Cyr61 and CTGF are molecular markers of bladder wall remodeling after outlet obstruction. (9/154)

Cysteine-rich protein (Cyr61) and connective tissue growth factor (CTGF) are key immediate early growth factors with functions in cell proliferation, differentiation, and extracellular matrix synthesis. Studies were performed to assess the gene expression profile of Cyr61 and CTGF in rat urinary bladder during growth in response to partial outlet obstruction. The mRNA levels of Cyr61 as determined by ribonuclease protection assay increased sharply after 1 day and remained elevated throughout the time period of the obstruction. This correlates well with increased bladder weight. The CTGF mRNA levels seemed to peak within the second week of the urethral obstruction and correlate well with increased type I collagen mRNA. The expression pattern of either Cyr61 or CTGF proteins corroborated that of their respective mRNAs. Immunohistochemical analyses showed that immunoreactivity of Cyr61 was confined to detrusor smooth muscle and that of CTGF was detected within both detrusor muscle and lamina propria layers. These data strongly indicate the involvement of Cyr61 and CTGF in bladder wall remodeling as a result of the outlet obstruction.  (+info)

New modification of transurethral incision of the prostate in surgical treatment of bladder outlet obstruction: prospective study. (10/154)

AIM: To analyze long-term effects of short and shallow incision of the prostate, a new modification of transurethral incision of the prostate (TUIP), as a method of resolving bladder outlet obstruction and preserving anterograde ejaculation and potency. METHOD: Fifty patients with symptoms of bladder outlet obstruction caused by a small benign prostate tumor of less than 30 g estimated weight were included in a nonrandomized, prospective study and underwent transurethral incision of the prostate. In the patients with normal sexual activity (n=28), short and shallow incisions were made, limited to the prostatic urethra and reaching to the fibrous capsule. In sexually inactive men (n=22), longer and deeper incisions were made, extending from below the urethral orifice upward to the verumontanum and in depth to the perivesical and periprostatic fat. All incisions were made at 5 and 7 o clock. Preoperative and postoperative evaluations performed 1, 3, 6, 12, 18, 24, 30, 36, 40, 48, 54, 60, 66, and 72 months after surgery were based on the International Prostate Symptom Scores (I-PSS), uroflowmetry, patients overall assessment of surgery outcome, and a sexual function questionnaire. RESULTS: Median follow-up was 42 months (6-72 months). There was a significant improvement in urinary peak flow rates and I-PSS decreased significantly during the follow-up period in both groups (p<0.05). Surgery outcome was rated satisfactory by all patients, with no difference between the groups. All 28 patients sexually active before the surgery retained their sexual activity after surgery; only one developed retrograde ejaculation. Two patients, one from each group, underwent further urologic treatment (transurethral resection of the prostate) 36 and 42 months after transurethral incision of the prostate, respectively. CONCLUSION: Transurethral short and shallow incision at 5 and 7 o clock is an effective method for long-term relief of bladder outlet obstruction in patients with small, benign prostate tumor. It has equally good long-term outcome as the classic long and deep transurethral incision but with fewer complications. None of the patients operated by this new method had lost potency and only a single one developed retrograde ejaculation.  (+info)

The influence of histological diagnosis on the postoperative complication rate following trans-urethral resection of prostate (TURP). (11/154)

BACKGROUND: A number of studies have shown that the early mortality following TURP is higher for patients with prostate cancer than those with benign disease. This study examines the effect of the histological diagnosis on the predischarge complication rate following TURP. METHODS: Information on the postoperative, predischarge complications of 3036 patients, who underwent TURP over the last decade at our institution, was collated from the urology department database (AuditBase for Windows). The information on this database is collected prospectively, at the point of care and validated at monthly audit meetings. Statistical analyses were performed using chi2 and difference of proportion where n > 60. Statistical significance was taken as P < 0.05. RESULTS: The postoperative, predischarge major complication rate for patients with benign disease was 2.1%. This was not statistically different from the 2.3% complication rate seen in patients with malignant disease. Patients suffering a postoperative complication stayed in hospital significantly longer than those who had a straightforward postoperative course (P < 0.001); however, patients with malignant histology suffering a postoperative complication did not stay statistically significantly longer than those with benign histology suffering a postoperative complication (P < 0.1). CONCLUSIONS: Patients undergoing TURP for prostate cancer do not suffer more postoperative, predischarge complications or stay in hospital longer than patients undergoing TURP for benign disease.  (+info)

Effect of partial outlet obstruction on rabbit urinary bladder smooth muscle function. (12/154)

Bladder outlet obstruction secondary to benign prostate hyperplasia is associated with many cellular changes. This study was designed to determine whether these changes involve the contractile apparatus. Bladder smooth muscles from rabbits subjected to partial outlet obstruction for 2 wk were mounted for isometric force, isotonic shortening velocity, and myosin light chain (MLC) phosphorylation levels. Muscle strips from obstructed bladders exhibited spontaneous phasic activity; muscle strips from control bladders did not. Muscle strips from obstructed bladders exhibited increased sensitivity and higher levels of stress in response to the cumulative addition of KCl or carbachol compared with control. During noncumulative addition of KCl or carbachol, no differences in sensitivity were noted. Muscle strips from obstructed bladders had elevated basal MLC phosphorylation levels and stimulation produced small increases in MLC phosphorylation compared with control. V(max) during KCl stimulation of muscle strips from obstructed bladders was 10-fold lower than control. Our results suggest that bladder outlet obstruction produces a muscle cell that develops higher levels of force but with greatly reduced cross bridge cycling rates.  (+info)

Infravesical obstruction due to benign intraurethral prostatic cyst. (13/154)

We report a case of symptomatic intraurethral prostatic cyst in a 42-yr-old man without clinical evidence of benign prostatic hyperplasia. The intraurethral cyst makes it unique from the all previously reported cases of prostatic cysts located medially within the prostate. Transurethral resection of the cyst with limited resection of the prostatic tissue at the base of the cyst was performed with successful resolution of voiding symptoms.  (+info)

Micturition patterns in patients paraplegic following spinal cord injury. (14/154)

Patterns of micturition in normal subjects and in patients after complete and incomplete injury of the spinal cord have been compared. All patients showed an abnormal flow pattern, this being least obvious in those who had undergone resection of the bladder neck and external sphincter. It is suggested that the Disa type 14 F 45 mictiograph is a useful instrument in determining the need for transurethral resection following spinal cord injury.  (+info)

Urinary outflow obstruction increases apoptosis and deregulates Bcl-2 and Bax expression in the fetal ovine bladder. (15/154)

During organogenesis, net growth of tissues is determined by a balance between proliferation, hypertrophy, and apoptotic death. Human fetal bladder outflow obstruction is a major cause of end-stage renal failure in children and is associated with complex pathology in the kidney and lower urinary tract. Experimental manipulation of the fetal sheep urinary tract has proved informative in understanding the pathobiology of congenital obstructive uropathy. In this study we used an ovine model of fetal bladder outflow obstruction to examine effects on apoptotic cell death in the developing urinary bladder. While 30 days of obstruction in utero between 75 and 105 days gestation resulted in overall growth of the fetal bladder as assessed by weight, protein, and DNA measurements, we found that apoptosis, as assessed by in situ end-labeling, was up-regulated in fetal bladder detrusor muscle and lamina propria cells and that this was accompanied by a down-regulation of the anti-death protein Bcl-2 and an up-regulation of the pro-death protein Bax. Moreover, activated caspase-3, an effector of apoptotic death, was increased in obstructed bladders. This is the first study to define altered death in an experimental fetal model of bladder dysmorphogenesis. We speculate that enhanced apoptosis in detrusor smooth muscle cells is part of a remodeling response during compensatory hyperplasia and hypertrophy. Conversely, in the lamina propria, an imbalance between death and proliferation leads to a relative depletion of cells.  (+info)

Hypertrophy changes the muscarinic receptor subtype mediating bladder contraction from M3 toward M2. (16/154)

Major pelvic ganglion electrocautery (MPGE) and spinal cord injury in the rat induce bladder hypertrophy and a change in muscarinic receptor subtypes mediating bladder contraction from predominantly M3 to a combination of M2 and M3. To determine whether this is a result of bladder hypertrophy or denervation, we studied the following groups: sham-operated controls, urinary diversion (DIV), MPGE together with urinary diversion (DIV-DEN), bilateral MPGE (DEN), bladder outlet obstruction (BOO), and MPG decentralization (MPGDEC). The degree of bladder denervation was determined by the maximal carbachol response normalized to the response to electric field stimulation. Receptor subtype density was determined by immunoprecipitation. The affinity of subtype-selective muscarinic antagonists for inhibition of carbachol-induced contractions was used to determine the subtype-mediating contraction. DEN, MPG-DEC, and BOO bladders were hypertrophic whereas DIV bladders were atrophic compared with sham operated. Bladder contraction in sham-operated, DIV, and DIV-DEN was mediated by the M3 receptor subtype, whereas the M2 subtype participated in contraction in the DEN, MPG-DEC, and BOO groups. The hypertrophied bladders had an increase in total and M2 receptor density while all experimental groups showed a reduction in M3 receptor density. Thus bladder hypertrophy, independent from bladder denervation, causes a shift in the muscarinic receptor subtype mediating bladder contraction from M3 toward M2.  (+info)