LUTS in pelvic ischemia: a new concept in voiding dysfunction

Area of Science:

• Urology
• Gerontology
• Physiology

Background:

• Lower urinary tract symptoms (LUTS) affect both genders with aging.
• Traditionally, LUTS in men were linked to benign prostatic enlargement (BPE) causing bladder outlet obstruction (BOO).
• However, LUTS in many men and women are not associated with BOO, suggesting other causes.

Purpose of the Study:

• To investigate the role of aging-associated pelvic ischemia in the development of nonobstructed nonneurogenic overactive bladder and LUTS.
• To explore pelvic ischemia as a potential primary factor in age-related bladder dysfunction.

Main Methods:

• Review of experimental models and clinical studies on pelvic ischemia and lower urinary tract function.
• Analysis of structural and functional consequences of bladder and prostate ischemia.
• Correlation of LUTS severity with bladder ischemia and assessment of LUTS improvement with alpha-blockers and increased bladder blood flow.

Main Results:

• Pelvic ischemia compromises lower urinary tract structure and function.
• Bladder and prostate blood flow decrease with aging.
• LUTS severity correlates with bladder ischemia, and improvement is linked to increased blood flow.

Conclusions:

• Aging-associated pelvic ischemia may be a primary factor in nonobstructed nonneurogenic bladder instability and LUTS.
• Pelvic ischemia could be an independent factor contributing to LUTS in the elderly.
• Further research into LUTS pathophysiology in pelvic ischemia may improve management strategies.