Precision medicine for female lower urinary tract dysfunctions: Pathophysiology and treatment - a narrative review

Female lower urinary tract symptoms (LUTS) are highly prevalent in urological practice. However, precision diagnosis of nonneurogenic lower urinary tract dysfunctions (LUTDs) and satisfactory medical treatment outcomes based on symptoms are usually unsuccessful. Except for structured questionnaires, uroflowmetry, cystoscopy, and ultrasonography of the lower urinary tract, videourodynamic studies are required to clearly identify the specific LUTD and determine suitable treatment or management. Nonneurogenic LUTDs arising from female LUTS include bladder oversensitivity, overactive bladder, interstitial cystitis, detrusor underactivity, stress urinary incontinence, and bladder outlet obstruction, such as bladder neck dysfunction, dysfunctional voiding, urethral obstruction, and poor relaxation of the pelvic floor muscles. The diagnosis and treatment of female LUTDs should be based on underlying bladder and bladder outlet dysfunction to ensure satisfactory therapeutic outcomes. This article reviews the current knowledge on the pathophysiology, diagnosis, and treatment strategies for female LUTS.