The Nephrologist's Guide to Lower Urinary Tract Conditions: A Urology-Based Review

Lower urinary tract symptoms and disorders are commonly encountered by nephrologists because they often coexist with or may contribute to various kidney diseases. Thus, an understanding of lower urinary tract disorders and knowing when consultation with urology is warranted are essential to nephrology practice. In this review, we examine lower urinary tract physiology and outline a practical, clinically oriented approach to the initial work-up for lower urinary tract symptoms, including history, physical examination, and office-based testing. Next, we discuss when referral to urology is indicated in patients with lower urinary tract symptoms, with particular emphasis on the identification of unsafe bladders and the process of urodynamics testing. We also summarize novel methods for evaluating the lower urinary tract which may provide noninvasive alternatives to urodynamics testing in the future. Third, we discuss common lower urinary tract disorders, highlighting key diagnostic considerations and management principles as relevant to nephrologists. Finally, disorders which warrant special attention by the nephrologist in patients with chronic kidney disease, end-stage renal disease and kidney transplantation will be explained.