Congenital bladder obstruction: research strategies and directions

The clinical significance of congenital bladder obstruction is evident to those who deal with children suffering from severe bladder dysfunction and renal failure. It is a lifelong effect often requiring complex surgical reconstruction and renal transplantation. CBO also represents an important pathophysiologic process with relevance to other organ systems in which hypertrophic and fibrotic processes occur. CBO occurs in a dynamic and developing organ in which function and development are interdependent. Alterations of one will induce alterations in the other which then affect the first. Multiple levels of organization are involved and relevant, from the cell to the whole bladder as a part of the organism. Functional and developmental changes have been demonstrated in models of CBO. Much attention has been focused on the connective tissue compartment of the bladder due to its important role in determining bladder compliance characteristics. Preliminary findings suggest that connective tissue remodeling may be affected by alterations in the balance of the regulatory mechanisms of collagen degradation. Further studies should be able to define these alterations and may permit specific modulation of these mechanisms.