Original Article

The role of detrusor rigidity in the lower urinary tract dysfunction. Hypothesis

  • MICHAEL D. LEVIN

Pelviperineology 2018;37(3):70-73

Objective

To define the role of detrusor rigidity in the pathogenesis of various forms of low urinary tract dysfunction.

Results

We hypothesize that the motility of the urinary system and anorectal zone are subject to the same laws. Extrapolating the known mechanisms of fecal continence and defecation to urination, we propose a hypothesis of motor function of the lower urinary system. Changes in voiding parameters in lower urinary tract dysfunction (LUTD) suggest that detrusor contractility and efficiency decrease with age. This is characterized by a decrease in volume of the urinary bladder, and the thickening of its wall. Smooth muscle fibers are gradually replaced by connective tissue, leading to loss of elasticity and hence increased rigidity of the detrusor. Similar changes occur in the urethral sphincters. Contraction of the prostate then acts to support urinary retention in men when urination is delayed for long periods. In patients experiencing LUTD, it strikes more frequently at night than during the daytime. In this paper we discuss the mechanisms of pathological change as a result of the detrusor rigidity from the detrusor overactivity to the bladder outlet obstruction and then to the underactive detrusor are discussed.

Conclusion

Taken in conjunction with the concept of age related rigidity of the detrusor and urethral sphincters, our proposed hypothesis of lower urinary tract motility allows us to view the pathogenesis of various impairments of urination as a single process. This makes it possible to explain all the symptoms of LUTD. Further testing of the hypothesis is necessary.

Keywords: Hypothesis,Physiology of urination,Prostate,Rigidity,Urodynamic dysfunction,Urethral sphincters