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Objective: To establish a cystoscopic grading system for trabeculation of neurogenic bladders., Materials and Methods: A total of 140 neurogenic bladder patients who had undergone both fluoroscopic urodynamic study and cystoscopic examination were retrospectively reviewed. Cystoscopic images were categorized into 4 grades according to the formation of the muscle bundle layer and height-to-width ratio of the muscle bundle: 0 (none), 1 (mild), 2 (moderate), and 3 (severe). Test-retest reliability and interobserver reliability were assessed. Cystoscopic grade of the trabeculated bladder was correlated with urodynamic results and the fluoroscopic grades of trabeculation., Results: The test-retest reliability showed almost perfect agreement with all levels of Cronbach alpha ranging from 0.925 to 0.970. The intraclass correlation coefficient was 0.986, indicative of an almost perfect level of interobserver reliability. The grading system showed clinical significance by correlation with urodynamic parameters (Qmax, P value = .016; postvoid residual, P value <.001; bladder outlet obstruction index, P value = .002). Cystoscopic grades correlated moderately well with fluoroscopic grades, showing comparable clinical significance with fluoroscopic grades., Conclusion: Our results showed that this novel cystoscopic classification of bladder trabeculation was highly reliable., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To investigate the feasibility and accuracy of the diagnosis of bladder outlet obstruction (BOO) in men using near-infrared spectroscopy (NIRS) as a noninvasive monitor., Materials and Methods: The study included 94 patients with lower urinary tract symptoms owing to benign prostatic hyperplasia. All patients underwent uroflow rate and post-void residual (PVR) followed by NIRS assessment of BOO and pressure-flow study for diagnosis. The results of the NIRS were compared with that of the pressure-flow study., Results: The data of 87 patients were finally enrolled in this study. According to the BOO judged by the NIRS, the 87 patients were divided into an obstruction group (52 cases) and a nonobstruction group (35 cases). The differences in the Abrams-Griffiths number, the linear passive urethral resistance relation value, and urethral resistance factor value between the 2 groups were significant (P ≤.001), indicating the practical significance of the NIRS method in the diagnosis of BOO. Further analysis showed the following: (1) the NIRS has a sensitivity of approximately 68.3%, specificity of 62.5%, and average diagnosis coincidence rate of 66.7% compared with the "gold standards"-Abrams-Griffiths number, and (2) the sensitivity (68.3%) and the coincidence rate (66.7%) of the NIRS diagnosis for BOO were significantly higher than the sensitivity (33.3%) and the coincidence rate (48.3%) of the examination method of free uroflow rate + PVR., Conclusion: Compared with the "maximum uroflow rate (Qmax) + PVR", NIRS can be more accurate and noninvasive for the diagnosis of BOO in men; this approach provides a new noninvasive method of high clinical value., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Evaluation of bladder wall mechanical behavior is important in understanding the functional changes that occur in response to pathologic processes such as partial bladder outlet obstruction (pBOO). In the murine model, the traditional approach of cystometry to describe bladder compliance can prove difficult secondary to small bladder capacity and surgical exposure of the bladder. Here, we explore an alternative technique to characterize murine mechanical properties by applying biaxial mechanical stretch to murine bladders that had undergone pBOO. 5-6 week old female C57/Bl6 mice were ovariectomized and subjected to pBOO via an open surgical urethral ligation and sacrificed after 4 weeks (n=12). Age matched controls (n=6) were also analyzed. Bladders were separated based on phenotype of fibrotic (n=6) or distended (n=6) at the time of harvest. Biaxial testing was performed in modified Kreb's solution at 37°C. Tissue was preconditioned to 10 cycles and mechanical response was evaluated by comparing axial strain at 50kPa. The normal murine bladders exhibited anisotropy and were stiffer in the longitudinal direction. All mice showed a loss of anisotropy after 4 weeks of pBOO. The two phenotypes observed after pBOO, fibrotic and distended, exhibited less and more extensibility, respectively. These proof-of-principle data demonstrate that pBOO creates quantifiable changes in the mechanics of the murine bladder that can be effectively quantified with biaxial testing., (© 2013 Published by Elsevier Ltd.)

β(3)-Adrenoceptors are major players in detrusor relaxation and have been suggested as a new putative target for the treatment of overactive bladder syndrome. We determined the effects of mirabegron (YM178), a novel β(3)-adrenoceptor agonist, on carbachol-induced tone in isolated human detrusor preparations from patients with bladder outflow obstruction (BOO) with and without detrusor overactivity (DO), and from patients with normal bladder function. We compared the effects to those of isoprenaline, a non-selective β-adrenoceptor agonist. Detrusor specimens were obtained from patients with benign prostatic hyperplasia undergoing cystoscopy and from patients undergoing radical prostatectomy/cystectomy (in total 33 donors). Detrusor contractility was evaluated by organ bath studies and strips were incubated with carbachol (1μM) to induce and enhance tension. Both mirabegron and isoprenaline reduced carbachol-induced tone in tissues from all groups. Isoprenaline decreased tension with higher potency than mirabegron in normal, BOO and BOO+DO detrusor strips with pIC(50) values of 7.49 ± 0.16 vs. 6.23 ± 0.26 (P=0.0002), 6.89 ± 0.34 vs. 6.04 ± 0.31 (P=0.01), and 6.57 ± 0.20 vs. 5.41 ± 0.08 (P<0.0001, n=4), respectively. The maximal relaxant effect of isoprenaline and mirabegron in the normal, BOO and BOO+DO detrusor was 37.7 ± 14.4% and 36.1 ± 23.3%, 14.4 ± 12.2% vs. 33.4 ± 21.0% and 18.3 ± 10.0% vs. 28.3 ± 12.2% (n=4, P>0.05), respectively. Mirabegron and isoprenaline reduced carbachol-induced tone in both normal bladders and obstructed bladder with and without DO. Isoprenaline had higher potency than mirabegron, but the efficacy of mirabegron effect was the same as that of isoprenaline., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Objective: To investigate the effects of prolyl 4-hydroxylase (P4H) inhibitor on the bladder in rats with partial bladder outlet obstruction., Methods: Forty-five female Sprague-Dawley rats were divided into 3 groups; partial bladder outlet obstruction with P4H inhibitor 20 mg/kg (groups A1, A2, and A4, each n = 5), partial bladder outlet obstruction with normal saline (groups B1, B2, and B4, each n = 5), and normal control (groups C1, C2, and C4, each n = 5). After partial bladder outlet obstruction for 1, 2, and 4 weeks in the groups A and B, respectively, the inhibitor or normal saline were administered orally at the indicated dosage once a day for 2 weeks. After either 3, 4, or 6 weeks, the bladders were removed after cystometry., Results: The pressure and volume parameters from the cystometry and the muscle thickness from the Masson trichrome staining of groups A and B increased significantly compared to those in group C (P < .05), and those in group A were significantly lower than those of group B (P < .05). Based on immunohistochemical staining and reverse transcription-polymerase chain reaction, P4H expression in groups A and B was increased compared with that in group C. Furthermore, P4H expression showed a larger decrease in group A compared to that in group B. Collagens I and III protein expressions increased with partial bladder outlet obstruction in comparison with that of group C, and expression in group A was marginally decreased compared with expression in group B., Conclusion: Our data suggest that the P4H inhibitor may improve bladder function and reduce the bladder fibrosis caused by partial bladder outlet obstruction., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objectives: To investigate the relationship between nitric oxide synthase (NOS) and oxidative stress and pathologic remodeling in the partial obstructed bladder of a rat model., Methods: We surgically established partial bladder outlet obstruction (PBOO) in 2 groups of rats and allowed it to persist for 3-6 weeks. Normal and sham-operated rats served as the controls. Each group contained 6 rats for a total of 24 rats. Cystometry was used to evaluate the bladder function. The bladders were removed, and histopathologic measurements were performed to evaluate bladder hypertrophy and fibrosis and NOS immunolocalization. Biochemical measurements were used to evaluated NOS mRNA and activity and the oxidative stress level., Results: The obstructed rats experienced significant increases in bladder weight, muscle hypertrophy, and deposits of collagen fibers compared with the normal and sham-operated groups. PBOO debilitated bladder contractibility, increased the residual urine volume and voiding interval, decreased the voiding volume, and caused poor bladder emptying, with an increased residual urine volume and decompensated bladder in the PBOO rats at 6 weeks. The elevation in malondialdehyde and reduction in superoxide dismutase activity in the PBOO rats suggested that oxidative stress injury occurred in the obstructed bladder. Lower inducible NOS and endothelial NOS (eNOS) mRNA expression was demonstrated through quantitative polymerase chain reaction. In particular, eNOS was significantly downregulated in the PBOO rats compared with the normal and sham-operated rats. The normal and PBOO bladder tissues did not express detectable levels of neuronal NOS mRNA or exhibit neuronal NOS immunoreactivity. The total NOS activity had decreased progressively in the PBOO groups in conjunction with the significantly decreased eNOS activity compared with that in the normal and sham-operated groups., Conclusions: These findings suggest that decreases in NOS activity and expression (mainly of eNOS) concomitant with increases in reactive oxygen species generation represent the underlying pathogenic mechanism of obstructed bladder remodeling and dysfunction., (Copyright © 2011 Elsevier Inc. All rights reserved.)

This study was aimed to examine the effects of pharmacological intervention on partial bladder outlet obstruction (PBOO) on expression of neuronal nitric oxide synthase (nNOS) and nitric oxide (NO) production and NO-related free radical damage using nitrotyrosine as a marker in the guinea-pig bladder. Partial urethral ligation was performed in young male guinea pigs which were then intraperitoneally administered l-arginine, N(G)-nitro-l-arginine methyl ester (l-NAME) or vehicle (saline) for 2 or 4 weeks. At the respective time points, the bladder was removed for nNOS immunohistochemistry, Western blot analysis, nitrotyrosine enzyme-linked immunosorbent assay test and NO colorimetric assay. In l-arginine-treated animals killed at 2 and 4 weeks, the total number of nNOS positive intramural neurons was significantly increased when compared with the corresponding control. Some neurons projected long extending fibers that were closely associated with the blood vessels. Furthermore, at 4 weeks, the nNOS protein content and NO production as reflected by the concentration of nitrite and nitrate were drastically elevated as measured by Western blot analysis and NO colorimetric assay, respectively. In l-NAME-treated group killed at 2 weeks, the number of nNOS positive neurons was markedly reduced when compared with the controls, but the change was not significant at 4 weeks. In the latter, however, the NO production as reflected by the concentration of nitrite and nitrate was markedly reduced; in addition, the nitrotyrosine concentration was significantly lower than the control. The present results support the role of NO in the pathophysiological changes following PBOO. We suggest the potential therapeutic application of l-arginine and l-NAME in PBOO; however, ultimately balancing the bidirectional effects of NO would be essential.

Objectives: Recent evidence indicates that ischemia and reperfusion (free radical generation) are major etiologic factors in the rabbit bladder subjected to partial outlet obstruction. The current investigation was designed to determine the time course of damage caused by reactive oxygen species (ROS) and reactive nitrogen species (RNS) by measuring the carbonyl and nitrotyrosine content of the bladder., Methods: Male rabbits underwent surgical partial bladder outlet obstruction for durations of 1, 2, 4, and 8 weeks. Sham-operated rabbits served as controls. The contractile responses to field stimulation (32 Hz) and carbachol (20 micromol/L) were determined. The nerve density was determined by using immunohistochemical methods. The carbonyl and nitrotyrosine contents within the bladder body wall and mucosa were analyzed by Western blotting., Results: Nerve density showed marked decrease in obstructed bladders. The responses to field stimulation and carbachol showed remarkable decrease in bladders after 8 weeks' obstruction. The protein carbonylation increased significantly in obstructed bladders when compared with controls, both in mucosa and muscles and reached the highest level in 4 weeks' obstruction. There was a 2-fold increase for nitrotyrosine in mucosa after 8 weeks of obstruction. The increased expression of nitrotyrosine in muscle was maximized at 4 weeks of obstruction., Conclusions: The free radicals mediated protein carbonylation and tyrosine nitration occurs to a significant degree in the partially obstructed rabbit bladder. This may be related with sensory and contractile dysfunction and can be used as markers for free radical damage and reperfusion injury.

The urinary bladder purinergic system is reported to change with age and with bladder dysfunction. Here, we examined the expression of purinergic P2X(1) receptors in detrusor and mucosa (urothelium+lamina propria) from male control bladder and investigated age-related P2X(1) receptor mRNA expression in control and obstructed detrusor. Biopsy specimens were obtained at cystoscopy from control patients (n=46, age range 30-86years) and patients diagnosed with outlet obstruction (n=29, 46-88years). Calponin expression (measured by RT-PCR) was similar in control and obstructed detrusor and did not change with age. Quantitative competitive RT-PCR was used to measure P2X(1) receptor and GAPDH mRNA in control and obstructed detrusor. P2X(1) receptor mRNA expression was 9-fold (p<0.0001) higher in the detrusor than in the mucosa. Expression of mRNA for the internal control GAPDH remained stable with age and across control and obstructed detrusor. No difference in P2X(1) receptor expression was observed between control and obstructed detrusor (p=0.35). However, an age-related decrease in P2X(1) mRNA expression was observed in control (n=27; p=0.0054; Spearman coefficient r=-0.520) but not obstructed detrusor (n=19; p=0.093; r=-0.396). Downregulation of P2X(1) mRNA expression might occur as a result of an increased component of neural ATP release in the aging bladder.

Objectives: Partial outlet obstruction mediates decreased contractile responses and increased collagen synthesis; however, it is not known to what extent the increased collagen contributes to contractile dysfunction., Methods: Sixteen WNZ rabbits were divided into three groups: control, 2-week obstructed, and 2-week sham. Each rabbit was anesthetized, and the bladder was excised and cut into equal width strips of 0.5, 1.0, and 2.0-cm lengths. The contractile responses to field stimulation, carbachol, potassium chloride, and adenosine triphosphate were determined. At the end of the experiment, each strip was fixed in formalin and immunostained for collagen., Results: The contractile responses for the control and sham strips were similar for all strip lengths. In obstructed tissue, the shorter strip lengths generated significantly more tension per cross-sectional area than did the longer strips. The collagen density and distribution were similar for the control and sham bladders. The obstructed bladders had significantly increased collagen deposits between and within the smooth muscle bundles and cells., Conclusions: Because the relationship between strip size and contraction were similar for field stimulation, carbachol, and potassium chloride, it is the increased density of connective tissue within and between the muscle bundles and fibers that interferes with contraction (ie, the greater the strip length, the greater the interference and the greater the contractile dysfunction). Therefore, both functional and structural alterations in the obstructed bladder participate in contractile dysfunction.

Objectives: To investigate alterations in gap junctional protein, connexin-43 (Cx-43), in the rat detrusor muscle with partial bladder outlet obstruction (P-BOO). Muscle cell actions, such as detrusor contractions, are thought to be synchronized by way of gap junctional intercellular communication. Gap junctions may play an important role in voiding, and P-BOO is a common medical problem., Methods: A total of 33 female Wistar rats (12 weeks old) were divided into a P-BOO group and a sham-operated control group and were killed at 2, 4, and 8 weeks after surgery. Cystometric investigation, the alteration of gap junction, and Cx-43 protein expression, which compose the gap junction, were examined., Results: The number of gap junctions was decreased in the P-BOO rat bladder. Furthermore, decreased cellular membrane expression of Cx-43 proteins was detected in rat detrusor muscle cells more than 4 weeks after surgery. The gap junctions of the detrusor muscle cell membranes were significantly fewer in number in the P-BOO rats with no detrusor contractions., Conclusions: These data suggest that the normal signals that contribute to voiding function could be transported directly through the gap junctions. Voiding dysfunction may be caused by the disruption of gap junctional intercellular communication.

Objectives: To determine the functional changes in the bladder and the expression of adhesion molecules in bladder tissue during chronic partial urethral obstruction and after release of partial obstruction in rats., Methods: Twenty-one male Sprague-Dawley rats were separated into three groups, each containing 7 rats. A sham operation was performed in group 1 and cystometry was done 6 weeks later. In groups 2 and 3, hypertrophied unstable bladders were developed by partial infravesical outflow obstruction during a 6-week period. After this period, cystometry was performed in all group 2 rats. In group 3, the ligature was removed, the rats were followed up for 6 weeks, and then cystometry was performed. After cystometric evaluation, the bladders in all the rats were removed, weighed, and studied immunohistopathologically., Results: After release of infravesical outflow obstruction, the bladder weight, residual volume, bladder capacity, maximal voiding pressure, voiding amplitude, and bladder contraction time decreased and bladder compliance increased in group 3 compared with group 2. CD44 and E-cadherin expression in the interstitial space and uroepithelial bladder tissue in group 2 rats stained intensely compared with those of groups 1 and 3., Conclusions: After release of 6 weeks of infravesical outflow obstruction, the cystometric parameters were significantly improved. Expression of CD44 and E-cadherin in the obstructed bladder tissue may be a pathologic sign of inflammation.

We attempted to clarify the preventive effects of cyclohexenonic long-chain fatty alcohol on detrusor overactivity induced by mild bladder neck obstruction. Bladder neck obstruction was created by partial ligation of the urethra. Female Sprague-Dawley rats were divided into three groups: those with bladder neck obstruction treated without long-chain fatty alcohol, those with bladder neck obstruction with long-chain fatty alcohol (8 mg/kg, i.p., every day) and the sham-operated control group (A, B, and C groups, respectively). Six weeks after the induction of bladder neck obstruction, voiding behavior was observed in the metabolic cage, and a cystometrogram was performed in the experimental animals. Furthermore, Hematoxylin and Eosin, Azan-Mallory, and Bodian stainings were performed in these bladders. Bladder weight, voiding behaviors and a cystometry indicated that rats in the A group showed detrusor overactivity, which was improved by treatment with long-chain fatty alcohol. The proportion of connective tissue and the density of bundles of neurofibers in the bladder of the A group was significantly less than that in the other bladders. Mild bladder neck obstruction induces detrusor overactivity, which is improved by treatment with long-chain fatty alcohol.

Objectives: To establish whether routine evaluation of light microscopic changes in bladder biopsies in men with graded bladder outlet obstruction correlates with urodynamic parameters and to evaluate the performance of two pathologists in bladder biopsy interpretation., Methods: In 63 consecutive patients presenting with lower urinary tract symptoms suggestive of bladder outlet obstruction, the workup included bladder biopsies, which were semiquantitatively and independently evaluated by two pathologists for fibrosis, elastosis, muscle cell degeneration, inflammation, and additional remarkable findings. Furthermore, as determined by their general impression, the pathologists gave a diagnosis of normal or graded abnormality. The pathologists' performance was compared and the clinical and urodynamic data were correlated to the consensus histologic diagnoses., Results: Fifty-four of 63 cases could be evaluated. The intraobserver and interobserver reproducibility were reasonable, with a kappa of 0.35 and 0.50, respectively. The consensus diagnosis of abnormal bladder biopsy correlated with impaired bladder compliance and capacity. However, no correlation was found between the presence and severity of histologic abnormalities and Schäfer class, urethral resistance factor, instability, postvoid residual urine volume, symptom score, and prostate volume., Conclusions: Although abnormal bladder biopsies correlated significantly with impaired bladder capacity and compliance, routine evaluation of bladder biopsies is not indicated in the evaluation of bladder outlet obstruction.

Objectives: To investigate the structural and morphologic effect of distension after partial outlet obstruction in rabbits., Methods: Thirty male New Zealand white rabbits were separated into two groups: control (sham) and partial outlet obstruction (3 weeks). Three rabbits from each group were distended to 5%, 25%, 50%, 100%, and 125% of capacity. Each bladder was fixed at the volume in buffered formalin for 6 to 8 hours. Sections of dorsal and ventral bladder were blocked, and cross sections were evaluated. Quantitative morphometry was performed, and CD31 immunohistochemistry was used to characterize the vascularity., Results: Partial outlet obstruction resulted in increased bladder weight and capacity and increased thickness of the mucosa, submucosa, detrusor, and serosa. In the control bladder, the greatest thinning was seen between 5% and 25% capacity, and in the obstructed group, the greatest thinning occurred between 25% and 50%. The level of vascular collapse was significantly greater for the control bladders than for the obstructed bladders at all levels of distension. Finally, the obstructed bladders showed a significantly greater level of vascularity in the submucosa than the control bladders., Conclusions: Normal bladder distension resulted in significant morphologic changes when the bladder was distended to 25% of capacity but changed relatively little between 25% and 125%. However, distension of the obstructed bladder resulted in significant morphologic changes when the bladder was distended from 25% to 50% of capacity but changed relatively little between 50% and 125%.

Objectives: To evaluate the efficacy of a new approach for treatment of prostatic obstruction involving transperineal injection of dehydrated ethanol into the prostate using transrectal ultrasound (TRUS)., Methods: Dehydrated ethanol was injected transperineally into 11 patients with prostatic obstruction due to hyperplasia or carcinoma. Injections were performed under TRUS surveillance at bilateral sites of the prostate for an overall amount of 2 to 8 mL of ethanol for each patient., Results: There were no intraoperative complications, but postoperative urinary retention occurred in 1 patient who received catheterization for 3 days. The mean symptom score decreased from 17.7 +/- 6.0 (median 23) to 8.5 +/- 1.1 (median 3.5) at 3 months postoperatively (P < 0.01); mean peak urine flow rate increased from 5.3 +/- 4.0 mL/s (median 7) to 13.5 +/- 3.6 mL/s (median 14) (P < 0.05); and mean residual urine volume decreased from 231.9 +/- 209.8 mL (median 108) to 28.7 +/- 13.7 mL (median 34) (P < 0.01). There were no significant differences at 6 months when the same parameters were assessed. Pathologic findings for 2 patients with prostatic obstruction due to carcinoma showed only granulation tissue, with no evidence of malignancy in the treated area., Conclusions: Our preliminary data suggest that this technique can be performed as an outpatient procedure. It is considered an alternative treatment for prostatic obstruction due to benign hyperplasia or carcinoma, especially when there is a high operative risk.

Objectives: To investigate mitochondrial DNA (mtDNA) mutations in human detrusor after partial bladder outlet obstruction (BOO) and correlate the findings with the results of urodynamic studies., Methods: Sixty-two male patients with and without BOO were recruited and assessed by the International Prostate Symptom Score, a quality-of-life assessment index, and sonography. The severity of partial BOO was determined by pressure-flow study with an International Continence Society (ICS) nomogram. Random detrusor biopsies obtained cystoscopically were analyzed by polymerase chain reaction (PCR) techniques to detect possible mtDNA deletions. Primer-shift PCR and DNA sequencing were then performed to characterize specific mtDNA deletions. A semiquantitative PCR method was used to determine the proportion of the deleted mtDNA in detrusor. Finally, the mtDNA deletion and the urodynamic results were compared statistically., Results: A 4977-bp mtDNA deletion was identified in the human detrusor. Its incidence and proportion were found to increase after partial BOO (P = 0.005 and 0.012, respectively). The incidence of the mtDNA deletion was 4.2% (1 of 24) in the unobstructed group, 27.8% (5 of 18) in the equivocal group, and 40% (8 of 20) in the obstructed group. The mean proportion of the 4977-bp deleted mtDNA was 23.7 and 12.7 times higher in the obstructed and equivocal groups, respectively, compared with that of the unobstructed group., Conclusions: We found mtDNA with the 4977-bp deletion in human detrusor and an increase of this deletion after partial BOO. This molecular change might account for the previous observations of mitochondrial functional impairment and voiding dysfunction after partial BOO.

Objective: This study was designed to characterize the resistive index (RI) of prostatic blood flows obtained by transrectal power Doppler sonography (TRPDS) in benign prostatic hyperplasia (BPH)., Method: In 140 patients with lower urinary tract symptoms, the RI was measured using TRPDS and compared with age and planimetric parameters of the prostate obtained by conventional transrectal sonography. In addition, the RI was related with pressure flow studies., Results: The RI was significantly higher in patients with BPH (0.72+/-0.06, p<0.0001) than those with a normal prostate (0. 64+/-0.04). Although the RI correlated significantly with age and all prostatic planimetric parameters, multiple regression analysis revealed that age and presumed circle area ratio were independent predictors for RI. The RI was also higher in patients with infravesical obstruction than those without (0.74+/-0.06 vs. 0. 70+/-0.05, p<0.005). There was a significant correlation between RI and urodynamic parameters obtained in pressure flow studies. Out of 33 patients with obstruction, 28 (85%) had an RI of 0.7 or more, while 11 out of 24 patients (46%) without obstruction had an RI less than 0.7., Conclusion: The RI is promising as a new parameter to estimate the intraprostatic pressure to investigate BPH. Its value to represent urodynamic information during voiding remains to be studied.

Objectives: This study was designed to compare urodynamic types of bladder outlet obstruction (BOO) and histological architecture of the prostate in patients with benign prostatic hyperplasia (BPH)., Patients and Methods: Twenty-four patients with symptomatic BPH, who underwent transurethral resection of the prostate (TURP), were included in the study. Before surgery, a pressure-flow (P-F) study was performed in all patients. According to the classification by Spanberg et al., they were divided into 5 normal type, 6 low-compliant, 6 compressive and 7 constrictive obstruction. The area density and total area of smooth muscle, fibrous tissue, glandular epithelium and glandular lumen in BPH specimens were estimated using morphometric analysis., Results: In all groups, the stromal component occupied about three fourths of BPH specimens, and fibrous tissue was the most prominent element. However, neither area density nor total volume of each histological component showed a significant difference among the four groups., Conclusion: The type of BOO in patients with BPH cannot be explained by histological architecture alone.

Objectives: In benign prostatic hyperplasia (BPH), bladder outlet obstruction is caused by mechanical blockage resulting from an enlarged prostate, and by the increased tone of prostatic smooth muscle. In patients with obstructive BPH, the prostatic urethra urodynamically corresponds to the flow-controlling zone (FCZ). We sought to investigate the relation between the obstruction and elastic properties of the FCZ and the histologic composition of the prostate in symptomatic patients with BPH., Methods: The grade of infravesical obstruction was classified according to preoperative pressure-flow data from 30 men with symptomatic BPH, and the elastic properties of the FCZ were evaluated as the mean elastance, which was calculated using the three-parameter model. The area densities of smooth muscle, fibrous tissue, epithelium, and lumen were determined by quantitative morphometry, using BPH tissue obtained by transurethral resection., Results: The area density of smooth muscle had a negative correlation with mean elastance (p = -0.50, P <0.01), the linear passive urethral resistance relation (p = -0.43, P <0.05), and the group-specific urethral resistance factor (p = -0.39, P <0.05). No other histologic element was correlated with these variables., Conclusions: Our results suggest that urethral elasticity and bladder outlet obstruction grade are influenced by the relative content of smooth muscle within the prostate in patients with BPH.

Objectives: To investigate whether angiotensin II has a role in the regulation of bladder smooth muscle growth and function, we developed a model of bladder neck obstruction (BNO) in the neonatal rabbit and investigated the effect of captopril (angiotensin converting enzyme inhibitor) on the obstructive changes in the developing bladder., Methods: Partial BNO was induced in a group of 2-day-old rabbits (n = 8) by placing a loose 2-0 silk ligature around the vesicourethral junction. A second group of rabbits subjected to the identical partial BNO procedure (n = 8) was given captopril (1 mg/kg/day). Twelve days postobstruction, bladders from these animals, along with paired controls (n = 8), were harvested and assayed for total protein, DNA, and collagen content., Results: Partial BNO resulted in a 170% increase in wet weight (P < 0.05), 132% increase in protein/deoxyribonucleic acid (DNA) ratio (P < 0.05), 75% increase in total DNA (P < 0.05), and 115% increase in total collagen (P < 0.05). When compared with obstructed animals, captopril administration significantly inhibited the increase in total DNA (P < 0.05) and reduced the amount of total collagen (P = 0.054). Examination of histology specimens demonstrated that captopril inhibited the serosal hyperplasia and collagen deposition associated with obstruction., Conclusions: These data demonstrate that captopril partially inhibits the changes in the neonatal rabbit bladder associated with obstruction, supporting the hypothesis that angiotensin II is involved in the regulation of bladder smooth muscle growth and collagen production.

The development of new imaging techniques has improved our knowledge of the cross-sectional anatomy of the pelvis and thereby our understanding of the bladder's response to prostatic obstruction. It is now known that changes in the bladder are intimately linked to the development of irritative and obstructive symptoms of BPH. This paper illustrates the anatomical changes within the pelvic region that can develop as a consequence of prostatic enlargement. The anatomical position of the prostate is such that its enlargement inevitably affects neighbouring organs. Enlargement of the median lobe can cause irritation of the trigone and the physical trapping of urine behind the lobe. The urethra may also become mechanically obstructed leading to an increase in the detrusor muscle mass as it struggles to overcome the restriction of the bladder outlet. In time, a change in the collagen to muscle ration in favour of collagen may develop, with the consequence that bladder compliance is reduced and the ability to increase volume without increasing pressure is diminished. Thereafter one of two scenarios may develop: the 'high pressure conflict' bladder or the 'distended low pressure' bladder. Urinary disturbance in BPH therefore results from an inadequate balance between bladder contractility and urethral resistance.

Bladder dysfunction secondary to benign prostatic hyperplasia (BPH) is a major affliction associated with ageing. As the disease slowly progresses, the bladder changes from a state of compensation to decompensation, in which there are severe, irreversible alterations in bladder function. Using a rabbit model of partial outlet obstruction we have identified three major cellular changes in the bladder which result from such obstruction. These include progressive denervation, mitochondrial dysfunction and disturbances of calcium storage and release from the sarcoplasmic reticulum. Our hypothesis is that outlet obstruction results in bladder hypertrophy which induces ischaemia. This leads to a release of intracellular calcium, leading to activation of specific enzymes and generation of free radicals. These then attack the membranes of nerves, sarcoplasmic reticulum and mitochondria. We have demonstrated that pretreatment of rabbits with Pygeum africanum extract (Tadenan) significantly reduced the severity of both the contractile and metabolic dysfunctions induced by partial outlet obstruction. Our current hypothesis is that Tadenan may either prevent the activation of degradative enzymes (or generation of free radicals), or protect the intracellular membranes against the destructive effects of free radicals or degredative enzymes. In conclusion, identifying cellular mechanisms responsible for bladder dysfunction induced by partial outlet obstruction provides new possibilities for non-surgical treatment of BPH. Our studies on Tadenan support this concept that the bladder provides a novel target for therapeutic intervention.

The morphology of the normal bladder has been compared with that of the obstructed and the ageing bladder, using both light and electron microscopy. In the normal bladder the smooth muscle cells are closely packed together with relatively little intervening connective tissue. The smooth muscle bundles are innervated predominantly by autonomic presumptive cholinergic nerve fibres, while adrenergic nerves are usually observed in association with blood vessels. In the obstructed bladder, many smooth muscle cells are surrounded by large amounts of connective tissue and some of the muscle cells change their function from contracting to seemingly being involved in collagen synthesis. A significant reduction in the innervation of the smooth muscle cells is observed. In the ageing bladder, the smooth muscle cells have a normal morphology which is in contrast to the findings in the obstructed bladder. A reduction in the innervation of the ageing bladder is observed, although to a considerably lesser extent than that observed in the obstructed bladder. As the morphology of the obstructed bladder differs from that of the ageing bladder, it is unlikely that the changes seen in the obstructed bladder simply reflect a function of age.

Objectives: To evaluate changes in the smooth muscle and connective tissue development in the obstructed and normal fetal bladder., Methods: The smooth muscle and connective tissue composition of 19 fetal urinary bladders, including those of 9 fetuses with anatomic obstruction and 10 controls free of urologic disease, were analyzed by light microscopy and computer-assisted color image analysis., Results: The bladder wall thickness was markedly increased in obstructed fetuses throughout gestation as compared with that in controls. The disparity in bladder wall thickness increased rapidly during gestation. The percent area density of smooth muscle and connective tissue as well as the ratio of smooth muscle to connective tissue remained the same in the obstructed and normal control fetal bladders., Conclusions: Although bladder outlet obstruction is associated with a marked increase in bladder wall thickness, the percent of smooth muscle and connective tissue comprising the mural histology remains relatively constant as compared with that of normal fetal controls. This study suggests that bladder outlet obstruction in the fetus is not associated with excess collagen deposition but rather with an increased amount of bladder with normal cellular content and a concomitant increase in smooth muscle development.

The aim of the present study was to evaluate the usefulness of ultrasonic estimation of bladder weight as a measure of bladder hypertrophy using transabdominal ultrasonography in men with infravesical obstruction. Ultrasonically estimated bladder weight (UEBW) was calculated from the thickness of the bladder wall measured ultrasonically and the intravesical volume at the ultrasonic measurement, assuming a spheric bladder. There was a statistically significant correlation (r = 0.970, P <0.001) between the actual bladder weight of cadaver bladders and the UEBW. The UEBW did not change with bladder filling. The UEBW in the obstructed group (group O, 49.7 +/- 19.5 g, mean +/- SD) was significantly greater than that in the normal control group (group NC, 25.6 +/- 5.7 g; P <0.001) or the nonobstructed group (group NO, 28.4 +/- 4.2 g; P <0.001). The greatest UEBW was 34.8 g in group NC and 35.2 g in group NO, whereas 94% (45 of 48) of group O had a UEBW greater than 35.0 g. In all 5 patients with benign prostatic hyperplasia (BPH), the increased UEBW decreased to a normal control level at 3 months after treatment of BPH. This new noninvasive method may be useful in investigation of bladder hypertrophy.

1. Partial outlet of obstruction of the rabbit urinary bladder results in a significant increase in the ability of ryanodine to inhibit field stimulated contraction. The current study determined the effect of outlet obstruction on ryanodine binding to microsomal membranes. 2. The results demonstrate: (i) Ryanodine binding is linear showing one set of ryanodine binding sites (Bmax = 28 +/- 3.5 fmol/mg protein; Kd = 4.2 nM). (ii) Total ryanodine binding was slightly increased at 1 and 3 day following obstruction. (iii) Binding increased approx 4-fold at 5 and 7 days post obstruction. (iv) No change in the Kds were noted at any time period. 3. The results of these studies indicate that smooth muscle hypertrophy secondary to partial outlet obstruction induces a marked increase in the role of intracellular calcium in the mediation of the contractile response to field stimulation.

The paraurethral glands in the female are the homologue of the male prostate. Inflammation in these in the cause of the very common syndrome of so-called 'recurrent cystitis' in women. Obstruction at the bladder neck, although not so common as in men, does occur. An analysis of the age incidence, clinical presentation, investigations, differential diagnosis and treatment of a personal experience of 88 cases is presented. Seven cases were treated conservatively by catheter drainage or urethral dilatation and 77 by perurethral resection using a Thompson cold punch with very satisfactory results.

The relative incidence and intensity of oviposition in schistosomiasis in different layers of both the urinary bladder and the ureter are presented. Histopathological changes in both organs are elucidated. Oviposition was heaviest in the submucosa of the urinary bladder, while the muscle layer was affected in 15% of specimens. Oviposition was mainly periureteral and in outer muscle layer of the ureter, and was present in only 22% in the ureteral submucosa. Epithelial changes, namely, Brunn nests, cystitis glandularis, cystitis cystica, and squamous metaplasia, were more marked in the bladder specimens than in the ureteral specimens. Squamous cell papilloma and squamous metaplasia associated with acanthosis of the bladder specimens were identified. Results indicate unanimously that the heavy deposition of ova in the submucosa of the bladder leads through its mechanical and toxic irritation to marked epithelial and premalignant changes which pave the way for the disturbing frequency of carcinoma of the bladder in the bilharzial patients which is not the case in the ureter.