Effect of Chronic Ischemia on Bladder Structure and Function

Abstract

Dysfunction of the lower urinary tract is an important cause of morbidity and even mortality. Severe bladder dysfunction may lead to infection, sepsis, renal failure, and even death. Less dramatic presentations include urinary incontinence, frequency, urgency, nocturia, and enuresis. The etiology of bladder dysfunction is poorly understood. In the male, bladder outlet obstruction due to an enlarged prostate has long been blamed. However, it has been shown that in one third to more than one half of cases, symptoms of “prostatism” are not associated with bladder outlet obstruction.^24,25 Interestingly, when women are asked to complete symptom questionnaires designed to document lower urinary tract symptoms, they yield identical scores to their age-matched male counterparts.^6,18 Similarly, urodynamic studies have demonstrated that there are age-specific changes in the bladder function affecting both genders. Madersbacher et al²⁰ have shown that there are significant urodynamic changes with age that are similar in both sexes, including decreased maximum flow rate, voided volume and bladder capacity, and an increase in post-void residual volume. Therefore, it seems reasonable to ask whether, in many cases of bladder dysfunction, more global, sex-independent mechanisms may play an important role.