The detrusor muscle cell in bladder outlet obstruction--ultrastructural and morphometric findings.
OBJECTIVE
Lower urinary tract symptoms (LUTS) in elderly males are not solely caused by bladder outlet obstruction (BOO) and may be at least partly attributable to detrusor dysfunction. Urodynamically, patients may show instability, hypocontractility, BOO or combinations of these findings. These findings have been related to specific ultrastructural changes in detrusor smooth muscle cells; however, this relationship is controversial. The aim of this study was to correlate ultrastructural findings in patients with BOO with urodynamic parameters.


METHODS
In 25 men with BOO verified by means of a full urodynamic evaluation, including a pressure-flow study, a detrusor biopsy was obtained. Six men without BOO served as controls. Biopsies for electron microscopy were analysed semiquantitatively and morphometrically to determine the presence of muscle cell hypertrophy, variation in intercellular distances, occurrence of abnormal cell junctions and configurations and intracellular changes.


RESULTS
The only parameter which was found to relate to the degree of obstruction in BOO was an increase in intra- and interfascicular elastin, all other correlations not reaching significance.


CONCLUSIONS
This study does not confirm a specific relationship between ultrastructural detrusor smooth muscle features and various types of BOO. Therefore ultrastructural investigation of detrusor smooth muscle cells cannot replace urodynamic evaluation in the classification of LUTS.
Holm
Nina Raae
NR
Department of Urology, Herley Hospital, University of Copenhagen, Denmark. nina.raae.holm@dadlnet.dk
Horn
Thomas
T
Smedts
Frank
F
Nordling
Jørgen
J
de la Rossette
Jean
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D032389:Myocytes, Smooth Muscle / Q000473:pathology / Q000648:ultrastructure; D001743:Urinary Bladder / Q000473:pathology* / Q000503:physiopathology / Q000648:ultrastructure*; D001748:Urinary Bladder Neck Obstruction / Q000473:pathology* / Q000503:physiopathology; D014563:Urodynamics