title: Urothelial dysfunction and increased suburothelial inflammation of urinary bladder are involved in patients with upper urinary tract urolithiasis--clinical and immunohistochemistry study.
abstract: OBJECTIVE
  To investigate the urothelial dysfunction and inflammation of urinary bladder in patients with upper urinary tract (UUT) urolithiasis through the results of cystoscopic hydrodistension and immunohistochemistry study.
  
  
  METHODS
  Ninety-one patients with UUT urolithiasis underwent cystoscopic hydrodistension before the stone surgery. Immunofluorescence staining of E-cadherin, zonula occludens-1 (ZO-1), tryptase (mast cell activation), and TUNEL (urothelial apoptosis) were performed in 42 patients with glomerulations after hydrodistension, 10 without glomerulations, and 10 controls.
  
  
  RESULTS
  Of the 91 patients, 62 (68.2%) developed glomerulations after hydrodistension. Lower urinary tract symptoms (LUTS) were present in 53.8% patients, in whom significantly smaller maximal anesthetic bladder capacity (MBC) was noted. Patients with middle or lower 1/3 ureteral stones had a significantly higher glomerulation rate (88.6% vs. 55.4%, p<0.01) and lower MBC (618.4 ± 167.6 vs. 701.2 ± 158.4 ml, p = 0.027) than those with upper 1/3 ureteral or renal stones. Patients with UUT urolithiasis had significantly lower expression of E-cadherin (26.2 ± 14.8 vs. 42.4 ± 16.7) and ZO-1 (5.16 ± 4.02 vs. 11.02 ± 5.66); and higher suburothelial mast cell (13.3 ± 6.8 vs. 1.3 ± 1.2) and apoptotic cell (2.6 ± 2.5 vs. 0.1 ± 0.3) numbers than in controls (all p<0.01).
  
  
  CONCLUSIONS
  Urothelial dysfunction and increased suburothelial inflammation and apoptosis are highly prevalent in the bladders of UUT urolithiasis patients, indicating inflammation cross-talk between UUT and urinary bladder. Patients with UUT urolithiaisis concomitant with LUTS had a smaller MBC, which may explain the presence of irritative bladder symptoms.
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
authors.forename: Yuan-Hong
authors.initials: YH
authors.lastname: Jiang
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
authors.forename: Hann-Chorng
authors.initials: HC
authors.lastname: Kuo
mesh_terms: D000328:Adult; D000368:Aged; D017209:Apoptosis; D015820:Cadherins / Q000378:metabolism; D003556:Cystitis / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D003558:Cystoscopy; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D053802:Tryptases / Q000378:metabolism; D001743:Urinary Bladder / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D052878:Urolithiasis / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D019459:Urothelium / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D062826:Zonula Occludens-1 Protein / Q000378:metabolism
chemical_list: D015820:Cadherins; C569042:TJP1 protein, human; D062826:Zonula Occludens-1 Protein; D053802:Tryptases