Autonomic dysfunction in patients with lower urinary tract disorders.

The autonomic nervous system (ANS) plays a key role in the control of micturition, ensuring an alternation between storage and voiding phases. Any lesion in the neural pathways may be responsible for lower urinary tract (LUT) dysfunction, usually associated with bowel and sexual disorders. In individuals with isolated LUT symptoms, dysregulation of the ANS may play a role in the origin of these disorders. This review summarizes the current evidence regarding the association between LUT disorders and ANS dysfunction, explored through a panel of autonomic tests (autonomic cardiovascular testing, heart rate variability, pupillometry, sudomotor tests, etc.). Special focus will be given to the most extensively studied relationship in the literature: ANS dysregulation and overactive bladder, a common syndrome characterized by urinary urgency. The potential of ANS assessment as a predictor of treatment outcomes will be also discusses, as well as the impact of LUT symptom therapies on ANS function.