Lower Urinary Tract Obstruction

Abstract

The lower urinary tract, comprising the bladder and urethra, acts as a functional unit that allows low pressure storage of urine and subsequent emptying at intervals when appropriate. At voiding, there is contraction of the bladder muscles, relaxation of the bladder neck and the external urethral sphincter allowing urine to flow, with complete bladder emptying facilitated by the urethrovesical reflex. Lower urinary tract obstruction (LUTO) refers to conditions that block the flow of urine from the bladder leading to difficulty with voiding. For this review, publications and ongoing research work on LUTO in the Urology Unit of the Department of Surgery are primarily considered. Generally, the causes of LUTO show some variation according to age and sex. Urethral stricture and benign prostate enlargement is a common cause of LUTO in the adult male population, while urinary tract infections, uterine fibroids and pelvic prolapsed disease are observed in females. The patients present with lower urinary tract obstructive symptoms such as straining at micturition and poor urine stream. Management is based on the cause of the LUTO which may include catheterization as an emergency intervention followed by a definitive medical management and/or surgical intervention. For malignant lesions radiation therapy may be used. LUTO remains a major presentation by patients in the Urology Unit. While preventive measures are helpful in some conditions, others require not only well planned management strategies but further research into more optimal and lasting interventions.