title: Ultrastructural study of the detrusor in end stage renal disease.
abstract: BACKGROUND
  After successful renal transplantation, almost 50% of the patients complained of lower urinary tract symptoms. There is no definite conclusion to explain these voiding symptoms and ultrastructural study of detrusor muscle in end stage renal disease (ESRD) has never been carried out before.
  
  
  OBJECTIVE
  To study ultrastructural changes of detrusor muscle in the specific group of patients with end stage renal disease.
  
  
  METHODS
  Detrusor biopsy of 20 patients, including 15 in end stage renal disease and five in patients with normal creatinine, was obtained by open technique. Biopsy was done during ureteral reimplantation at the time of kidney transplantation. In normal renal function group, detrusor biopsy was done at the time of open bladder surgery from other urologic diseases. The specimens were processed for light microscopy and transmission electron microscopy using standard techniques.
  
  
  RESULTS
  All specimens from open biopsy provided sufficient quality to be examined by electron microscope. The average creatinine level was 9.2 and 1.0 mg/dl in the ESRD group and control group, respectively In the ESRD group, all showed hypertrophy of muscle bundles, fibrosis between muscle bundles, muscle bundle degeneration, and fragmentation of muscle cells. In ESRD group, 93% had fibrosis around nerve bundles and enlarged muscle cell nuclei. About 60% had enlarged nerve bundles, and 53% showed amorphous inclusion in muscle cells. The ESRD group displayed many more ultrastructural changes than in the control group and some appearances were not present in the control group.
  
  
  CONCLUSIONS
  There were distinct ultrastructural changes of detrusor muscles in ESRD patients. These ultrastructural changes of detrusor muscles may be associated with voiding dysfunction after kidney transplantation.
authors.affiliation: Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol Univesity, Bangkok, Thailand. premsanti@gmail.com
authors.forename: Premsant
authors.initials: P
authors.lastname: Sangkum
authors.forename: Panas
authors.initials: P
authors.lastname: Charermsanyakorn
authors.forename: Kittinut
authors.initials: K
authors.lastname: Kijvikai
authors.forename: Wisoot
authors.initials: W
authors.lastname: Kongcharoensombat
authors.forename: Wachira
authors.initials: W
authors.lastname: Kochakarn
mesh_terms: D000328:Adult; D001706:Biopsy; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D016030:Kidney Transplantation; D059411:Lower Urinary Tract Symptoms; D008297:Male; D008854:Microscopy, Electron; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D009130:Muscle, Smooth / Q000473:pathology* / Q000503:physiopathology / Q000648:ultrastructure*; D011446:Prospective Studies; D001743:Urinary Bladder / Q000473:pathology* / Q000503:physiopathology / Q000648:ultrastructure*; D055815:Young Adult
chemical_list: D003404:Creatinine