The changes of ultrastructure of detrusor in patients with benign prostatic hyperplasia
during treatment by tamsulosin
Article published in Urologia Polska 2008/61/Supl. 1.
Aleksander Lychkovsky, Andrzej Zhuravchak, Aleksander Shuliak, V. Kovalyshyn
- Danylo Halytsky Lviv National Medical University, Ukraine
Introduction. The benign prostatic hyperplasia (BPH) is widely spread disease affecting about one third of men over 50. The ultrastructural investigation of detrusor which we performed testify, that disturbance in microcirculation due to infravesical obstruction in patients with BPH cause preapoptosis of smooth muscle cells and fibroblasts. α-adrenoblockers play important role in elimination of obstructive and irritative symptoms. Tamsulosin is the prostate-selective α1A-adrenoblocking agent for treatment of patients with BPH, and its efficacy and safety in use are confirmed by the results of many investigations.
Materials and methods. The ultrastructural investigations of detrusor were made in 10 patients with BPH who received tamsulosin – 1 capsule once a day during 3 months. TURP was done to above mentioned patients after treatment. “Cold” biopsy in the urinary bladder cervix and its lateral walls were done during operations by biopsy forceps. We used electronic microscope UEMB-100K with 1000x – 124000 x magnifications.
Results. We have determined that after treatment cells and non cellular structures of detrusor are preserved. Detrusor is mainly composed of elongated smooth muscle cells with medium electronic density which, are tightly close to one another. Cell nuclei are a bit fragmented and filled with euchromatin. Mitochondria, ribosomes and polysomes are located in the cytoplasm near nucleus. Ground substance between smooth muscle cells and fibroblasts is with small granules. In the cytoplasm of fibroblasts there are hyaloplasm with low electronic density and small granules, ribosomes and polysomes. We can observe in those cells developed mitochondria rough and smooth endoplasmic reticulum, system of small vesicles of Golgi complex. We paid attention to the positive changes in the detrusor microcirculation having analyzed the data of our investigations. We determined, that ultrastructure of big and small blood capillaries in the electronic-light connective tissue, close to muscle fibers was unchanged. Lumens of big blood capillaries are filled with blood plasma with medium electronic density, small granules and single erythrocytes. Endothelial cells in this capillaries are elongated, have nucleus and cytoplasm with medium electronic density. The results of our investigation testify, that α1A-adrenoblocker tamsulosin have positive effect on the
- ultrastructural organization of detrusor. During treatment there are no signs of preapoptotic changes in smooth muscle cells, which are present during obstruction.
Conclusion. The most essential disorders in urinary bladder function during obstruction are caused, to our mind, by microcirculation disorders. That is why, by means of vasoactive drugs, such as tamsulosin, we can essentially influence on the microcirculation in urinary bladder.