Adjustable Continence Therapy (act) for the Treatment of Pediatric Neurogenic Voiding Disorders


Introduction and Objectives: The benign prostatic hyperplasia (BPH) is widely spread disease in man over 50. The results of investigation show, that clinical symptoms of BPH are caused by detrusor hypoxia and insufficiency of energetic metabolism due to infravesical obstruction.

Methods: The ultrastructural investigations of detrusor were made in 10 patients with BPH whom open prostatectomy were done. We used electronic microscope U-100 with 1000 - 124000 magnifications.

Results: Detrusor of patients with BPH patients mainly composed of smooth muscle cells which formed bundles and connective tissue. Smooth muscle cells are hypertrophic and have few irregular shape nuclei each. Some disorganized mitochondria, autolizosomes, ribosomes and polysomes were found among channels of rough and smooth endoplasmic reticulum. Considerable changes of connective tissue, especially in parts adjacent to smooth muscle cells were observed in detrusor. The nuclei of fibroblasts have irregular shape. Fragmented nucleus and hypetrophic nucleolus of fibroblasts and some smooth muscle cells is manifestation of preapoptosis. Severe disturbances of microcirculation were observed in detrusor of patients with BPH. We noted disorganization of small and large capillary. The wall of small capillary has partly swollen basal membrane and endothelial cells with oedema and low electronic density. Erythrocytes in such capillary were very close by situated to luminal surface of endothelium. In the lumen of large capillary sludge was found.

Conclusions: The ultrastructural investigation of detrusor testify that disturbance of microcirculation due to infravesical obstruction in patients with BPH cause preapoptosis of smooth muscle cells and fibroblasts.