Underactive bladder:Pathophysiology and clinical significance

Underactive bladder(UAB)is a voiding disorder which generates disabling lower urinary tract symptoms(LUTS)due to the inability to produce an effective voiding contraction sufficient to empty the bladder.The underlying abnormality,that is usually appreciated when performing urodynamic studies,has been defined by the International Continence Society(ICS)as detrusor underactivity(DUA).DUA is a common yet under-researched bladder dysfunction.The prevalence of DUA in different patient groups suggests that multiple aetiologies are implicated.Currently there is no effective therapeutic approach to treat this condition.An improved understanding of the underlying mechanisms is needed to facilitate the development of new advances in treatment.The purpose of this review is to discuss the epidemiology,pathophysiology,common causes and risk factors potentially leading to DUA;to aid in the appropriate diagnosis of DUA to potentially improve treatment outcomes.

The treatment of complex female urethral pathology

Lower urinary tract symptoms(LUTS)in women produce significant bother.Common conditions causing LUTS in women include urinary tract infections,overactive bladder,and stress incontinence.Urethral diverticulae and female urethral strictures are rare pathologies.They can cause symptoms,which can mimic commoner conditions,leading to delay in diagnosis and unnecessary delay in treatment.In this article,we discuss in detail the definition,symptoms,epidemiology,pathogenesis,diagnosis,and treatment option for these two conditions.Further understanding of these conditions will aid in the proper diagnosis and prevent delay in management.

Overcoming scarring in the urethra: Challenges for tissue engineering

Urethral stricture disease is increasingly common occurring in about 1%of males over the age of 55.The stricture tissue is rich in myofibroblasts and multi-nucleated giant cells which are thought to be related to stricture formation and collagen synthesis.An increase in collagen is associated with the loss of the normal vasculature of the normal urethra.The actual incidence differs based on worldwide populations,geography,and income.The stricture aetiology,location,length and patient’s age and comorbidity are important in deciding the course of treatment.In this review we aim to summarise the existing knowledge of the aetiology of urethral strictures,review current treatment regimens,and present the challenges of using tissue-engineered buccal mucosa(TEBM)to repair scarring of the urethra.In asking this question we are also mindful that recurrent fibrosis occurs in other tissuesdhow can we learn from these other pathologies?

Corrigendum to “Overcoming scarring in the urethra: Challenges for tissue engineering”

The author regrets the misprint in the sentence cited from reference 9 under section“Urethral stricture and histopathology”:“In contrast,the type III collagen in urethral stricture tissue was increased to 84%with a corresponding decrease in type I collagen(to 16%).”The correct sentence is“In contrast,the type I collagen in urethral stricture tissue was increased to 84%with a corresponding decrease in type III collagen(to 16%).”The author would like to apologise for any inconvenience caused.