The Ups and Downs of Aging in the Male Genitourinary Tract

Abstract

Lower urinary tract symptoms (LUTS), are a collection of filling, storage, voiding and postmicturition symptoms highly prevalent and negatively impacting the quality of life of aging men. These symptoms are commonly caused by benign prostatic hyperplasia (BPH), and additional risk factors include obesity, diabetes, hypercholesteremia and hypertension. In order to understand the pathological changes that occur in the lower male genitourinary (GU) tract, it is important to review the normal anatomy, physiology, vascular and neural control of the bladder, prostate and penis. Significant alterations in the male GU tract with aging manifest as impairments in physiological functions such as blood flow, neuropathy, fibrosis, and hypertrophy. Prostate enlargement (BPH) with bladder outlet obstruction due to dynamic and statics factors such as smooth muscle cell hyperplasia impair bladder emptying and promote dysfunction. Sexual dysfunction is highly prevalent and results from loss of compliance of the penile sinusoids associated with increased deposition of collagen, decreased elastic fibers, endothelial dysfunction, and neuropathy. Additionally, aging and cardiovascular disease can impair the structure and function of the internal pudendal arteries which supply blood to the penis during an erection. Understanding the changes in anatomy, the symptoms associated with impaired lower GU function and disease‐specific therapies for these conditions will no doubt improve the care and quality of life for our aging male population.