How Aging Impacts Lower-Urinary Tract Symptoms
Summary
- Desai Sethi Urology Institute’s Dr. Alan Wein recently discussed how aging impacts lower-urinary tract symptoms at the American Urological Association AUA2025 annual meeting.
- Lower-urinary tract symptoms occur to some degree in everyone who ages and can be missed by primary care doctors.
- Dr. Wein and colleagues are developing compounds to decrease or even reverse changes due to oxidative stress, which plays a major role in lower-urinary tract symptoms.
Alan J. Wein, M.D., Ph.D. (hon.), professor of clinical urology at the University of Miami Miller School of Medicine and director of business development and mentoring for Desai Sethi Urology Institute (DSUI), recently discussed how aging impacts lower-urinary tract symptoms (LUTS). Dr. Wein’s remarks came during the Geriatric Urological Society’s aging urinary bladder session at the American Urological Association AUA2025 annual meeting.
“The percentages of people over 65 and over 85 are growing in leaps and bounds. Lower-urinary tract symptoms are among the things that doctors of many specialties are going to have to recognize exist in their patients. It’s good to know what to expect and to realize that, if you can’t or don’t want to deal with this, you should consult a urologist or urogynecologist,” Dr. Wein said.
The good news is that the pipeline is full of potential treatments for patients with common urinary symptoms. DSUI researchers, including Raveen Syan, M.D., assistant professor of clinical urology, and Katherine Amin, M.D., assistant professor of urology, are leading lower-urinary tract research. They train future subspecialists in South Florida’s only American College of Graduate Medical Education-accredited urogynecology and reconstructive pelvic surgery fellowship.
Impact of Aging on the Lower-Urinary Tract
Lower-urinary tract symptoms occur to some degree in everyone who ages, according to Dr. Wein. Symptoms include:
• Decreased bladder capacity and increased need to void.
• Decreased urethral pressure (especially in women), which can result in stress urinary incontinence.
• Decreased bladder compliance, or a gradual increase in pressure that occurs with volume, which contributes to increased urine frequency.
• Decreased urine flow and bladder contractility, which Dr. Wein said is due to fibrosis that occurs in the bladder wall and changes in the neurons that innervate the bladder.
“There’s a phenomenon called involuntary bladder contractions, or detrusor contractility, which means that the bladder contracts without the owner’s permission. You may be walking along and all of the sudden have this really severe desire to go to the bathroom and sometimes you can’t hold it,” Dr. Wein said. “That, again, is probably due to changes in the nervous system, and it’s very difficult to treat.”
Lower-urinary tract symptoms are common. About half of nursing home residents and 15% of elderly people who live at home have urinary incontinence.
The symptoms often come with serious quality-of-life consequences. People may limit activities or socializing because of the symptoms.
Doctors, according to Dr. Wein, might never know their patients are suffering if they don’t ask the simple question, “Do you ever leak any urine?”
Healthy Lifestyle for a Healthy Bladder
Oxidative stress appears to play a major role in lower-urinary tract symptoms. But the reasons underlying the problem require more work to discern.
“Basically, we know that oxidative stress can be related to decrease in perfusion, or blood flow,” Dr. Wein explained. “When you get ischemia, you get a release of free radicals that cause degeneration in the neurological supply to the bladder. That changes the bladder’s function and causes inflammation. Oxidative stress is related to tobacco usage, diabetes, neurologic disease, hormone changes and simply aging.”
Lifestyle changes can help alleviate symptoms, according to Dr. Wein.
“People should address health issues, maintain exercise, eat healthy and see doctors about any complaints they might have. Seeing a doctor early could result in reversing or alleviating symptoms, as well as pushing off deleterious changes,” he said.
Dr. Wein also recommended not letting bladders get distended by urinating whenever the urge arises.
DSUI Lower-Urinary Tract Research
Miller School faculty are studying ways to treat lower-urinary tract symptoms in men and women. Research topics include quality-of-life improvements and outcomes for women who have cancer surgery involving genitourinary organs and men with prostate cancer. Researchers are also investigating ways to avoid lower-urinary tract symptoms stemming from benign conditions.
Dr. Wein and colleagues from the University of Pittsburgh and Vanderbilt University are conducting ongoing research to develop compounds that will decrease or even reverse changes due to oxidative stress.
Drs. Amin and Syan are conducting a DSUI-funded pilot study looking at injecting a bulking agent during pelvic organ prolapse surgery to prevent stress incontinence, which commonly occurs after the procedure.
This preliminary study could pave the way for larger studies on using polyacrylamide hydrogel instead of mesh slings to prevent de novo stress urinary incontinence in prolapse repair patients.
The hydrogel is FDA approved for the indication. Compared to using mesh slings, polyacrylamide hydrogel is a less complex, lower-risk procedure. It also is reversible. Positive results from this and larger, multi-center trials would be a game-changer for patients, according to Dr. Amin.
“The benign urology aspect of LUTS research in women’s and men’s health has sometimes been overlooked because of the focus on cancer in urology,” she said. “It is exciting to see the potential for improved quality of life. The market is booming with new and investigational, minimally invasive options to help improve the everyday life of these patients who are truly suffering.”
Tags: bladder continence, Department of Urology, Desai Sethi Urology Institute, Dr. Alan Wein, Dr. Katherine Amin, Dr. Raveen Syan, genitourinary cancer, overactive bladder, urology