed  Google Scholar 

  51. Lowalekar SK, Cristofaro V, Radisavljevic ZM, Yalla SV, Sullivan MP. Loss of bladder smooth muscle caveolae in the aging bladder. Neurourol Urodyn. 2012;31(4):586–92.

    Article  PubMed  Google Scholar 

  52. Lai HH, et al. Loss of caveolin-1 expression is associated with disruption of muscarinic cholinergic activities in the urinary bladder. Neurochem Int. 2004;45(8):1185–93.

    Article  CAS  PubMed  Google Scholar 

  53. Zhu Q, Resnick NM, Elbadawi A, Kuchel GA. Estrogen and postnatal maturation increase caveolar number and caveolin-1 protein in bladder smooth muscle cells. J Urol. 2004;171(1):467–71.

    Article  CAS  PubMed  Google Scholar 

  54. Sadegh MK, et al. Biomechanical properties and innervation of the female caveolin-1-deficient detrusor. Br J Pharmacol. 2011;162(5):1156–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Cristofaro V, Peters CA, Yalla SV, Sullivan MP. Smooth muscle caveolae differentially regulate specific agonist induced bladder contractions. Neurourol Urodyn. 2007;26:71–80.

    Article  CAS  PubMed  Google Scholar 

  56. Betschart C, et al. Histomorphological analysis of the urogenital diaphragm in elderly women: a cadaver study. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(11):1477–81.

    Article  CAS  PubMed  Google Scholar 

  57. Klauser A, et al. Age-related rhabdosphincter function in female urinary stress incontinence: assessment of intraurethral sonography. J Ultrasound Med. 2004;23(5):631–7.

    PubMed  Google Scholar 

  58. Kurihara M, et al. Lack of the complete circular rhabdosphincter and a distinct circular smooth muscle layer around the proximal urethra in elderly Japanese women: an anatomical study. Int J Urogynecol J Pelvic Floor Dysfunct. 2004;15(2):85–94.

    Article  Google Scholar 

  59. Strasser H, et al. Age dependent apoptosis and loss of rhabdosphincter cells. J Urol. 2000;164(5):1781–5.

    Article  CAS  PubMed  Google Scholar 

  60. Strasser H, Tiefenthaler M, Steinlechner M, Bartsch G, Konwalinka G. Urinary incontinence in the elderly and age-dependent apoptosis of rhabdosphincter cells. Lancet. 1999;354(9182):918–9.

    Article  CAS  PubMed  Google Scholar 

  61. Rechberger T, Donica H, Baranowski W, Jakowicki J. Female urinary stress incontinence in terms of connective tissue biochemistry. Eur J Obstet Gynecol Reprod Biol. 1993;49(3):187–91.

    Article  CAS  PubMed  Google Scholar 

  62. Takacs P, et al. Fibulin-5 expression is decreased in women with anterior vaginal wall prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(2):207–211.

    Google Scholar 

  63. Snooks SJ, Badenoch DF, Tiptaft RC, Swash M. Perineal nerve damage in genuine stress urinary incontinence. An electrophysiological study. Br J Urol. 1985;57(4):422–6.

    Article  CAS  PubMed  Google Scholar 

  64. Andersson RS. A neurogenic element to urinary genuine stress incontinence. Br J Obstet Gynaecol. 1984;91(1):41–5.

    Article  Google Scholar 

  65. Snooks SJ, Swash M, Mathers SE, Henry MM. Effect of vaginal delivery on the pelvic floor: a 5-year follow-up. Br J Surg 1990;77(12):1358–60.

    Google Scholar 

  66. Snooks SJ, Setchell M, Swash M, Henry MM. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet. 1984;2(8402):546–50.

    Google Scholar 

  67. Mansfield KJ. Muscarinic receptor subtypes in human bladder detrusor and mucosa, studied by radioligand binding and quantitative competitive RT-PCR: changes in ageing. Br J Pharmacol. 2005;144(8):1089–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Yoshida M, Miyamae K, Iwashita H, Otani M, Inadome A. Management of detrusor dysfunction in the elderly: changes in acetylcholine and adenosine triphosphate release during aging. Urology. 2004;63(3 Suppl 1):17–23.

    Article  PubMed  Google Scholar 

  69. Li G, Li K, Li Z, Wang P. Age-dependent changes in beta-adrenoceptor function in human detrusors and possible mechanisms. Chin Med J (Engl). 2003;116(10):1511–4.

    CAS  Google Scholar 

  70. Gilpin SA, Gilpin CJ, Dixon JS, Gosling JA, Kirby RS. The effect of age on the autonomic innervation of the urinary bladder. Br J Urol. 1986;58(4):378–81.

    Article  CAS  PubMed  Google Scholar 

  71. Smith PP. Aging and the underactive detrusor: a failure of activity or activation? Neurourol Urodyn. 2010;29(3):408–12.

    PubMed  Google Scholar 

  72. Suskind AM, Smith PP. A new look at detrusor underactivity: impaired contractility versus afferent dysfunction. Curr Urol Rep. 2009;10(5):347–51.

    Article  PubMed  Google Scholar 

  73. van Koeveringe GA, et al. Detrusor underactivity: Pathophysiological considerations, models and proposals for future research. ICI-RS 2013. Neurourol Urodyn. 2014;33(5):591–6.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Shafik A, Shafik AA, El-Sibai O, Ahmed I. Role of positive urethrovesical feedback in vesical evaluation. The concept of a second micturition reflex: the urethrovesical reflex. World J Urol. 2003;21(3):167–70.

    Article  PubMed  Google Scholar 

  75. Blok BF, Willemsen AT, Holstege G. A PET study on brain control of micturition in humans. Brain. 1997;120(Pt 1):111–21.

    Article  PubMed  Google Scholar 

  76. Griffiths DJ. Cerebral aetiology of urinary urge incontinence in elderly people. Age Ageing. 1994;23(3):246–50.

    Article  CAS  PubMed  Google Scholar 

  77. Wakefield DB. White matter hyperintensities predict functional decline in voiding, mobility, and cognition in older adults. J Am Geriatr Soc. 2010;58(2):275–81.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Hanno P, Malkowicz SB, Wein A, editors: Benign prostatic hyperplasia, clinical manual of urology, New York, 2001, McGraw Hill, F15-1, p 441.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alan J. Wein .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer Science+Business Media New York

About this chapter

Cite this chapter

Pearlman, A.M., Smith, A.L., Wein, A.J. (2016). Lower Urinary Tract Symptoms. In: Guzzo, T., Drach, G., Wein, A. (eds) Primer of Geriatric Urology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-4928-1_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-4928-1_10

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-4926-7

  • Online ISBN: 978-1-4939-4928-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics