Lower Urinary Tract Symptoms and Aging: The Impact of Chronic Bladder Ischemia on Overactive Bladder Syndrome

Abstract

Introduction: The overactive bladder syndrome (OAB) is one of the most common and bothersome subsets of lower urinary tract symptoms (LUTS), affecting predominantly the aged population, with a worldwide distribution. This syndrome has not been completely understood, yet the aging process and the decreased blood flow to the bladder have been highlighted as closely related to this phenomenon. Materials and Methods: We performed a search on the online database PubMed/MEDLINE with the following MESH terms: ‘Overactive Bladder AND (Ischemia OR Aging OR Vascular Disease)'. We considered manuscripts written in English and published in the last 10 years (2004-2014, October). Additional manuscripts, such as referenced by reviews, were further included. Results: The aging process and the structural and functional changes resulting from an ischemic process emerge as important features that contribute to OAB. The ischemic-induced molecular and structural modifications that occur in the bladder have only recently been the objective of thorough studies, which link cardiovascular risk factors, vascular lesions and OAB. New animal models are being created to test new areas of treatment or prevention of ischemic-induced bladder dysfunction. Conclusion: Recent data point out that several physiological and pathological modifications that occur in the bladder associated with OAB and aging are closely related to ischemia.

Solifenacin in the Elderly: Results of an Observational Study Measuring Efficacy, Tolerability and Cognitive Effects

“…These findings could be attributed to age-related changes in the urinary tract [14,15] and to severe incontinence being more common in older than younger patients with OAB [2,16] . Incontinence is more prevalent in women [17,18] and our population was predominantly female, although 55% of men also presented with wet OAB.…”

The Efficacy of Antimuscarinics Alone or in Combination with Alpha-Blockers for the Treatment of Ureteral Stent-Related Symptoms: A Systematic Review and Meta-Analysis

“…The pathophysiology of stent-related symptoms has not been clearly proved yet, pain and LUTS caused by stent placement have been attributed to the pressure transmitted to the renal pelvis during urination, bladder ischemia and lower ureteric and bladder spasm due to local irritation [6][7][8] . The stent-related symptoms resemble LUTS secondary to benign prostatic hyperplasia (BPH) and overactive bladder (OAB) symptoms caused by urethral and bladder resistance, bladder instability and involuntary bladder contraction [25,26] .…”

“…Though pain and lower urinary tract symptoms (LUTS) caused by stent placement have been attributed to the pressure transmitted to the renal pelvis during urination, bladder ischemia and lower ureteric and bladder spasm due to local irritation [6][7][8] , the exact pathophysiology of ureteral stent-related symptoms is not clear. For this reason, several attempts to alleviate ureteral stentrelated symptoms have been reported, such as improving stent materials, physical properties and design [9] .…”

Association of Prostate Blood Flow with Male Lower Urinary Tract Symptoms

“…Azadzoi et al [16] also showed that ischemia and hypoxia might induce bladder neuropathy and lead to overactive bladder in the rabbit. Also, recent data supported that ischemia is associated with several physiological and pathological alteration in the bladder with OAB [17]. Although it is not proper to extrapolate these findings, alteration of blood flow at bilateral NVB vessels may reflect the different degree of hypoxia or congestion in the base of the bladder, since the inferior vesical artery provides blood to both branches along the prostate (NVB vessels) and the branches into the bladder neck and trigonal area [18].…”