Studies revealed both structural and functional alterations in bladders from patients with LUTS symptoms or animals with experimentally induced bladder dysfunction .
In particular , the urothelium and the suburothelial space , containing afferent nerve fibres and interstitial cells , have been found to form a functional unit that is essential in the process of bladder function .
Various imbalances within this suburothelial complex have been identified as significant contributors to the generation of storage LUTS , along with potential abnormalities of central function
CONTEXT The focus of clinical underst and ing and management of male storage lower urinary tract symptoms ( LUTS ) has shifted from the prostate to the bladder .
This is mirrored by an increasing body of experimental evidence suggesting that the bladder is the central organ in the pathogenesis of LUTS .
OBJECTIVE A systematic review of the literature available on pathophysiologic aspects of storage LUTS .
Suburothelial myofibroblasts in the human overactive bladder and the effect of botulinum neurotoxin type A treatment.
BACKGROUND An increasing body of evidence suggests a possible role of suburothelial myofibroblasts ( MFs ) in bladder mechanosensation and in the pathophysiology of detrusor overactivity ( DO ) . OBJECTIVE To determine whether markers of MFs , including gap junction protein connexin43 ( Cx43 ) and c-kit have altered immunohistochemical expression in the suburothelium of patients with neurogenic DO ( NDO ) or idiopathic DO ( IDO ) and whether this is affected by successful treatment of DO with botulinum neurotoxin type A ( BoNTA ) . DESIGN , SETTING , AND PARTICIPANTS Patients with NDO ( n=10 ) or IDO ( n=11 ) were treated in a single-centre , open-label study of intradetrusor BoNTA injections . Control tissue was obtained from 10 patients undergoing pelvic-floor repair procedures who had no overactive bladder ( OAB ) symptoms . This study is registered with Clinical Trials.gov , number NCT00662064 . INTERVENTIONS Bladder biopsies performed with flexible cystoscopes were obtained from control subjects and from NDO and IDO patients before BoNTA treatment and at 4 wk and 16 wk after treatment . They were studied with quantitative immunofluorescence using antibodies to connexin 43 ( Cx43 ) , vimentin , and c-kit . MEASUREMENTS Differences in Cx43 , vimentin , and c-kit immunoreactivity between control subjects and NDO or IDO patients ( primary outcomes ) . Changes in NDO or IDO , Cx43 immunoreactivity , and c-kit immunoreactivity after BoNTA treatment ( secondary outcomes ) . RESULTS AND LIMITATIONS Cx43 immunoreactivity was increased in both IDO and NDO patients compared to controls , but remained unchanged after BoNTA treatment . C-kit immunoreactivity was similar in NDO/IDO patients and controls and remained unchanged after BoNTA treatment . CONCLUSIONS Increased gap junction formation in the suburothelium has been demonstrated in biopsies from humans with DO . It is hypothesised that this change could have a significant role in the pathogenesis of the detrusor abnormality . Successful treatment of NDO or IDO does not appear to be associated with changes in the expression of Cx43 or c-kit on suburothelial MFs
Studies revealed both structural and functional alterations in bladders from patients with LUTS symptoms or animals with experimentally induced bladder dysfunction .
In particular , the urothelium and the suburothelial space , containing afferent nerve fibres and interstitial cells , have been found to form a functional unit that is essential in the process of bladder function .
Various imbalances within this suburothelial complex have been identified as significant contributors to the generation of storage LUTS , along with potential abnormalities of central function
CONTEXT The focus of clinical underst and ing and management of male storage lower urinary tract symptoms ( LUTS ) has shifted from the prostate to the bladder .
This is mirrored by an increasing body of experimental evidence suggesting that the bladder is the central organ in the pathogenesis of LUTS .
OBJECTIVE A systematic review of the literature available on pathophysiologic aspects of storage LUTS .