Functional Abnormalities of the Bladder

Abstract

Simple morphological or anatomical imaging has obvious limitations when applied to the bladder, as there is no information about the functional health or otherwise of this structure. In most cases, patients present with functional symptoms, which are the consequence of a structural abnormality, particularly that due to outflow obstruction or sphincter or pelvic floor weakness. To divorce functional assessment from structural imaging would provide only a limited insight into the wellbeing of the lower urinary tract. This chapter discusses the various functional perturbations of the bladder and their diagnostic features on functional investigations (flowmetry and urodynamics). However, to guide diagnostic evaluation, it is first necessary to categorize the numerous lower urinary tract symptoms into broad subgroups.

A patient with abnormal bladder function presents with either a single or a mixture of symptoms, which are commonly grouped together and referred to as lower urinary tract symptoms or LUTS. It is current practice, as recommended by the International Continence Society (ICS - see bibliography), to consider these LUTS under the broad groupings of storage and voiding symptoms; a further group relates to postmicturition symptoms, but this is not discussed separately here. These groups are also used to categorize the clinical burden of the LUTS, using a validated score - the International Prostate Symptom Score (Table 8.1).