Abstract
Simple SummaryDisorders of bladder function can result from congenital spinal cord developmental defects and can remain in a significant number of patients despite surgical improvements to repair the primary defect. We studied the ability of bladder wall muscle from such patients to contract, a function essential to void collected urine and avoid urinary tract infections and potential damage to the kidneys. Tissue was taken when patients were several years old, at the time of surgical operations to improve bladder function. This tissue would otherwise have been discarded and was collected with the full ethical approval and consent of parents or guardians. We found that the ability of the bladder wall samples to contract was impaired and was generally stiffer; both of which would make it more difficult for the bladder to void urine. These functional changes were associated with a replacement of muscle with connective tissue (fibrosis). The experiments provide a pathway to devise strategies that might improve bladder function in these patients through reversal of the intrinsic tissue pathways that increase fibrosis.Neurogenic lower urinary tract (NLUT) dysfunction in paediatric patients can arise after congenital or acquired conditions that affect bladder innervation. With some patients, urinary tract dysfunction remains and is more difficult to treat without understanding the pathophysiology. We measured in vitro detrusor smooth muscle function of samples from such bladders and any association with altered Wnt-signalling pathways that contribute to both foetal development and connective tissue deposition. A comparator group was tissue from children with normally functioning bladders. Nerve-mediated and agonist-induced contractile responses and passive stiffness were measured. Histology measured smooth muscle and connective tissue proportions, and multiplex immunohistochemistry recorded expression of protein targets associated with Wnt-signalling pathways. Detrusor from the NLUT group had reduced contractility and greater stiffness, associated with increased connective tissue content. Immunohistochemistry showed no major changes to Wnt-signalling components except down-regulation of c-Myc, a multifunctional regulator of gene transcription. NLUT is a diverse term for several diagnoses that disrupt bladder innervation. While we cannot speculate about the reasons for these pathophysiological changes, their recognition should guide research to understand their ultimate causes and develop strategies to attenuate and even reverse them. The role of changes to the Wnt-signalling pathways was minor.
Highlights
Neurogenic lower urinary tract (LUT) dysfunction results from either a congenital or acquired condition that affects lower urinary tract innervation
Absolute nerve-mediated contractions to electrical field stimulation (EFS) were significantly smaller at all frequencies than neuropathic compared to control (Figure 1A) with estimated Tmax,EFS values of 2.10 ± 0.62 vs. 7.68 ± 2.50 mN.mm−2 (n = 10,14; p < 0.05)
Each condition requires separate study to understand their unique pathogenesis and origin of fibrosis. Detrusor from this group of children with Neurogenic lower urinary tract (NLUT) dysfunction was less contractile and was associated with loss of smooth muscle when compared to connective tissue
Summary
Neurogenic lower urinary tract (LUT) dysfunction results from either a congenital or acquired condition that affects lower urinary tract innervation. Congenital lesions include neural tube defects such as myelomeningocele, tethering of the spinal cord, and sacral agenesis [1,2]. A current ‘two-hit’ hypothesis [4] is that a spinal defect exposes regions of the cord to amniotic fluid, which are subsequently damaged by fluid exposure, trauma or raised fluid pressures, leaving a motor neurone lesion that affects the lower urinary tract. Upper urinary tract damage can result from LUT dysfunction and, in some cases, a decrease in bladder compliance [6,7]; incontinence is usual [8]. In utero surgical repair has led to improvements in lower limb development but has yet to show changes to urological outcomes [10]
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