Correlation of urodynamic studies with bladder neck innervation in patients after radical prostatectomy
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Tomasz Borkowski, Agnieszka Bossowska, Piotr Radziszewski, Mariusz Majewski, Andrzej Borkowski

Katedra i Klinika Urologii Ogólnej, Onkologicznej i Czynnościowej Warszawskiego Uniwersytetu Medycznego, Szpital Dzieciątka Jezus
Zespół Fizjologii Klinicznej, Katedra Morfologii Funkcjonalnej, Wydział Medycyny Weterynaryjnej, Uniwersytet Warmińsko-Mazurski w Olsztynie

summary

Introduction.

Radical prostatectomy (RP) disassembles and re-assembles the connection between the bladder neck and urethra. Therefore RP should be regarded as the nerve damage, leading to the axonal degeneration/regeneration processes producing a considerable neuronal plasticity within the bladder neck region.

Objectives.

We wanted to evaluate the innervation/re-innervation processes within this region and to correlate these results with the functional studies of the lower urinary tract.

Materials and methods.

20 patients in the age from 57 to 67 (mean 65) years undergoing RP due to prostate cancer were studied. Before RP urodynamics was performed. During the RP samples from the bladder neck were collected and processed for immunohistochemistry. 3-6 months after the surgery patients were re-evaluated with the urodynamics and bladder neck biopsies were harvested and processed for immunohistochemistry. Immunohostochemical staining was performed using the antisera against: nitric oxide synthase (NOS), substance P (SP), calcitonie gene related peptide (CGRP), pituitary adenylate cyclase-activating peptide (PACAP), galanine (GAL), somatostatine (SOM), vasoactive intestinal polypetide (VIP), neuropeptide Y(NPY), dopamine-beta hydroxylase (DbH), vesicular actetylocholine transporter(VACHT)

Results.

Patients before RP could be divided into patients with outflow obstruction (8) and without obstruction (12). 3 patients with obstruction had OAD. In obstructed patients the quantity of nerve fibers containig VIP and GAL was reduced and nerve fibers (NF) containing SP, SOM and VACHT were vanished, as compared with nonobstructed patients. After RP we observed 3 distinct functional and innervation patterns. Patients without obstruction (9), without OAD, in whom the innervation pattern was only minimally damaged (reduced density of NPY, VACHT, SOM and DbH positive NF). Patients without obstruction and with de novo OAD (5) in whom increased NPY NF density was observed, DbH and VIP NF density was reduced and the rest of NF was vanished. Patients with obstruction and OAD (6) in which NPY and VIP NF were slightly reduced and other NF were vanished.

Conclusions.

Radical prostatectomy evokes a pronounced neuronal plasticity within the bladder neck. This could be responsible for the lower urinary tract functional disorders seen after the surgery.