Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts.
Department of Surgery, Harvard Medical School, Boston, Massachusetts.
Neurourol Urodyn. 2018 Jun;37(5):1583-1593. doi: 10.1002/nau.23512. Epub 2018 Feb 10.
Mounting evidence indicates that a variety of factors released from the urothelium or suburothelium can modulate smooth muscle activity. Although the relationship between the mucosa and smooth muscle has been investigated, little is known about the pathophysiologic changes in detrusor-mucosa interactions in neurogenic bladders. The goal of the study was to determine the impact of the mucosa on evoked responses in spinal cord injured (SCI) bladders.
Urinary bladders were obtained from 6wk SCI rats or age-matched uninjured controls. Ex vivo isometric tension studies were performed and muscarinic receptor expression was measured in bladder tissue with and without mucosa.
The magnitude and area of nerve evoked responses in SCI tissue with mucosa was higher than without mucosa. The duration and decay time of nerve-evoked responses were longer in SCI than control tissue irrespective of the mucosa. The level of the muscarinic M receptor was decreased in the mucosa of SCI bladders.
Detrusor-mucosa interactions are substantially altered in the neurogenic bladder. After spinal cord injury, an excitatory modulation of smooth muscle contraction by the mucosa emerges, and could be targeted via intravesical treatment in the context of neurogenic bladder dysfunction.
越来越多的证据表明,从尿路上皮或下尿路上皮释放的多种因素可以调节平滑肌活动。尽管已经研究了黏膜和平滑肌之间的关系,但对于神经源性膀胱中逼尿肌-黏膜相互作用的病理生理变化知之甚少。本研究的目的是确定黏膜对脊髓损伤(SCI)膀胱诱发反应的影响。
从 6 周龄 SCI 大鼠或年龄匹配的未受伤对照大鼠获得尿液膀胱。进行离体等长张力研究,并在有和没有黏膜的情况下测量膀胱组织中的毒蕈碱受体表达。
有黏膜的 SCI 组织中神经诱发反应的幅度和面积高于没有黏膜的组织。无论是否有黏膜,SCI 组织中的神经诱发反应的持续时间和衰减时间均长于对照组织。SCI 膀胱黏膜中的毒蕈碱 M 受体水平降低。
神经源性膀胱中的逼尿肌-黏膜相互作用发生了实质性改变。脊髓损伤后,黏膜对平滑肌收缩的兴奋性调节作用出现,并且可以通过在神经源性膀胱功能障碍的情况下进行膀胱内治疗来靶向。