Ultrastructural changes in the underactive bladder

Ho, Han‐Chen; Hsu, Yung‐Hsiang; Jhang, Jia‐Fong; Jiang, Yuan‐Hong

doi:10.4103/tcmj.tcmj_153_20

Cited by 3 publications

(3 citation statements)

References 36 publications

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“…10 These abnormalities are associated with distinctive ultrastructural changes. 12,13 Damage to the efferent neural mechanism at any point can lead to aberrations in detrusor contraction. This might be at the level of neuromuscular end plate, peripheral nerves, spinal pathways including interneurons, or the pontine micturition center.…”

Section: Neuromuscular Pathways Involved In Detrusor Contractionmentioning

confidence: 99%

“…These could involve different components of the contraction mechanism including the contractile proteins and filaments, cytoskeleton, actin‐myosin interaction, cellular metabolism, and mechanical properties of the detrusor muscle 10 . These abnormalities are associated with distinctive ultrastructural changes 12,13 …”

Section: Pathogenesis Of Abnormal Contractilitymentioning

confidence: 99%

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Could a better understanding of the underlying pathophysiologies lead to more informed treatment choices in patients with lower urinary tract dysfunction due to an acontractile or underactive detrusor? ICI‐RS 2023

Sinha,

Everaert,

Kheir

et al. 2023

Neurourology and Urodynamics

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IntroductionThe underlying pathophysiology behind a diagnosis of acontractile or underactive detrusor at invasive urodynamics is very heterogeneous. Lack of etiological classification currently limits the possibility of stratifying therapy.MethodsThis subject was discussed at a think‐tank on the subject at the International Consultation on Incontinence‐Research Society held in Bristol, June 2023. This manuscript is a result of those deliberations and the subsequent discussions of the think‐tank.ResultsThere are challenges in defining abnormalities of detrusor contraction with resultant implications for available evidence. Pathology at any level of the neuromuscular pathway can impair or prevent a detrusor voiding contraction. Attempts have been made to identify clinical markers that might predict an underactive detrusor but strong supporting evidence is lacking. Hence, a holistic approach to phenotyping requires specialized neuro‐imaging as well as physiological investigations. Several general measures can help individuals with an abnormal detrusor contraction. The search for a molecule to enhance the detrusor voiding contraction remains elusive but there are promising new candidates. Neuromodulation can help select individuals but data is not well stratified by underlying etiology. Manipulation of central neurotransmitters might offer an alternate therapeutic option.ConclusionsA better understanding of the underlying pathophysiologies behind an abnormality of the detrusor voiding contraction is needed for improving management. Towards this goal, the think‐tank proposes a classification of the underactive detrusor that might help in selecting and reporting more well‐defined patient cohorts.

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Section: Neuromuscular Pathways Involved In Detrusor Contractionmentioning

confidence: 99%

Section: Pathogenesis Of Abnormal Contractilitymentioning

confidence: 99%

Could a better understanding of the underlying pathophysiologies lead to more informed treatment choices in patients with lower urinary tract dysfunction due to an acontractile or underactive detrusor? ICI‐RS 2023

Sinha,

Everaert,

Kheir

et al. 2023

Neurourology and Urodynamics

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“…Prostatic hyperplasia is urodynamically manifested as obstruction of the bladder outlet. Prolonged obstruction will lead to a loss of bladder detrusor function, resulting in bladder capacity sensitivity disorder, varying degrees of detrusor contraction, or even premature end of the micturition reflex, which affects the process of urination [4] [5]. In the past, for patients with decreased urethral muscle function, the choice of traditional electrosurgical methods needed to be more careful due to the occurrence of postoperative urinary retention again or the lack of significant symptom improvement.…”

Section: Introductionmentioning

confidence: 99%

Study on the Treatment of Benign Prostate Hyperplasia Combined with Underactive Bladder Detrusor Contraction by Transurethral Plasma Enucleation of the Prostate

Li,

Chen

2023

JBM

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Objective: Exploring the clinical efficacy of transurethral plasma enucleation of the prostate in the treatment of benign prostatic hyperplasia with underactive bladder detrusor contractility. Methods: Retrospective analysis of the clinical data of 68 patients with benign prostatic hyperplasia and underactive detrusor muscle contractility treated by our department from July 2021 to July 2022. The above patients all met the diagnosis of benign prostatic hyperplasia, excluding prostate cancer and urethral stricture. Urodynamics showed a decrease in the contractile force of the bladder detrusor muscle, and the surgical equipment used Olympus bipolar plasma resection equipment method. Divide the above patients into two groups: the experimental group of 34 patients who underwent transurethral plasma enucleation of the prostate and the control group of 34 patients who underwent transurethral plasma resection of the prostate. Evaluate the preoperative clinical baseline level and postoperative observation indicators of the two groups of patients, and compare the statistical differences between the two groups. Results: Both groups of patients successfully completed the surgery, and there were no serious complications such as rectal or bladder perforation during the surgery, with less bleeding. The postoperative QOL, IPSS, Qmax, and residual urine volume of patients undergoing transurethral plasma enucleation and resection of the prostate were significantly improved compared to those before surgery (P < 0.05). Meanwhile, through inter group comparison, the improvement of QOL, IPSS, Qmax, and residual urine volume after plasma enucleation was better than that of the plasma resection group, and the differences were statistically significant (P < 0.05), but there was no significant difference in surgical time between the two groups (P > 0.05). Conclusion: Transurethral enuclea-How to cite this paper: Li, Y. and Chen, Z.J.

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Bladder Decompensation in Patients with Benign Prostatic Hyperplasia: Causes, Complications, Rehabilitation

Leonid¹,

Roman²

2021

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Background Despite the high efficiency of surgical methods in correction of bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia (BPH), a significant proportion of patients (up to 35%) remains after surgery with impaired contractile function of the bladder and lower urinary tract symptoms (LUTS). Both are consequences of structural and functional changes of the detrusor due to long-term exposure to obstructive factor. Today there is a lack of systematic reviews that provide a specialist with an integrative conception of pathological changes in the bladder wall caused by BPH associated prolonged BOO and evidence based methods of detrusor rehabilitation. The objective: systematization of modern conceptions about structural and functional changes in the bladder of patients with BPH caused by prolonged BOO, and methods of their correction. Materials and methods. An analytical review of the literature covering pathogenesis of bladder remodeling due to BPH associated long-term BOO and methods of bladder rehabilitation was performed. Literature sources were searched in PubMed, Google Scholar, Scopus and Web of Science databases by keywords. The search depth was 40 years. 74 relevant publications were selected for analysis. Results. Bladder remodeling due to obstructive factor is a complex staged process that involves all layers of the wall at the tissue, cellular and subcellular levels, affecting not only the executive structures (urothelium, smooth-muscle syncytium, fibrous connective tissue matrix), but also the system metabolism. Depending on the nature of the changes, there are 3 stages of this process: compensation, subcompensation and decompensation. In the compensatory stage, an increase of the load on the bladder leads to hypertrophy of smooth muscle fibers. At the same time, there is a reorganization of the vascular bed – neoangiogenesis, which should provide increased energy needs of muscles. In the stage of subcompensation, vicarious hypertrophy and neoangiogenesis cease. The most prominent disorders of the structure and function of the bladder are observed in the stage of decompensation. It includes a number of pathological processes: hypoxia, anaerobic metabolism, oxidative stress, inflammation, changes in the paracrine environment (increased levels of HIF-1α, vascular endothelial growth factor (VEGF) and angiopoietin-1). It is characterized by progressive loss of contractile function of the detrusor due to the death of smooth muscle cells and neurons, deterioration of viscoelastic characteristics of the bladder wall due to excessive collagen synthesis by fibroblasts, loss of barrier properties of the mucous membrane due to dystrophy. It was found that the severity of these pathological changes correlates with the severity of LUTS in patients who underwent surgery for BPH. The current arsenal of measures for bladder rehabilitation is quite diverse and includes periodic sterile catheterization, pharmacotherapy (cholinesterase inhibitors, antioxidants), physiotherapy (electrical stimulation, muscles training) and plastic surgery. However, there is still a lack of high-level studies to prove their effectiveness in patients who have undergone prostate surgery for BOO caused by BPH. Conclusions. Persistence of LUTS in patients who have undergone prostate surgery due to BOO may be caused by bladder decompensation. Long-term bladder decompensation due to prolonged exposure to obstructive factor is a complex process that includes decreased contractile activity, deterioration of the viscoelastic characteristics of the bladder, and impaired mucosal barrier function. Further research is needed to develop an effective bladder rehabilitation protocol.

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Ultrastructural changes in the underactive bladder

Cited by 3 publications

References 36 publications

Could a better understanding of the underlying pathophysiologies lead to more informed treatment choices in patients with lower urinary tract dysfunction due to an acontractile or underactive detrusor? ICI‐RS 2023

Could a better understanding of the underlying pathophysiologies lead to more informed treatment choices in patients with lower urinary tract dysfunction due to an acontractile or underactive detrusor? ICI‐RS 2023

Study on the Treatment of Benign Prostate Hyperplasia Combined with Underactive Bladder Detrusor Contraction by Transurethral Plasma Enucleation of the Prostate

Bladder Decompensation in Patients with Benign Prostatic Hyperplasia: Causes, Complications, Rehabilitation

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