No abstract

The current study investigated the relationship between duration of outlet obstruction, magnitude of bladder mass, and functional dysfunction on the rabbit urinary bladder. Following the production of obstruction with the "cuff model", bladder wet weight increased to twice control weight within one week, and then slowly to four times control weight by one month, and remained at this level for the six month period. Bladder capacity decreased significantly by one week but returned to control volumes by one month. The in vitro ability of the bladder to empty in response to field stimulation and bethanechol decreased significantly in the one and two week obstructed bladders and remained decreased for six months. One of the major observations of this study was the relatively large variation of bladder weight and histology observed for the one to six month obstructed rabbits. Although the bladders with mild mass increase (less than 3 gm./kg. body weight) had normal distribution of urothelium and muscular elements, the bladders with moderate mass increase (3 to 6 gm./kg.) had thick extrinsic connective tissue deposits and the bladders with severe mass increase (greater than 6 gm./kg.) had thick extrinsic and intrinsic connective tissue deposits and muscular degeneration. The percentage occurrence of mild, moderate and severe mass increase was approximately the same (58%, 30% and 12%, respectively) for the one, three, and six month groups. The bladders with mild mass increase had normal bladder capacities and increased pressure responses to field stimulation and bethanechol. The bladders with moderate-to-severe mass increase showed enlarged bladder capacities and had progressively smaller pressure responses. As the magnitude of bladder mass increased, the ability of the bladder to empty in response to field stimulation and bethanechol decreased proportionally. We conclude that the functional impairment of the bladder is related to the amount of extrinsic and intrinsic connective tissue and the degree of muscle degeneration.

No abstract

Bladder outlet obstruction has been the subject of numerous studies. In previous studies on severe obstruction, the initial response of the bladder has been to produce an acute overdistension of the bladder resulting in severe tissue damage and functional disorders. This is quite different from the slow onset of outlet obstruction seen in association with benign prostatic hypertrophy (BPH). The present study describes the functional effect of mild outlet obstruction created in a rabbit model, and compares it to a previously described model of severe obstruction. Mild bladder outlet obstruction was created by placing a silicon sleeve (inner circumference 30 mm.) around the bladder neck of mature male NZW rabbits. Individual groups of rabbits were studied at one, seven, and 14 days following the creation of the outlet obstruction. The following studies were performed on each group of rabbits: in vivo and in vitro cystometry, field stimulation and cholinergic stimulation using the in vitro whole bladder model. In addition, the tissue concentration of ATP (adenosine triphosphate) and CP (creatine phosphate) and the muscarinic receptor density were determined. The obstructed bladders showed no significant cystometric difference at one day, but revealed a marked decrease of compliance and capacity at one and two weeks. Unlike the response to severe outlet obstruction, there was no initial acute overdistension of the bladder wall. Although the ability of the obstructed bladders to generate intravesical pressure in response to both field stimulation and bethanechol did not decrease, the ability of both forms of stimulation to empty the obstructed bladders was markedly impaired. The response to field stimulation was reduced to a significantly greater extent than the response to bethanechol, indicating neuronal damage. The muscarinic receptor number per bladder was increased above control at all time periods. The intracellular concentration of ATP and CP in the obstructed bladders was similar to that of control. Our present model of mild obstruction was not accompanied by a massive increase in tissue mass nor was there an overdistension of the detrusor; thus, this model would be a more suitable model for the study of clinical outlet obstruction.