Rising age, rising problems: the male lower genitourinary tract

Lower urinary tract symptoms (LUTS), mainly caused by benign prostatic hyperplasia (BPH), erectile dysfunction (ED), ejaculatory dysfunction, and urinary incontinence (UI) are highly prevalent urologic problems among the aging male population. In order to understand the complex changes that occur in the lower male genitourinary (GU) tract, it is important to review the normal anatomy, physiology, 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 apoptosis, neuropathy, fibrosis, and hypertrophy in response to growth factor stimulation. Prostate enlargement with bladder outlet obstruction due to dynamic and statics factors such as smooth muscle cell hyperplasia impair bladder emptying and promote bladder 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. All clinical interventions derived their beginning in a full anatomical, molecular, and dynamic knowledge base of the male lower genitourinary tract. Knowledge of the changes in anatomy, the symptoms associated with impaired lower GU function and disease‐specific therapies for these conditions will no doubt improve care for our aging male population.