Pathophysiological effect of bladder outlet obstruction on the urothelium

Bladder outlet obstruction (BOO) and associated lower urinary tract symptoms are major urological issues that significantly affect patient's quality of life and may lead to severe complications. The prevalence of both is increasing each year, raising the burden to health system. Therefore, casual and symptomatic treatment should be of great importance. However, management of symptoms is often difficult as their pathophysiology is multifactorial and not well elucidated. Recently urothelium has gathered much attention as one of the potential causal agents. It has been suggested that in addition to its barrier function, urothelium regulates transport through blood-urine barrier and is a part of "sensory web" by which it modulates afferent input. In this review we focus on adjustment of urothelium related to BOO in terms of its ultrastructure, barrier and transport function, and impact on "sensory web."