Potential for recovery in bladder function after removing a urethral obstruction

Abstract

The potential for functional recovery decreases with increasing loss of bladder function. At all stages of bladder dysfunction, voiding pressure appears to normalize after de-obstruction. However, contractility remains high and compliance low. Such a bladder may be more vulnerable to new events of outflow obstruction than a low contractile, normal compliant bladder.

Obstruction enhances rho‐kinase pathway and diminishes protein kinase C pathway in carbachol‐induced calcium sensitization in contraction of α‐toxin permeabilized guinea pig detrusor smooth muscle

“…The mild increase of bladder mass in BOO compared to that in controls and the maintained contractile response observed in this study may represent the compensated bladder 13. Another in vivo study with similar BOO model of Guinea pig urodynamically showed the increased contractility following 6–8 weeks of obstruction which was maintained even after de‐obstruction suggesting the compensated bladder 14…”

Persistent myopathy despite release of partial obstruction: in vivo reversal of dysfunction and transcriptional responses using rapamycin

“…The failure to resolve after REL is seen at multiple levels (matrix, neural input, and smooth muscle cellular phenotype) and leads to ongoing sequelae such as increased residual volumes and altered activity. 15,16,[19][20][21][22][23][24][25][26][27][28][29][30] To treat REL bladders, experimental approaches will have to move beyond treating early and ensuing responses to PBO. [31][32][33] Indeed, the clinically relevant period available to treat and study this condition is during the post-release phase, 34 once the anatomic obstruction itself has been detected and mitigated.…”

“…Clinical treatments focus on mitigating the source of out‐flow obstruction, yet removal of the anatomical PBO itself does not completely reverse the pathology and dysfunction, in a large proportion of BPH and PUV patients, even months or years following REL. The failure to resolve after REL is seen at multiple levels (matrix, neural input, and smooth muscle cellular phenotype) and leads to ongoing sequelae such as increased residual volumes and altered activity …”

The detrusor glycogen content of a de‐obstructed bladder reflects the functional history of that bladder during PBOO

“…7 This previous study showed that although the level of functional changes is related to the length of the obstructive period individual variation in the response to PBOO does occur. Since each animal was urodynamically monitored each weak, the rate of functional changes rather than the duration of obstruction was used as measure to decide the time of sacrifice.…”

“…The severity of bladder damage can be exactly described on basis of the complete data set from both periods. 7 However, when blinded to the developments that occurred during obstruction and relying only on one urodynamic measurement, it is impossible to distinguish a bladder that just entered the path of functional loss from a bladder that is close to decompensation.…”