Obstruction-induced pathological alterations within the urinary bladder due to Benign Prostate Hyperplasia (BPH) A review of the literature

Christos Komninos, Iraklis C. Mitsogiannis


Benign prostatic hyperplasia (BPH) is a frequent cause of Bladder Outlet Obstruction (BOO) and Low Urinary Tract symptoms (LUTS). BPH process
induces functional, biochemical and morphological alterations, in order for the urinary bladder to maintain a normal functionality. There is substantial
evidence that detrusor blood flow significantly decreases in the presence of BOO. This review addresses the bladder response to BOO and focuses on the alterations and biochemical adaptability of the bladder wall in the presence of hypoxia.

A literature review of published articles has been performed, including both in vivo and in vitro studies on human and animal tissue.

In the presence of obstruction and hypoxia, muscle enlargement and collagen deposition comes upon, mitochondria sustain damage, mitochondrial DNA deletions and decrease mitochondrial enzyme activity occur leading to a decreased oxidative metabolism and ATP synthesis. Anaerobic metabolism and probably glycogen deposit increase, in
order for the muscle cells to find alternative energy supplies. As a result, lactic acid due to the anaerobic metabolism accumulates in the smooth
muscle causing contractile dysfunction. Furthermore, hypoxia induces bladder wall denervation and reduces cholinergic nerve density.

BOO is a key factor in the aetiology of LUTS/BPH. Obstruction is associated with a variety of morphological, contractile and biochemical changes within
the bladder.

Παθοφυσιολογικές μεταβολές στην ουροδόχο κύστη από την υποκυστική απόφραξη που προκαλεί η Καλοήθης Υπερπλασία του Προστάτη (ΚΥΠ).

Σκοπός: Η Καλοήθης Υπερπλασία του Προστάτη (ΚΥΠ) αποτελεί συνήθη αιτία υποκυστικής απόφραξης και πρόκλησης συμπτωμάτων από το κατώτερο ουροποιητικό σύστημα (LUTS). Στο τοίχωμα της ουροδόχου κύστης συμβαίνουν σημαντικές λειτουργικές, βιοχημικές και μορφολογικές μεταβολές κατά την εξέλιξη της ΚΥΠ, ώστε να διατηρηθεί η φυσιολογική λειτουργικότητά της. Μελέτες έχουν καταδείξει μειωμένη αιμάτωση του εξωστήρα μυός όταν υπάρχει υποκυστική απόφραξη. Η παρούσα ανασκόπηση παρουσιάζει την απάντηση της ουροδόχου κύστης κατά την υποκυστική απόφραξη και εστιάζει στις μεταβολές και βιοχημικές προσαρμογές του κυστικού τοιχώματος παρουσία της υποξίας.

Μέθοδος: Πραγματοποιήθηκε ανασκόπηση της δημοσιευμένης βιβλιογραφίας, η οποία συμπεριέλαβε in vivo και in vitro μελέτες σε ανθρώπινους και ζωικούς ιστούς.

Κατά τη διάρκεια της απόφραξης και της υποξίας επέρχεται μυϊκή υπερτροφία, εναπόθεση κολλαγόνου, βλάβη στα μιτοχόνδρια, διαγραφές μιτοχονδριακού DNA και μείωση της μιτοχονδριακής ενζυμικής δραστηριότητας, με αποτέλεσμα τον μειωμένο οξειδωτικό μεταβολισμό και την ελαττωμένη σύνθεση ATP. Επίσης, παρατηρείται στροφή προς τον αναερόβιο μεταβολισμό και πιθανόν εναπόθεση γλυκογόνου, προκειμένου να ανευρεθούν εναλλακτικές πηγές ενέργειας από τα μυϊκά κύτταρα. Αποτέλεσμα αυτών των διαδικασιών είναι η συσσώρευση γαλακτικού οξέος στις λείες μυϊκές ίνες λόγω του αναερόβιου μεταβολισμού, η οποία προκαλεί
συστολική δυσλειτουργία του εξωστήρα. Επιπρόσθετα, η υποξία προάγει την απονεύρωση του τοιχώματος της κύστης και τη μείωση της πυκνότητας των χολινεργικών νευρώνων.

Συμπέρασμα: Η υποκυστική απόφραξη σχετίζεται με ποικίλες μορφολογικές και βιοχη-μικές μεταβολές στο τοίχωμα της κύστης που επηρεάζουν τη συσταλτικότητά της. Η μακροχρόνια απόφραξη μπορεί να οδηγήσει σε μη αναστρέψιμες βλάβες στον εξωστήρα μυ, με παραμονή της συμπτωματολογίας ακόμη και μετά την άρση του κωλύματος.  


Benign prostatic hyperplasia; bladder outlet obstruction; urinary bladder; detrusor muscle; Καλοήθης Υπερπλασία Προστάτη; Υποκυστική Απόφραξη; Ισχαιμία Εξωστήρα; Συμπτώματα Κατώτερου Ουροποιητικού

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DOI: http://dx.doi.org/10.19264/hj.v26i1.53