To investigate the nature of morphological alterations in the urinary bladder wall in BPH patients receiving pharmacotherapy to establish treatment time limits.
The study comprised 120 BPH patients who underwent a transvesical adenomectomy. Prior to the surgery, 110 patients received pharmacotherapy (-blockers and 5-reductase inhibitors) lasting from 1-6 months to 5-10 years. Preoperative evaluation included a standard diagnostic algorithm. During the surgery, the urinary bladder wall specimens were taken for morphological examination. Histologic specimens were stained with hematoxylin-eosin and according to van Giesonn, and underwent immunohistochemical examination using desmin, vimentin, CD31, type IV collagen and pancitokeratin monoclonal antibodies. In patients who did not take medications or used them for less than 6 months, the bladder preserved the normal histological structure. Pharmacotherapy lasting 1 to 5 years resulted in microcirculatory alterations characterized by extensive hemorrhages, damage to the endothelium and vessel basal membranes, hypertrophy of the bladder muscle membrane. In patients taking the medications for 6 to 10 years, microcirculatory alterations resulted in the vascular wall sclerosis and thickening, narrowing of the vessel lumen, hypoplasia of the transitional epithelium and muscle layer atrophy.
The study findings suggest that prolonged (over 1 year) pharmacotherapy can adversely affect the urinary bladder wall and worsen the results of radical adenomectomy.
Urologiia (Moscow, Russia : 1999). 2017 Jun [Epub]
M E Sitdykova, D E Tsyplakov, E N Sitdykov, A R Nurtdinov
Department of Urology, Kazan State Medical University of Minzdrav of Russia, Kazan, Russia.