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Ultrasonography of the Adult Male Urinary Tract for Urinary Functional Testing
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LUTS in pelvic ischemia: a new concept in voiding dysfunction.

Portia Thurmond1, Jing-Hua Yang2, Kazem M Azadzoi3

  • 1Department of Urology, Veterans Affairs Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts.

American Journal of Physiology. Renal Physiology
|January 22, 2016
PubMed
Summary

Pelvic ischemia, or reduced blood flow, may cause lower urinary tract symptoms (LUTS) in aging individuals, independent of bladder outlet obstruction. This finding suggests new avenues for managing LUTS in the elderly.

Keywords:
LUTSbladderischemiaoxidative stressprostate

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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.