Reflections and the Way Forward

Abstract

The last two decades in urology has seen major refinements in thought with regards to the categorization of lower urinary tracts symptoms (LUTS) and the understanding of the underlying pathophysiological basis of these symptoms. For the most part there has been an overwhelming focus on detrusor overactivity (DO) and bladder outlet obstruction (BOO) as the causes storage and voiding LUTS respectively. This focus has been beneficial in that it has generated a large body of basic and clinical research that has furthered our understanding and led to the development of numerous beneficial medical and surgical therapies. By contrast the problem of detrusor underactivity (DU), although recognized, has been largely neglected and it is salutary to note that last major advance in management was the introduction of clean intermittent catheterization by Jack Lapides over 40 years ago.