Bladder function in health and disease

The lower urinary tract (LUT) comprises the bladder and its outlet, which serve roles in urine storage and voiding. Coordination of LUT structures in the micturition cycle is mediated by brain centers. LUT symptoms comprise impaired storage (incontinence, urgency, frequency, and nocturia), voiding (poor stream, hesitancy, dribbling), or post voiding (dribbling). Basic clinical assessment uses symptom scores, bladder diary, and flow rate testing. More advanced testing uses urodynamics to measure bladder pressures during storage and voiding. Incontinence is the involuntary loss of urine resulting when bladder pressure exceeds outlet resistance. Detrusor overactivity (DO) signifies that bladder contractions arise inappropriately during the storage phase. In overactive bladder syndrome (OAB), patients complain of excessive urinary urgency. Conservative, medical and surgical interventions are available according to degree of quality of life impairment. In neurological disease, various combinations of LUT dysfunctions arise, and clinical management aims to protect renal function and ameliorate symptoms.