[Anatomo-physiological aspects of the lower urinary tract in men and modifications related to ageing]. / Aspects anatomo-physiologiques de l'appareil vésico-sphinctérien chez l'homme et modifications liées au vieillissement.

MICTURITION AND INCONTINENCE: The lower urinary tract, composed of several organs necessary for micturition, is controlled by the encephalic and peripheral centres, which have a synergic effect and coordinate the lower urinary tract. Continence is ensured by the effect of the adrenergic sympathetic nerve that increases urethral sphincter tonus and maintains low pressure in the bladder during filling. Micturition appeals to the cholinergic system mediated by the muscarinic receptors situated in the bladder. AGEING OF THE PROSTATE: Under the influence of dihydrotestosterone and growth factors, ageing of the prostate is characterized by histological modifications leading to hypertrophy, obstructing the flow of urine. AGEING OF THE BLADDER: Electronic microscopy studies have shown the presence of degenerative lesions and, on urodynamic level, are characterised by over or under-activity. Ageing of the peripheral and central nervous centres is morphological and metabolic with the production of vascular and free radicals, involving the systems that control micturition and continence. The ageing kidney has a tendency to produce more urine at night because of the functional changes that intervene in the salt and water balance regulation systems.

[Clinical manifestations of urinary disorders and their treatment in ageing men]. / Manifestations cliniques des troubles urinaires chez l'homme vieillissant et leur traitement.

PROBLEMS OF THE PROSTATE: Benign hypertrophy of the prostate (BHP), when it occurs, is manifested by an obstruction or irritation related to overactivity of the bladder. The obstructive syndrome is defined by urodynamic tests. Urge incontinence and study of the pressure-flow ratio are the tests of choice. The functional handicap and impact on quality of life are assessed using the International Prostatism Symptoms Score (I-PSS). Efficient and fairly well tolerated medical treatment has reduced the indications for surgery. It relies on alpha-blockers, 5a-reductase inhibitors and phytotherapy. When indicated, the surgical treatment of choice is endoscopic resection of the prostate. Among the non-prostatic micturition disorders, urge micturition with, in extreme cases, incontinence are due to detrusor instability. This is of multifactor origin; enhanced by the local irritation or environmental factors, it usually occurs within a context of acute or chronic pathologies. Treatment is recommended with anticholinergic agents. New molecules have recently been launched, better tolerated than oxybutinine. Electrostimulation can be a good alternative in mentally normal patients. Micturition due to excess urine may be due to overactivity of the bladder, the major risk of which is acute urine retention. It can also be observed during neurological affections such as Parkinson's disease or during administration of certain drugs. Nocturnal polyuria is a frequent problem. However, simple hygiene and dietary measures and the control of certain concomitant diseases can usually relieve the symptoms. Medical treatment relies on desmopressine.