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At least 73 records · Page 4Linked to original sources
PubMed2000

Light penetration in bladder tissue: implications for the intravesical photodynamic therapy of bladder tumours.

OBJECTIVES: To assess (i) the optical properties and depth of penetration of varying wavelengths of light in ex-vivo human bladder tissue, using specimens of normal bladder wall, transitional cell carcinoma (TCC) and bladder tissue after exposure to ionizing radiation; and (ii) to estimate the depth of bladder wall containing cancer that could potentially be treated with intravesical photodynamic therapy (PDT), assuming satisfactory tissue levels of photosensitizer. Materials and methods The study included 11 cystectomy specimens containing invasive TCC (five from patients who had previously received external-beam bladder radiotherapy, but with recurrent TCC) and three 'normal' bladders removed from patients treated by exenteration surgery for extravesical pelvic cancer. Full-thickness bladder wall and tumour samples were taken from these specimens and using an 'intravesical' and a previously validated interstitial model, the optical penetration depths (i.e. the tissue depth at which the light fluence is 37% of incident) were calculated at wavelengths of 633, 673 and 693 nm. RESULTS: There were no significant differences in light penetration between normal and tumour-affected bladder tissue at each wavelength. There were significant differences in light penetration among wavelengths; light at 693 nm penetrated approximately 40% further than light at 633 nm (P < 0.002). The light currently used in bladder PDT (633 nm) has a mean (SEM) optical penetration depth of 4.0 (0.1) mm within TCC. In addition, at this wavelength, there was 29% greater light penetration in previously irradiated than in unirradiated bladder wall (P = 0.001). This did not occur in the tumour-affected bladder. CONCLUSIONS: Bladder tissue is relatively more translucent than other human tissues and there is therefore great potential for PDT in the treatment of bladder cancer. As there is no difference in light penetration between TCC and normal bladder tissue, a tumour-specific response with diffuse illumination of the bladder will depend on drug localization within the tumour. The currently used wavelength of 633 nm can be expected to exert a PDT effect within bladder tumour up to a depth of 20 mm. Increasing the wavelength will allow deeper pathology to be treated.

Humans↗
PubMed1998

Bladder calculi in the pediatric augmented bladder.

PURPOSE: Bladder augmentation is now a commonly accepted treatment in children with neuropathic bladder and other bladder anomalies. Bladder calculi have been reported in a third to a half of pediatric patients after bladder augmentation. We identify the incidence of bladder calculi and risk factors for stone formation in a large series of pediatric patients after bladder augmentation. MATERIALS AND METHODS: We reviewed the records of 286 patients who underwent bladder augmentation between 1978 and 1994, assessed the incidence of and risk factors for bladder calculi, and reviewed treatment methods. RESULTS: Bladder calculi developed in 29 of the 286 patients (10%) who underwent bladder augmentation. The type of bowel used for augmentation did not affect the rate of stone formation except stomach, which did not lead to stone formation in any case. Stones formed more commonly after bladder outlet resistance procedures and in patients with catheterizable abdominal wall stomas. Patients underwent open cystolithotomy or cystolitholapaxy with an overall 44% recurrence rate and no statistically significant difference between treatment methods. CONCLUSIONS: Bladder calculi are a known complication of bladder augmentation. An increased risk of stone formation is associated with bladder outlet resistance procedures and catheterizable abdominal wall stomas. Daily irrigations to clear mucus and crystals as well as complete emptying of the augmented bladder may have important roles in decreasing stone formation.

Adolescent↗
PubMed1998

The role of bladder neck biopsy in men undergoing radical retropubic prostatectomy with preservation of the bladder neck.

PURPOSE: Radical retropubic prostatectomy is often performed with preservation of the bladder neck. We examine the incidence of benign and malignant prostatic tissue at the bladder neck margin in men undergoing radical retropubic prostatectomy with preservation of the bladder neck for clinically localized prostate cancer. MATERIALS AND METHODS: The study included 100 cases of radical retropubic prostatectomy with preservation of the bladder neck performed by a single surgeon (H. L.). A 2 mm. thick circumferential specimen was excised from the bladder neck, divided into 4 quadrants (anterior, posterior, right and left) and submitted for frozen section examination. The permanent sections from these bladder neck biopsies and the entire surgical specimens were analyzed by a single pathologist (J. M.). RESULTS: The frozen section diagnosis from the bladder neck biopsies were adenocarcinoma, benign prostatic tissue and no prostatic tissue in 3, 38 and 59 cases, respectively. The permanent section diagnosis of the bladder neck biopsies was adenocarcinoma, benign prostatic tissue and no prostatic tissue in 4, 57 and 39 cases, respectively. The sensitivity specificity, and positive and negative predictive values for examination of the surgical specimen to identify benign prostatic tissue was 67, 90, 90 and 65%, respectively. The bladder neck was re-biopsied because of the findings of adenocarcinoma and benign prostatic tissue in 3 and 8 cases, respectively. The initial bladder neck biopsy resulted in pathological down staging to pT2c in only 1 case. Repeat resection of the bladder neck in all cases with 10% or less benign prostatic tissue showed no prostatic tissue, whereas 50% of the cases with more than 10% benign prostatic tissue demonstrated residual benign prostatic tissue. Serum prostate specific antigen was undetectable immediately after radical retropubic prostatectomy in all cases with benign prostatic tissue only. CONCLUSIONS: Preservation of the bladder neck during radical retropubic prostatectomy does not significantly compromise total extirpation of the malignant process. Benign prostatic tissue at the bladder neck margin is relatively common. Examination of the surgical specimen has limited sensitivity, and negative and positive predictive values for the presence of benign prostatic tissue at the bladder neck margin. The impact of benign prostatic tissue as it relates to future malignant transformation is unknown. Submitting frozen section specimens from the bladder neck is reasonable for the younger man who may be at risk from benign prostatic tissue at the bladder neck margin.

Adenocarcinoma↗
PubMed2001

Effect of chronic bladder outlet obstruction on blood flow of the rabbit bladder.

PURPOSE: Previous studies have shown that the initial reaction of the rabbit bladder to partial bladder outlet obstruction is increased blood flow at day 1 and a return to baseline blood flow at 1 week. Mucosal and muscle blood flow followed this pattern but mucosal blood flow was always 4 to 5-fold greater. In this study we examined the effect of 4 weeks of outlet obstruction on bladder blood flow and correlated it with the severity of bladder contractile dysfunction. MATERIALS AND METHODS: A total of 14 male New Zealand White rabbits underwent partial outlet obstruction creation by standard methods. After 4 weeks the rabbits were anesthetized, and blood flow to the muscle and mucosa was determined by standard fluorescent microsphere technique. A section of each detrusor was used for in vitro contractility studies. Contractile responses to field stimulation, carbachol and potassium chloride were determined. A section of each detrusor tissue was fixed in formalin and used to determine the smooth muscle volume fraction. RESULTS: Four weeks of partial bladder outlet obstruction caused a significant and variable increase in bladder weight and a decrease in blood flow to bladder muscle without changes in the blood flow to mucosa. There was a clear correlation between the severity of contractile dysfunction, bladder weight and the magnitude of the decrease in blood flow in muscle. The smooth muscle volume fraction remained stable at approximately 40%. CONCLUSIONS: Bladder decompensation was associated with decreased blood flow to bladder smooth muscle. Because compensated obstructed bladders with relatively normal contractile function are also hypertrophied but have normal blood flow, decreased blood flow in decompensated bladders is not simply a response to bladder hypertrophy. From this study we hypothesize that decreased blood flow to bladder smooth muscle is an etiological factor in bladder contractile dysfunction (bladder decompensation) secondary to partial outlet obstruction.

Animals↗
PubMed2006

Bladder tissue formation from cultured bladder urothelium.

Tissue recombination is a powerful method to evaluate the paracrine-signaling events that orchestrate the development of organs using the in vivo environment of a host rodent. Studies have reported the successful generation of primary cultures of rodent bladder urothelium, but none have reported their use to recapitulate bladder tissue with tissue recombination. We propose that primary cultured bladder urothelium, when recombined with inductive embryonic bladder mesenchyme, will form bladder tissue in a recombination model. Adult rat bladders were isolated and urothelium obtained. Sheets of bladder urothelium were re-suspended in collagen and maintained in tissue culture. After expansion (>20 passages), the urothelium was recombined with embryonic day-14 mouse bladder mesenchyme, then grafted beneath the renal capsule of immunocompromised mouse hosts. Grafts were harvested after 28 days. Control grafts were performed with bladder mesenchyme alone, cultured bladder urothelium alone, and collagen matrix alone. Final tissues were evaluated with staining and immunohistochemistry (H&E, Gomori's trichrome, broad-spectrum uroplakin, and smooth muscle actin alpha and gamma). Immunocytochemistry on cultured urothelium for broad-spectrum keratin, vimentin, and broad-spectrum uroplakin confirmed pure populations, void of mesenchymal contaminants. Staining of recombinant grafts demonstrated bladder tissue with mature urothelium and stromal differentiation. Control tissues were void of bladder tissue formation. We have successfully demonstrated that a chimeric bladder is formed from primary cultured bladder urothelium recombined with embryonic bladder mesenchyme. This is a powerful new tool for investigating the molecular mechanisms of bladder development and disease. Future applications may include the in vitro genetic manipulation of urothelium and examining those effects on growth and development in an in vivo environment.

Animals↗
PubMed2002

Biochemical and morphological effects of bladder pumping on the urinary bladder in rats.

AIMS: To study the influence of bladder pumping on the urinary bladder in 44 female rats. METHODS: Under halothane anesthesia, a urethral catheter was inserted into the bladder of 27 rats, and air (0.4-0.8 mL) was pumped in and out of the bladder at 0.5 cycles/second for a period of 5 minutes. Twenty-four hours after pumping, the bladder was harvested for measurement of the tissue levels of myosin, actin, and nerve growth factor, as well as for electron microscopy. In nine of the 27 rats, cystometry was performed without anesthesia before and 1, 7, 30, and 90 days after bladder pumping. The remaining 17 rats that did not undergo pumping were anesthetized and their bladders were harvested as a control. RESULTS: Bladder pumping increased the bladder capacity and decreased the maximum bladder contraction pressure, but did not increase the residual volume. Bladder pumping also increased the tissue level of nerve growth factor and decreased the levels of myosin and actin. Electron microscopy showed degeneration of bladder smooth muscle cells and nerve fibers after bladder pumping, as well as derangement and disruption of collagen fiber bundles in the bladder wall. These functional and morphological effects of pumping disappeared within 90 days. CONCLUSIONS: Bladder pumping therapy appears to have various effects on the bladder wall collagen fiber bundles, smooth muscle cells, and nerves.

Actins↗
PubMed2004

Effect of bladder volume, gender and body position on the shape and position of the urinary bladder.

OBJECTIVE: The optimal design of bladder volume-monitoring equipment, e.g. regarding transducer design and software algorithms, depends greatly on the shape and position of the bladder or on potential changes due to body position and bladder volume. The purpose of this study was to study the influence of body position, bladder volume and gender on the shape and position of the bladder. MATERIAL AND METHODS: MRI scans of 11 young volunteers were performed during changes in posture. Images were recorded in the transverse and frontal planes and repeated four to six times through the bladder-filling cycle from empty to full. The position of the bladder midpoint was measured in the three planes. Moreover, to account for shape, the compactness of the cross-section of the bladder was calculated based on its perimeter and area. The effect of body position and gender was analyzed using repeated-measures ANOVA and the independent samples t-test, respectively. RESULTS: No significant effect of body position on bladder position or shape was found. Gender was shown to have a significant impact on both the position and shape of the bladder: the female bladder was positioned more caudally and was less compact in the transverse plane than the male bladder. Furthermore, there was significant cranial-dorsal movement of the bladder during filling. CONCLUSION: No significant changes in the position or shape of the bladder were observed during changes in body position in young subjects, regardless of bladder volume or gender. However, changes in both parameters were found due to bladder filling.

Adult↗
PubMed2003

Integrins expressed with bladder extracellular matrix after stretch injury in vivo mediate bladder smooth muscle cell growth in vitro.

PURPOSE: It is unknown how bladder smooth muscle cells sense extrinsic mechanical stimuli. The integrins are a large versatile family of transmembrane mechanoreceptors that transduce extracellular matrix (ECM) alterations into the cell, thereby, regulating proliferation, differentiation and ECM synthesis. To our knowledge we provide the first evidence that the integrins may be involved in responses to whole bladder distention and bladder smooth muscle cell stretch. MATERIALS AND METHODS: Bladders from 100 to 120 gm. rats were stretched to 40 cm. H2O for 5 minutes. Five to 96 hours after distention whole bladder mRNAs were isolated for analysis of temporal expression of collagen and integrin genes. Separately quiescent primary culture bladder smooth muscle cells from 1-day-old Sprague-Dawley rats were stretched cyclically for 4 hours. Relative expression of select integrin subunit mRNAs was assessed by semiquantitative reverse transcriptase-polymerase chain reaction. Integrin blockade with asparagine-glycine-arginine peptides was used to determine the role of integrins in stretch induced proliferation and the cell cycle in bladder smooth muscle cells. RESULTS: Within 24 hours bladder distention stimulated collagen expression 2-fold (type I) and 5-fold (type III). Collagen levels beyond 24 hours were 8-fold (type I) and 2-fold (type III) greater than in controls, revealing an inverse temporal type I-to-III ratio beyond 24 hours. Coordinate alterations were observed in integrin and collagen expression. In vitro bladder smooth muscle cell integrin beta1, beta3 and alphav subunit expression was increased by mechanical stretch 2.5, 3.8 and 5-fold, respectively, while alpha1 expression decreased. Asparagine-glycine-arginine peptide inhibition of integrin function significantly inhibited stretch induced bladder smooth muscle cell proliferation and exit from the G2/M phase of the cell cycle. CONCLUSIONS: To our knowledge these results demonstrate for the first time that that bladder distention initiates dynamic alterations in ECM expression. The ability of integrin blockade to suppress stretch induced bladder smooth muscle cell proliferation and the coordinate changes in bladder ECM and integrin expression suggest that integrins mediate key responses to mechanical stimuli in the bladder. Furthermore, cell cycle analysis of resting and stretched bladder smooth muscle cells revealed novel avenues for the examination of integrin and stretch regulation of bladder smooth muscle cell growth.

Animals↗
PubMed2002

Differential expression of bladder neurotrophic factor mRNA in male and female rats after bladder outflow obstruction.

PURPOSE: We validated a male rat model of bladder outflow obstruction and compared the expression of bladder neurotrophic factor mRNA in male and female rats 6 weeks after bladder outlet obstruction. MATERIALS AND METHODS: We examined the proximal urethra in male Wistar rats. Urethral lumen reducing ligatures were placed in 15 females and 19 males, while 10 male and 10 female controls underwent sham surgery. Awake cystometry was performed 6 weeks after surgery. Ribonuclease protection assay was used to measure changes in bladder neurotrophic factor mRNA expression in the 2 sexes. RESULTS: Average bladder capacity in rats with bladder outlet obstruction increased 3-fold in males and 4.4-fold in females compared with controls, while bladder weight increased 2.2 and 4.3-fold, respectively. Filling and threshold pressure increased significantly and nonvoiding bladder contractions were recorded in 100% of female and 80% of male rats with bladder outlet obstruction. An 8-fold increase in bladder brain derived neurotrophic factor mRNA was noted in each sex after obstruction. A 2-fold increase in bladder nerve growth factor mRNA after obstruction was only observed in females. CONCLUSIONS: This male rat model of bladder outlet obstruction was created by placing lumen reducing ligatures at the urethrovesical junction. The dramatic increase in bladder brain derived neurotrophic factor mRNA expression and differential expression of nerve growth factor mRNA in male and female rats with bladder outlet obstruction suggest that additional neurotrophic factors may contribute to the lower urinary tract neuroplasticity associated with bladder outlet obstruction and this contribution may be gender dependent.

Animals↗
PubMed2004

Bladder-filling sensation in patients with spinal cord injury and the potential for sensation-dependent bladder emptying.

STUDY DESIGN: Investigation of bladder-filling sensation in 73 consecutive traumatic spinal cord injury (SCI) patients during laboratory cystometry. OBJECTIVES: To determine the frequencies of bladder-filling sensation in SCI patients with complete lesions above T11 and below T10 and with incomplete lesions, to examine the quality of the preserved sensation, as well as to determine the potential for sensation-dependent bladder emptying in this patient group. SETTING: Physical Medicine and Rehabilitation Education and Research Hospital of Ministry of Health, Ankara, Turkey. METHODS: Bladder-filling sensation was investigated in 73 consecutive patients with traumatic SCI using continuous medium fill cystometry. Bladder-filling sensation was categorised as absent, partially preserved or preserved. Presence of bladder-filling sensation before intravesical pressure (Pves) reached 25 and 40 cmH2O, and simultaneous presence of bladder capacity of more than 150 ml were investigated as the measures of the quality of the sensation. RESULTS: Bladder-filling sensation was present to some degree in all incomplete SCI patients, in 82.4% of the patients with complete lesions below T10, and 38.9% of the patients with complete lesions above T11. There were statistically significant differences between three groups with respect to bladder sensation category (P<0.001). About 86% of the patients with incomplete lesions, 53% of the patients with complete lesions below T10 and 22% of those with lesions above T11 had bladder-filling sensation before Pves reached 25 cmH2O and simultaneous bladder capacity of more than 150 ml was present in 61.2, 41.2 and 22.2% of the patients in the groups, respectively. Bladder-filling sensation investigations were reliable in terms of bladder filling sensation category in 36 SCI patients who had second cystometric examination. CONCLUSION: Presence of bladder-filling sensation in many of the SCI patients observed in this study revealed the potential for sensation-dependent bladder emptying in SCI patients, especially in the ones with complete lesions below T10 and the ones with incomplete lesions. This method may prevent early emptying attempts, unnecessary catheterisations and overdistension episodes and may improve the patient's self-esteem and quality of life. However, further studies on clinical experience and patient compliance for this method are needed.

Adolescent↗
PubMed1998

Combined bladder closure and epispadias repair in the reconstruction of bladder exstrophy.

PURPOSE: Children with bladder exstrophy in whom initial closure fails are less likely to achieve adequate bladder capacity for later bladder neck reconstruction and continence. Repeat bladder closure may be combined with epispadias repair as initial management, decreasing the need for repeat anesthesia as well as providing increased outlet resistance to permit bladder growth in preparation for later bladder neck reconstruction. We compared results in boys who underwent combined bladder closure and epispadias repair or staged reconstruction. MATERIALS AND METHODS: A total of 16 boys with a mean age of 22 months with bladder exstrophy were referred for bladder closure after previous closure had failed in 15 and for delayed primary closure in 1. Osteotomies were performed in all patients, with bladder closure and epispadias repair as initial treatment. Results were compared to those in 21 boys with a mean age of 26 months in whom exstrophy closure had failed, and who underwent standard staged reconstruction by repeat closure followed by epispadias repair and subsequent bladder neck reconstruction in those who achieved adequate bladder capacity. RESULTS: At a mean followup of 87 months fistula rates were similar in the 2 groups. Eventual bladder neck reconstruction was possible in 69% of the patients in each group. In addition, 2 boys in the combined repair group achieved continence before bladder neck reconstruction was performed. CONCLUSIONS: We recommend epispadias repair combined with bladder exstrophy closure for treating failed exstrophy closure or late initial closure. Operative complications and results are comparable to those in patients in whom previous exstrophy closure failed and who undergo standard staged repair.

Abnormalities, Multiple↗
PubMed1998

Noninvasive evaluation of bladder compliance in children using ultrasound estimated bladder weight.

PURPOSE: In healthy children as well as those with urinary disturbance we determined ultrasound estimated bladder weight with the aim of revealing its possible usefulness as a measure of bladder compliance. MATERIALS AND METHODS: We measured ultrasound estimated bladder weight in 71 healthy children with a mean age of 10.3 years, and determined a standard value. A total of 82 patients with a mean age of 9.6 years with urinary disturbance also underwent ultrasound estimated bladder weight measurement as well as conventional urological examinations, including filling cystometry. RESULTS: In healthy children ultrasound estimated bladder weight increased with age, showing a significant linear correlation (r = 0.80, p < 0.0001). Using the formula for linear correlation, 0.86 x patient age + 6.9 gm., we obtained an age matched estimated weight. In 82 patients the percent deviation of the estimate from age matched values was calculated using the formula, (measured ultrasound estimated bladder weight -age matched ultrasound estimated bladder weight)/age matched ultrasound estimated bladder weight x 100, and then correlated with bladder compliance. In 75 of 77 patients (97%) with compliance of 10 ml./cm. water or more the estimate was within 100% deviation. In contrast, 4 of 5 patients (80%) with a low compliant bladder (less than 10 ml./cm. water) had an ultrasound estimated bladder weight greater than 100% deviation. When the estimate was within 100% deviation, all but 1 patient (75 of 76, 98.7%) had compliance of 10 ml./cm. water or more compared to 33.3% (2 of 6) of those with an estimate greater than 100% deviation. As a result, with the use of a cutoff value of 100% deviation ultrasound estimated bladder weight predicted a low compliant bladder with a diagnostic accuracy as high as 96.3% (79 of 82 cases). CONCLUSIONS: Ultrasound estimated bladder weight may be used to evaluate bladder compliance in children. It seems to be a suitable noninvasive urodynamic test in children with suspected urodynamic abnormalities.

Adolescent↗
PubMed2000

Changes in urinary bladder neurotrophic factor mRNA and NGF protein following urinary bladder dysfunction.

Spinal cord injury and cyclophosphamide-induced cystitis dramatically alter lower urinary tract function and produce neurochemical, electrophysiological, and anatomical changes that may contribute to reorganization of the micturition reflex. Mechanisms underlying this neural plasticity may involve alterations in neurotrophic factors in the urinary bladder. These studies have determined neurotrophic factors in the urinary bladder that may contribute to reorganization of the micturition reflex following cystitis or spinal cord injury. A ribonuclease protection assay was used to measure changes in urinary bladder neurotrophic factor mRNA (betaNGF, BDNF, GDNF, CNTF, NT-3, and NT-4) following spinal cord injury (acute/chronic) or cyclophosphamide-induced cystitis (acute/chronic). The correlation between urinary bladder nerve growth factor mRNA and nerve growth factor protein expression was also determined. Each experimental paradigm resulted in significant (P </= 0.05-0.005) changes in urinary bladder neurotrophic factor mRNA, although the magnitude of the changes differed between paradigms. Urinary bladders from rats with acute spinal cord injury (4 days) exhibited the largest increase in neurotrophic factor mRNA levels (betaNGF, 21-fold increase; BDNF, 78-fold increase; GDNF, 11-fold increase; CNTF, 5.5-fold increase; NT-3, 10-fold increase; NT-4, 25-fold increase) relative to control urinary bladders. More modest but significant increases were demonstrated for urinary bladders from rats with chronic (4-6 weeks) spinal cord injury. Significant increases in urinary bladder neurotrophic factor mRNA levels of comparable magnitude were demonstrated following either acute or chronic cyclophosphamide-induced cystitis. Increased abundance of urinary bladder nerve growth factor mRNA was not always associated with increased total urinary bladder nerve growth factor. Total urinary bladder nerve growth factor decreased following acute or chronic cystitis despite increased abundance of nerve growth factor mRNA. Urinary bladder nerve growth factor mRNA correlates with protein measures 5-6 weeks following spinal cord injury but not earlier. The 5- to 6-week time point coincided with the reemergence of the spinal bladder-to-bladder reflex mechanisms following spinal cord injury. Discrepancies between two measures (mRNA and protein) may reflect retrograde axonal transport of nerve growth factor to the dorsal root ganglia (L6-S1). Retrogradely transported NGF may play a role in altered lower urinary tract function following spinal cord injury or cyclophosphamide-induced cystitis.

Acute Disease↗
PubMed1992

Correlation of contractile function and passive properties of rabbit urinary bladder subjected to outlet obstruction--an in vitro whole bladder study.

The present study investigated the correlation between contractile function and passive properties of rabbit urinary bladder subjected to outlet obstruction. Mild bladder outlet obstruction was induced by placing silicone rings (7 mm. diameter) around the bladder necks of male New Zealand rabbits. The animals were sacrificed after 2 weeks of obstruction. Contractile function was evaluated by measuring the response of the in vitro whole bladder to 500 microM bethanechol administration. Passive properties was assessed by performing in vitro cystometry and stress-relaxation techniques utilizing six different infusion rates. When the intravesical pressure reached 30 cm. H2O the infusion was stopped, allowing the bladder to relax and intravesical pressure to drop to a steady state level. The results can be summarized as follows: 1) Although the intravesical pressure response to bethanechol was about the same in control (13.3 cm. H2O) and obstructed (12.4 cm. H2O) bladder, the obstructed bladder emptied significantly less than control (20.4 vs 89.3%); 2) the results of the passive properties study showed that bladder stiffness was significantly higher at all infusion rates in the obstructed bladder, 3) the obstructed bladder showed significantly less relaxation after rapid stretching of the whole bladder by high speed fluid infusion; 4) histological examination of obstructed bladders revealed marked fibrous thickening of the serosal layer, interstitial fibrosis of the muscle layers, and hypertrophic and/or degenerative changes of the muscle fibers. In summary, 2 weeks after mild outlet obstruction of the urinary bladder the emptying ability, but not pressure generation, was reduced along with increased bladder stiffness and diminished capacity for stress-relaxation. Interstitial fibrosis and changing the properties of the smooth muscle cells might be involved in the functional impairment and deranged viscoelasticity of the urinary bladder after outlet obstruction.

Animals↗
PubMed1998

Bladder augmentation using allogenic bladder submucosa seeded with cells.

OBJECTIVES: The search for a suitable material to reconstruct the genitourinary tract has been a challenging task. Bowel has been widely used for urinary tract reconstruction, despite its subsequent complications. We investigated the possibility of using allogenic bladder submucosa, a tissue consisting of nonimmunogenic acellular collagen, either with or without cells, as a material for bladder augmentation. METHODS: Partial cystectomies were performed in 10 beagle dogs. Both urothelial and smooth muscle cells were harvested and expanded separately in 5 animals. The allogenic bladder submucosa obtained from sacrificed dogs was seeded with muscle cells on one side and urothelial cells on the opposite side. All beagles underwent cruciate cystotomies on the bladder dome. Augmentation cystoplasty was performed with the allogenic bladder submucosa seeded with cells in 5 animals and with the allogenic bladder submucosa without cells in 5. The augmented bladders were retrieved 2 and 3 months after augmentation. RESULTS: Bladders augmented with the allogenic bladder submucosa seeded with cells showed a 99% increase in capacity compared with bladders augmented with the cell-free allogenic bladder submucosa, which showed only a 30% increase in capacity. All dogs showed a normal bladder compliance, as evidenced by urodynamic studies. Histologically, all retrieved bladders contained a normal cellular organization consisting of a urothelial lined lumen surrounded by submucosal tissue and smooth muscle. Immunocytochemical analyses confirmed the urothelial and muscle cell phenotype and showed the presence of nerve fibers. CONCLUSIONS: These results show that allogenic bladder submucosa seeded with cells appears to be an excellent option as a biomaterial for bladder augmentation.

Animals↗
PubMed1996

Bladder stimulation therapy improves bladder compliance: results from a multi-institutional trial.

PURPOSE: We examined data from multiple institutions to determine whether intravesical bladder stimulation therapy is effective in improving bladder compliance by increasing bladder capacity and lowering bladder storage pressures. MATERIALS AND METHODS: The charts of 568 patients from 11 institutions were evaluated. Of the 568 patients 335 had adequate and accurate pretreatment and posttreatment urodynamic studies, and were included in this study. A total of 155 patients was from Children's Memorial Hospital, while the remaining 180 were from 10 other institutions. Bladder capacity and bladder capacity pressure were determined for each patient before and after therapy. RESULTS: Overall, 53% of patients had increased bladder capacity of 20% or greater after treatment (average increase 105 cc), which represents a 63% increase from pretreatment values. This increase occurred in an average of 1.9 years. Further analysis of this subset of patients revealed that in 90% intravesical storage pressures were decreased or maintained within a safe range (less than 40 cm. water). Evaluation of patients who did not respond to bladder stimulation with a 20% or greater increase in bladder capacity revealed that they had nearly normal bladder capacity before therapy. When the data on bladder capacity and bladder capacity pressure from Children's Memorial Hospital were compared to results from the 10 other institutions, there were no appreciable differences. CONCLUSIONS: Bladder stimulation is effective in increasing bladder capacity without significantly elevating storage pressure in a majority of patients. We conclude that this technique is safe and effective in improving bladder compliance, and that it is reproducible elsewhere.

Adolescent↗
PubMed1994

[A new method of measurement of the urinary bladder blood flow in patients with low compliant bladder].

Laser-doppler blood flowmetry, a new instrument for measurement of tissue blood flow, was used to evaluate the changes occurring in the bladder blood flow and the intravesical pressure during bladder distension in 4 patients with normal detrusor function, 4 patients with neurogenic bladder dysfunction and one patient with non-neurogenic contracted bladder. In patients with normal detrusor function and normal compliance, the bladder blood flow relatively decreased, but the intravesical pressure was not affected by the bladder distension. On the other hand, the bladder distension in patients with low compliant bladder caused a significant decrease of the bladder blood flow and marked increase of the intravesical pressure. These observations suggest that the reduction of the bladder compliance is related to the decrease of the bladder blood flow. Furthermore, the bladder over distension and the high intravesical pressure in patients with low compliant bladder are thought to induce deterioration of bladder compliance and upper urinary tract.

Atrophy↗
PubMed2003

Long-term results of bladder neck reconstruction for incontinence in children with classical bladder exstrophy or incontinent epispadias.

OBJECTIVE: To review the long-term results of bladder neck reconstruction (BNR) in patients with classical bladder exstrophy or epispadias, and to review the concept of continence surgery in these two groups, stressing the difficulty in finding an adequate balance between urine storage (which implies high outlet resistance and low storage pressure) and complete bladder emptying (which implies low outlet resistance and a transient increase in bladder pressure); surgery cannot achieve 'continence' (which implies active mechanisms) but only 'dryness' (which implies passive mechanisms). PATIENTS AND METHODS: Eighty patients with classical bladder exstrophy (52 male, 28 female) and 25 with incontinent epispadias (17 male, 18 female) had their bladder neck reconstructed after a Young-Dees-Leadbetter procedure, subsequently modified by Mollard. The treatment is detailed and results reviewed after a mean follow-up of 11 years. All patients were treated and followed in the same institution. RESULTS: In the exstrophy group, 36 (45%) patients presented with a dry interval of > 3 h, with urethral emptying after one BNR; 52 (65%) presented with recurrent urinary tract infections, 19 (24%) with urinary stones, 21 (26%) with dilated upper urinary tracts, 13 (16%) with bladder perforations and one with an adenocarcinoma of the bladder. Thirty-eight patients (48%) required further surgery; 51% of all patients required an endoscopic procedure within 3 months after the BNR and 26% had endoscopic procedures for late (> 3 months) urine retention. In the epispadias group, 13 (52%) patients presented with a dry interval of > 3 h with urethral emptying after one BNR; 12 (48%) had recurrent urinary tract infections, five (20%) upper tract dilatation, two (8%) bladder stones, one (4%) bladder perforation and one an adenocarcinoma of the bowels after a ureterosigmoidostomy. Ten (40%) children required further surgery. CONCLUSION: We compared the present results for continence with those in other published series; most complications encountered were related to the obstructive pattern of bladder emptying and the abnormal bladder urodynamic behaviour caused by BNR. We consider that BNR is unpredictable and the roles of the other factors in urinary continence are discussed. Alternative procedures are detailed. The concept of continence surgery in exstrophy and incontinent epispadias is reviewed, stressing the importance of favouring bladder development and limiting obstructive patterns of bladder emptying that cause severe and recurrent complications.

Bladder Exstrophy↗