Lower Urinary Tract Function

As described by Wein,5 the LUT has two phases of function, the filling/storage phase, and the emptying phase. In the filling/storage phase, the bladder is able to accommodate increasing volumes of urine at low intravesical pressures with appropriate sensation. This occurs in the absence of involuntary bladder contractions. The bladder outlet is closed and remains closed throughout this process. In the emptying phase, there is a lowering of resistance at the level of the smooth and striated sphincters. The bladder smooth muscle then contracts with an adequate magnitude, in the absence of anatomic obstruction, to evacuate urine. The bladder and outlet have reciprocal actions under normal circumstances, which are regulated by the nervous system. When the bladder is contracting, the outlet is relaxed, and when the bladder is relaxed, the outlet is contracting. This scheme describes the general process of urinary storage and micturition. Any alteration in the function of the LUT will affect one of these basic actions.

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