The application of ultrastructural studies in the diagnosis of bladder dysfunction in a clinical setting

Purpose: We examine the ultrastructural changes reported to be present in d ysfunctional bladders and determine whether they can be used as a predictor of urodynamic diagnosis in a clinical setting. Materials and Methods: Subjects who required urodynamic diagnosis and cysto scopy as part of clinical management were recruited for this study. After u rodynamic diagnosis cases were classified into 1 of 5 dysfunction groups as normal bladder outflow obstruction, idiopathic sensory urgency, obstructio n with detrusor instability and pure detrusor instability. A detrusor muscl e biopsy was taken from the lateral wall of the bladder at cystoscopy for s ubsequent electron microscopy. Results: Of the 27 cases 6 were normal, 9 had bladder outflow obstruction a nd detrusor instability, 8 had pure detrusor instability and 4 had idiopath ic sensory urgency. The obstructed group showed the myohypertrophy pattern previously reported. In contrast to previous reports, abnormal junctions we re found in all patients. For each patient the ratios of abnormal-to-normal junctions were calculated. Mean and standard error ratios were 1.1 +/- 0.1 , 2.7 +/- 0.2, 6.1 +/- 1.2, 13.3 +/- 4.4 for normal, idiopathic sensory urg ency, obstruction with detrusor instability and pure detrusor instability, respectively (p = 0.0003, 0.0042 and 0.04). Conclusions: There are distinct morphological changes in the detrusor assoc iated with bladder dysfunction. The ratio of abnormal-to-normal junctions i s a novel measurement and can be used to predict urodynamic dysfunction. Ul trastructural studies may be useful as an adjunct in the diagnosis of bladd er dysfunction.