All members of the International Continence Society know how devastating disorders of bladder function can be, particularly with a devastated bladder because of the impact on quality of life. Standardised assessment of lower urinary tract function is essential and that is an area that has been pioneered by the ICS over the last 50 years. In the devastated bladder, there is marked disruption of all aspects of lower urinary tract function leading to storage, voiding and post-micturition symptoms. This lecture will focus on disorders of lower urinary tract function, the emphasis being on benign (not malignant) conditions, albeit in some cases after cure of cancer by radiotherapy where devastating consequences result. I will discuss the appropriate evaluation of patients with reference to the most effective functional restoration of lower urinary tract function wherever possible.

I hope that I will be able to convince you that this topic is important and brings together all of the issues which we at the ICS feel are important. A current hot topic in this context is the post-ketamine bladder which we are seeing increasingly commonly.

In terms of readings for this, I would suggest of course the International Consultation document provided by the ICS, but also the European Association of Urology Guidelines 2021 which can be found online here and here.

The ICS is the only major international society that has as its raison d'etre evaluation and scientific investigation of such disorders and has the great strength of being a multidisciplinary organisation involving medical clinicians from all disciplines, urology, urogynaecology, nursing, physiotherapy, clinical science and of course basic scientific research.

Over the past six months, there has been much discussion on the UPSTREAM study which looked at the evaluation of lower urinary tract symptoms using pressure-flow urodynamics and its potential impact on surgery. I look forward to the upcoming results from the randomised UPSTREAM study and also the randomised study of the use of urodynamics in female patients with refractory overactive bladder symptoms. Urodynamics has now come of age and evidence-based assessment of its application in routine clinical practice is the next important development in our evaluation of how most effectively to investigated our patients to provide them with the best quality of care.

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