Clinical Geriatrics

Introduction
Overactive bladder (OAB) is the syndrome of lower urinary tract symptoms (LUTS), defined by the International Continence Society (ICS) in 2002 as “urgency, with or without urge incontinence, usually with frequency and nocturia.”¹ Urgency, the sudden and compelling, often difficult (or impossible) to delay, desire to urinate is the hallmark of the OAB syndrome.² The symptom complex of OAB represents a final common pathway of dysfunctions relating to the lower urinary tract and its neurophysiologic control, concurrent systemic morbidities and pharmacology, and environmental interactions. Thus, the term overactive bladder probably should not be used as a diagnostic term, despite its widespread implication as a diagnosis in common clinical usage. Nonetheless, the use of the term among practitioners is generally understood to refer to the presence of the symptom complex in the absence of identifiable and treatable cause.

Significant alterations in the hormonal milieu occur in the aging population.1,2 In women, these changes are predictable and well recognized, and include a constellation of somatic and psychological symptoms due to a decline in circulating estrogenic hormones, called menopause. In contradistinction to menopause, the changes in the hypothalamic-pituitary-gonadal (HPG) axis in men are highly variable and are not seen in all men. These manifestations often may go unrecognized. These changes in the hormonal milieu in men are known by a collective term, male climacteric, or andropause. Andropause i