Bladder outlet obstruction has been the subject of numerous studies. In previous studies on severe obstruction, the initial response of the bladder has been to produce an acute overdistension of the bladder resulting in severe tissue damage and functional disorders. This is quite different from the slow onset of outlet obstruction seen in association with benign prostatic hypertrophy (BPH). The present study describes the functional effect of mild outlet obstruction created in a rabbit model, and compares it to a previously described model of severe obstruction. Mild bladder outlet obstruction was created by placing a silicon sleeve (inner circumference 30 mm.) around the bladder neck of mature male NZW rabbits. Individual groups of rabbits were studied at one, seven, and 14 days following the creation of the outlet obstruction. The following studies were performed on each group of rabbits: in vivo and in vitro cystometry, field stimulation and cholinergic stimulation using the in vitro whole bladder model. In addition, the tissue concentration of ATP (adenosine triphosphate) and CP (creatine phosphate) and the muscarinic receptor density were determined. The obstructed bladders showed no significant cystometric difference at one day, but revealed a marked decrease of compliance and capacity at one and two weeks. Unlike the response to severe outlet obstruction, there was no initial acute overdistension of the bladder wall. Although the ability of the obstructed bladders to generate intravesical pressure in response to both field stimulation and bethanechol did not decrease, the ability of both forms of stimulation to empty the obstructed bladders was markedly impaired. The response to field stimulation was reduced to a significantly greater extent than the response to bethanechol, indicating neuronal damage. The muscarinic receptor number per bladder was increased above control at all time periods. The intracellular concentration of ATP and CP in the obstructed bladders was similar to that of control. Our present model of mild obstruction was not accompanied by a massive increase in tissue mass nor was there an overdistension of the detrusor; thus, this model would be a more suitable model for the study of clinical outlet obstruction.
Studies on the effect of partial bladder outlet obstruction demonstrate that significant alterations in urinary bladder structure and function occur within 24 hours of the creation of the obstruction. These studies suggest that many of the functional and structural alterations following partial outlet obstruction may result from the initial overdistension which occurs within the first 24 hours. In these present studies, we investigated the time course of the effect of complete obstruction of the rabbit urinary bladder on the contractile response to bethanechol and field stimulation and on the muscarinic receptor density. Male White New Zealand rabbits were divided into five groups: controls, four, eight, 20, and 24 hours of complete obstruction. The results demonstrated that there was a significant decrease in both the contractile response to muscarinic stimulation and muscarinic receptor density at four hours following outlet obstruction (at a time when there was no bladder overdistension). The receptor density and contractile response to stimulation further decreased over the 24 hour period. These studies indicate that the initial decrease in muscarinic receptor density and contractile response to muscarinic stimulation may be mediated in part by the high level of spontaneous contractile activity induced by ligation of the urethra.
Urokinase-type plasminogen activator (u-PA) is thought to be implicated in cancer invasion and metastasis. The aim of this study was to determine whether the u-PA content of cancer tissue is a prognostic factor in bladder cancer. Tissue samples from 46 patients with bladder cancer were assessed for u-PA antigen by a highly sensitive enzyme immunoassay. The relationships between the u-PA level in extracts of bladder cancer and the survival rates of the bladder-cancer patients were examined. Patients with a high u-PA level (8 ng/mg of protein and more) showed a statistically significantly higher rate of survival than those with a low u-PA level (p less than 0.005). The u-PA antigen level in cancer tissue was significantly lower in low-graded and non-invasive cancers than in others (p less than 0.01).
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