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      Sex differences in lower urinary tract biology and physiology

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          Abstract

          Females and males differ significantly in gross anatomy and physiology of the lower urinary tract, and these differences are commonly discussed in the medical and scientific literature. However, less attention is dedicated to investigating the varied development, function, and biology between females and males on a cellular level. Recognizing that cell biology is not uniform, especially in the lower urinary tract of females and males, is crucial for providing context and relevance for diverse fields of biomedical investigation. This review serves to characterize the current understanding of biological sex differences between female and male lower urinary tracts, while identifying areas for future research. First, the differences in overall cell populations are discussed in the detrusor smooth muscle, urothelium, and trigone. Second, the urethra is discussed, including anatomic discussions of the female and male urethra followed by discussions of cellular differences in the urothelial and muscular layers. The pelvic floor is then reviewed, followed by an examination of the sex differences in hormonal regulation, the urinary tract microbiome, and the reticuloendothelial system. Understanding the complex and dynamic development, anatomy, and physiology of the lower urinary tract should be contextualized by the sex differences described in this review.

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          Most cited references135

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              The epidemiology of urinary tract infection.

              Urinary tract infections (UTIs) are among the most common bacterial infections acquired in the community and in hospitals. In individuals without anatomical or functional abnormalities, UTIs are generally self limiting, but have a propensity to recur. Uropathogens have specialized characteristics, such as the production of adhesins, siderophores and toxins that enable them to colonize and invade the urinary tract, and are transmitted between individuals both through person-to-person contact and possibly via food or water. Although generally self limiting, treatment of UTIs with antibiotics leads to a more rapid resolution of symptoms and is more likely to clear bacteriuria, but also selects for resistant uropathogens and commensal bacteria and adversely affects the gut and vaginal microbiota. As uropathogens are increasingly becoming resistant to currently available antibiotics, it may be time to explore alternative strategies for managing UTI.
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                Author and article information

                Contributors
                216-444-1103 , damasem@ccf.org
                Journal
                Biol Sex Differ
                Biol Sex Differ
                Biology of Sex Differences
                BioMed Central (London )
                2042-6410
                22 October 2018
                22 October 2018
                2018
                : 9
                : 45
                Affiliations
                [1 ]ISNI 0000 0001 0675 4725, GRID grid.239578.2, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, ; Cleveland, OH USA
                [2 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Department of Biophysics and Biophysical Chemistry, , Johns Hopkins School of Medicine, ; Baltimore, MD USA
                [3 ]ISNI 0000 0000 9759 5784, GRID grid.416103.1, Society for Women’s Health Research, ; Washington, DC, USA
                [4 ]ISNI 0000 0001 0860 4915, GRID grid.63054.34, UConn Center on Aging, , University of Connecticut, ; 263 Farmington, Farmington, CT USA
                [5 ]ISNI 0000000419368710, GRID grid.47100.32, Department of Obstetrics, Gynecology & Reproductive Sciences, , Yale School of Medicine, ; New Haven, CT USA
                [6 ]ISNI 0000 0004 1936 7961, GRID grid.26009.3d, Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Surgery, , Duke University, ; Durham, NC USA
                [7 ]ISNI 0000000419368710, GRID grid.47100.32, Department of Urology, , Yale School of Medicine, ; New Haven, CT USA
                [8 ]Close Pediatric Urology, Henderson, NV USA
                [9 ]GRID grid.411897.2, Department of Biomedical Sciences, , Cooper Medical School of Rowan University, ; Camden, NJ USA
                [10 ]ISNI 0000000100241216, GRID grid.189509.c, Department of Surgery, Division of Urology, , Duke University Medical Center, ; Durham, NC USA
                [11 ]ISNI 0000 0001 2299 3507, GRID grid.16753.36, Department of Urology and Obstetrics and Gynecology, , Northwestern University Feinberg School of Medicine, ; Chicago, IL USA
                [12 ]ISNI 0000 0001 1089 6558, GRID grid.164971.c, Department of Urology, , Loyola University Chicago, ; Maywood, IL USA
                [13 ]ISNI 0000 0001 1089 6558, GRID grid.164971.c, Department of Obstetrics/Gynecology, , Loyola University Chicago, ; Maywood, IL USA
                [14 ]ISNI 0000000122483208, GRID grid.10698.36, School of Nursing, , University of North Carolina at Chapel Hill, ; Chapel Hill, NC USA
                [15 ]ISNI 0000 0001 2185 3318, GRID grid.241167.7, Department of Obstetrics and Gynecology, , Wake Forest School of Medicine, ; Winston-Salem, NC USA
                [16 ]ISNI 0000 0001 2185 3318, GRID grid.241167.7, Department of Urology, , Wake Forest School of Medicine, ; Winston-Salem, NC USA
                [17 ]ISNI 0000 0001 1089 6558, GRID grid.164971.c, Department of Microbiology and Immunology, , Loyola University Chicago, Health Sciences Division, Stritch School of Medicine, ; Maywood, IL 60153 USA
                [18 ]ISNI 0000 0001 0675 4725, GRID grid.239578.2, Department of Biomedical Engineering, Lerner Research Institute, , The Cleveland Clinic, ; 9500 Euclid Avenue, ND20, Cleveland, OH 44195 USA
                [19 ]ISNI 0000 0004 0420 190X, GRID grid.410349.b, Louis Stokes Cleveland VA Medical Center, ; Cleveland, OH USA
                Article
                204
                10.1186/s13293-018-0204-8
                6196569
                30343668
                86890d50-4212-4f54-8c00-81046af52e75
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 20 June 2018
                : 26 September 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100004324, Astellas Pharma US;
                Funded by: FundRef http://dx.doi.org/10.13039/100005616, Allergan Foundation;
                Funded by: FundRef http://dx.doi.org/10.13039/100010479, Cook Medical;
                Funded by: FundRef http://dx.doi.org/10.13039/100007018, Kimberly-Clark Corporation;
                Categories
                Review
                Custom metadata
                © The Author(s) 2018

                Human biology
                sex differences,lower urinary tract,cell biology,urology
                Human biology
                sex differences, lower urinary tract, cell biology, urology

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