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Structural basis of neurogenic bladder dysfunction. III. Intrinsic detrusor innervation
Axel Haferkamp1, Joachim Dörsam, Neil M Resnick
1Department of Pathology, Upstate Medical University, State University of New York, Syracuse, New York, USA.
The Journal of Urology
|January 25, 2003
Summary
Neurogenic bladder dysfunction in humans shows nerve degeneration and regeneration in the detrusor muscle. These findings may help identify neuropathic causes and distinguish spinal from supraspinal origins.
Area of Science:
- Urology
- Neuroscience
- Pathology
Background:
- Neurogenic bladder dysfunction (NBD) significantly impacts bladder function.
- Understanding the intrinsic detrusor innervation is crucial for managing NBD.
Purpose of the Study:
- To investigate the ultrastructural changes in intrinsic detrusor nerves in patients with long-standing NBD.
- To analyze the patterns of axonal degeneration and regeneration in the detrusor muscle.
Main Methods:
- Detrusor biopsies were collected from 46 patients with hyperreflexic NBD.
- Electron microscopy was used for qualitative and quantitative evaluation of intrinsic nerves.
- Patients had conditions including meningomyelocele, spinal cord injury, and brain disorders.
Main Results:
- Axonal degeneration was prevalent in 44 of 45 biopsies.
- Axonal regeneration was observed in 76% of biopsies, independent of NBD duration.
- Copeptidergic axons constituted a significantly higher proportion (20%) in NBD detrusors compared to normal controls (<1%).
Conclusions:
- Combined axonal degeneration and regeneration characterize intrinsic detrusor nerves in upper motor neuron NBD.
- These ultrastructural changes can aid in recognizing neuropathic contributions to detrusor dysfunction.
- The findings may help differentiate between spinal and supraspinal etiologies of NBD.