STRUCTURAL BASIS OF GERIATRIC VOIDING DYSFUNCTION .5. STANDARDIZED PROTOCOLS FOR ROUTINE - ULTRASTRUCTURAL-STUDY AND DIAGNOSIS OF ENDOSCOPIC DETRUSOR BIOPSIES

Purpose: Previous ultrastructural and clinical studies have establishe d criteria for distinctive ultrastructural patterns in the normal, ove ractive, hypocontractile and obstructed detrusor of the elderly. This study was conducted to standardize procedures of detrusor biopsy proce ssing, identify and address pitfalls and difficulties in applying the criteria to routine evaluation of biopsies in the surgical pathology l aboratory, verify reproducibility of ultrastructural observations and diagnosis in biopsies from different sites in the bladder wall, and de velop a standard approach to routine ultrastructural evaluation of the biopsy. Materials and Methods: Blinded to clinical information, 25 ra ndomly selected detrusor biopsies were evaluated by a pathologist with prior knowledge of electron microscopy but none of detrusor ultrastru cture. The observations and diagnoses made were subsequently correlate d with urodynamic bladder behavior evaluated comprehensively before bi opsy. Biopsies from different sites of 4 detrusors and specimen sample s of multiple sites from a bladder obtained at autopsy were also blind ly assessed to determine the reproducibility of single site biopsies. Results: Essential parameters of all criteria were verified. Potential pitfalls and sources of difficulty in some were identified and correc ted to refine the criteria. Diagnoses were reproducible in all 5 detru sors with multiple site biopsies. Detailed protocols for electron micr oscopic study and diagnosis of dysfunctional detrusor biopsies were ge nerated. Conclusions: The protocols eliminate problems that may be enc ountered in ultrastructural evaluation of biopsies from dysfunctional detrusors, and have been applied readily and successfully in our subse quent studies. Uniformity of structural organization of detrusor allow s valid application of the protocols and study criteria to small biops ies obtained from different sites in the bladder wall.