Structural basis of geriatric voiding dysfunction. V. Standardized protocols for routine ultrastructural study and diagnosis of endoscopic detrusor biopsies.

Purpose: Previous ultrastructural and clinical studies have established criteria for distinctive ultrastructural patterns in the normal, overactive, hypocontractile and obstructed detrusor of the elderly. This study was conducted to standardize procedures of detrusor biopsy processing, identify and address pitfalls and difficulties in applying the criteria to routine evaluation of biopsies in the surgical pathology laboratory, verify reproducibility of ultrastructural observations and diagnosis in biopsies from different sites in the bladder wall, and develop a standard approach to routine ultrastructural evaluation of the biopsy.

Materials And Methods: Blinded to clinical information, 25 randomly selected detrusor biopsies were evaluated by a pathologist with prior knowledge of electron microscopy but none of detrusor ultrastructure.

Who misses out with school-based health programmes? a study of schistosomiasis control in Egypt.

There has been a recent revival of interest in school-based health programmes in developing countries as a means of reducing the morbidity observed in school-aged children, of improving their physical growth and cognitive development, and of controlling transmission of disease in the community at large. This study used data collected from a large epidemiological survey of schistosomiasis in Egypt to examine what proportion of infected children missed treatment from an established national school-based schistosomiasis control programme simply because they did not attend school. It showed that children who were not enrolled in school had a higher prevalence of infection and were more intensely infected than children who attended school.

A new technique for detrusor biopsy and its applicability in the ultrastructural study and diagnosis of voiding dysfunction.

Objective: To determine the clinical applicability of ultrasound-guided detrusor biopsy from the anterior bladder wall and to assess whether it is as representative and as sufficient for determining detrusor ultrastructure as the traditional transurethral biopsy from the lateral bladder wall.

Materials And Methods: The detrusor structure in 22 biopsies. 11 obtained transabdominally and 11 transurethrally from 11 patients, was evaluated without knowledge of the biopsy method by light and electron microscopy, including morphometric analysis.

Functional anatomy of the organs of micturition.

The anatomy of the organs of micturition has been the subject of study for nearly 150 years. As a result of advances in techniques and methods of clinical and research investigation, studies over the past three decades have intensified and have been increasingly directed at the functional implications and significance of organ anatomy and structure. This has led to revision of many traditional ideas about micturition and the development of new viewpoints and modalities for study of its disorders.

Distinctive ultrastructural pathology of nonulcerative interstitial cystitis: new observations and their potential significance in pathogenesis.

Ultrastructural study of the bladder in interstitial cystitis has, so far, been limited, mainly to the urothelium. The present study was conducted first to study in detail the ultrastructural features of all tissue components of the bladder wall in nonulcerative interstitial cystitis and second to derive clues from the observed changes to pathogenesis of the disease. Endoscopic biopsies of urothelium with attached suburothelium, and muscularis, were obtained from both lesional and nonlesional areas in 5 female patients with unequivocal clinical diagnosis of interstitial cystitis.

Pathology and pathophysiology of detrusor in incontinence.

Incontinence is a common urologic problem, especially in the elderly. Ultrastructural study of the detrusor is crucial for the understanding of its normal and abnormal functional behavior. Prospective, correlative, ultrastructural studies in the elderly revealed distinctive patterns of the overactive (unstable) detrusor, whether occurring alone or together with impaired detrusor contractility or bladder outlet obstruction.

"Cercariform" cells: a clue to the cytodiagnosis of transitional cell origin of metastatic neoplasms?

The "cercariform" cell is described as a distinct cytomorphologic clue that may be helpful in the diagnosis of metastatic transitional cell neoplasms, particularly low grade. This cell has a nucleated globular body and a cytoplasmic process with a nontapering, flattened, bulbous or fishtail-like end. The cercariform cell corresponds to intermediate cells in histologic and ultrastructural preparations of normal urothelium.

Comparative biochemical characteristics of the cat and rabbit urinary bladder.

The cat and the rabbit are two of the most popular models for the study of lower urinary bladder function. The cat has been used extensively for in vivo studies of spinal and supra-spinal micturition reflexes. In contrast, the rabbit has been used extensively for the in vitro study of bladder function.

Inverted papilloma of the urinary bladder in a boy.

Inverted papilloma of the urinary bladder is not uncommon in adults. In children, only two cases had been reported to our knowledge. Another pediatric case is described herein, in which the lesion occurred in a 9-year-old boy; he is the youngest patient reported to have this condition.

Structural basis of geriatric voiding dysfunction. IV. Bladder outlet obstruction.

Several aspects of the pathogenesis of voiding dysfunction in bladder outlet obstruction remain unresolved. The structural basis of obstructive versus nonobstructive dysfunction was investigated in a prospective ultrastructural/urodynamic study of 35 elderly subjects of comparable age. Detrusor structure was examined by electron microscopy, with blinded clinical and urodynamic information.

Structural basis of geriatric voiding dysfunction. III. Detrusor overactivity.

Detrusor overactivity in the absence of outlet obstruction is common in the elderly. The few available studies on structure of the overactive detrusor generally have dealt only with its innervation. We conducted a prospective study to examine the ultrastructure of muscle cells, interstitium and nerves of the detrusor in biopsies from 35 elderly subjects to identify structural correlates of various urodynamically defined forms of voiding dysfunction.

Structural basis of geriatric voiding dysfunction. II. Aging detrusor: normal versus impaired contractility.

Little information on the structural norm of the aging detrusor is currently available. To gain insight into the pathophysiology of geriatric voiding dysfunction, detrusor biopsies were examined by electron microscopy to identify structural correlates of specific, urodynamically defined abnormalities of vesical function in 35 elderly subjects. Prospective urodynamic grouping of the subjects and segregation of the detrusor specimens by ultrastructural features were done independently and blindly.

Structural basis of geriatric voiding dysfunction. I. Methods of a prospective ultrastructural/urodynamic study and an overview of the findings.

Voiding dysfunctions are common in the elderly. Yet the pathogenesis and pathophysiology have remained largely unknown. To date there has been little information on structure of the aging detrusor.

Functional pathology of urinary bladder muscularis: the new frontier in diagnostic uropathology.

Disorders of micturition (voiding dysfunction), the essence of urinary bladder function, are unknown to the discipline of pathology, despite their prevalence and profound socioeconomic impact. Their pathogenesis has remained largely unknown, their diagnosis often difficult or uncertain, and the outcome of their management generally unpredictable. A new approach to morphologic study of the bladder has been developed to identify microstructural correlates of its function.

Studies on experimental bladder outlet obstruction in the cat: long-term functional effects.

Experimental bladder outlet obstruction in cats induces a significant increase in the in vivo leakage pressure. The effects of obstruction on the detrusor function were analyzed, using control, 3, 6 and 12 month obstructed cats. The in vivo leakage pressures were substantially increased in all obstructed groups.

Comparative autonomic responses of the cat and rabbit bladder and urethra.

The cat and the rabbit have both been utilized extensively in the study of lower urinary tract function. Previous studies have demonstrated that although both the cat and rabbit bladder are approximately the same weight, the in-vitro cat bladder can generate over 6 times the intravesical pressure of the rabbit bladder. The current study was designed to compare the ability of the isolated bladder to generate pressure with the pressures required to maintain flow through the isolated urethra for both the cat and the rabbit.

Creation of a feline model of obstructive uropathy.

The aim of this project was to create a reproducible, quantifiable feline model of obstructive uropathy. Seventy-three adult female cats of comparable age were evaluated to obtain the normal control urodynamic data base. Twenty-four cats had a silastic cuff installed around the urethra to induce bladder outlet obstruction, and eight underwent a sham operation.

Effects of parasympathetic decentralization on some nerve-mediated functions in the feline urinary bladder.

Isolated detrusor muscle from control cats and cats parasympathetically decentralized for 3 and 10 weeks responded to electrical field stimulation by tetrodotoxin-sensitive, frequency-dependent contractions. There were no significant differences in the frequencies producing 50% response. However, the amplitude of the scopolamine-resistant contraction was distinctly lower in decentralized bladder preparations than in controls.

Short term functional effects of bladder outlet obstruction in the cat.

Experimental bladder outlet obstruction in cats was produced by surgical placement of a silastic cuff around the urethra. Two sizes of cuff were used to produce either moderate or severe obstruction. The following is a summary of the short-term effects on bladder function.

Comparative physiology and pharmacology of the cat and rabbit urinary bladder.

The cat and the rabbit are two of the most popular models for the study of lower urinary bladder function. The cat has been used extensively for in-vivo studies of spinal and supra-spinal micturition reflexes. In contrast, the rabbit has been used extensively for the in-vitro study of bladder function.

Interaction between adrenergic and cholinergic nerve terminals in the urinary bladder of rabbit, cat and man.

The influence of muscarinic receptor stimulation (carbachol) and blockade (scopolamine) on the release of 3H-labelled noradrenaline from adrenergic neurons was investigated in isolated detrusor preparations from rabbit, cat and man. A significant influence on the release of 3H from adrenergic nerve terminals was found in the three species with a concentration-dependent decrease and increase induced by carbachol and scopolamine, respectively. Using the alpha 2-adrenoceptor stimulating and blocking agents clonidine and rauwolscine in rabbit and human detrusor preparations, the presence of prejunctionally located inhibitory alpha 2-adrenoceptors could also be demonstrated.

Mixed germ-cell tumor of the pineal region. Case report.

The case is presented of a 15-year-old boy with a mixed nongerminomatous germ-cell tumor of the pineal region associated with elevated cerebrospinal fluid and serum levels of the beta subunit of human chorionic gonadotropin. Treatment consisted of initial subtotal resection followed by radiotherapy and systemic chemotherapy with cisplatin, vinblastine, and bleomycin. The patient is alive without evidence of tumor 37 months after his initial diagnosis.