Lack of ultrastructural detrusor changes following endoscopic injection of botulinum toxin type a in overactive neurogenic bladder.

Détails

ID Serval
serval:BIB_F2A2BE5C39A9
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Lack of ultrastructural detrusor changes following endoscopic injection of botulinum toxin type a in overactive neurogenic bladder.
Périodique
European Urology
Auteur(s)
Haferkamp A., Schurch B., Reitz A., Krengel U., Grosse J., Kramer G., Schumacher S., Bastian P.J., Büttner R., Müller S.C., Stöhrer M.
ISSN
0302-2838 (Print)
ISSN-L
0302-2838
Statut éditorial
Publié
Date de publication
2004
Volume
46
Numéro
6
Pages
784-791
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov'tPublication Status: ppublish
Résumé
INTRODUCTION: Endoscopical injections of Botulinum toxin type A into the detrusor muscle are gaining clinical acceptance in the treatment of neurogenic detrusor overactivity. Structural effects of Botulinum toxin type A are only known from studies on striated muscles, where a widespread nerve sprouting occurs temporarily. The aim of this study was to evaluate the ultrastructural effects of Botulinum toxin type A injections on the human detrusor.
MATERIAL AND METHODS: 30 detrusor biopsies were obtained from 24 patients with neurogenic detrusor overactivity. Patients were divided into two groups: Group I included 13 biopsies from patients before the first Botulinum toxin type A injection. Group II included 6 biopsies from patients within 3 months after the first injection and 11 biopsies at the time of decreasing efficacy of Botulinum toxin type A. The biopsies were processed by standard procedure for detailed electron microscopic study and evaluated by 2 examiners without prior knowledge of clinical/urodynamic data.
RESULTS: No statistically significant detrusor changes have been found concerning muscle cell fascicle structure (p = 0.445), width of intercellular space (p = 0.482) and number/kind of muscle cell junctions (p = 0.443). A median of 70% of intrinsic axon terminals presented with signs of degeneration in group I, a median of 66% in group II (p = 0.840). Out of 309 evaluated axon terminals in both groups, 1 sprouting axon was found in group I, 3 sprouting axons in group II (p = 0.864). Specimen from group I and group II showed only limited collagen deposits within the detrusor. No changes in the ultrastructure of the detrusor have been observed in those biopsies obtained before and after the Botulinum toxin type A injection of the same patient.
CONCLUSION: This study verifies our earlier report of severe intrinsic axon degeneration in the detrusor of patients with neurogenic detrusor overactivity. It also shows nearly no structural differences of the detrusor before and after Botulinum toxin type A injections. Contrary to reports of striated muscle, axonal sprouting within the detrusor was very limited after Botulinum toxin type A injections indicating pathophysiologically different reactions to the toxin either between striated muscle and smooth muscle or between different treated diseases.
Mots-clé
Adolescent, Adult, Aged, Botulinum Toxins, Type A/administration & dosage, Cystoscopy, Female, Humans, Injections, Intralesional/methods, Male, Microscopy, Electron, Middle Aged, Muscle, Smooth/drug effects, Muscle, Smooth/ultrastructure, Neuromuscular Agents/administration & dosage, Urinary Bladder/drug effects, Urinary Bladder/ultrastructure, Urinary Bladder, Neurogenic/drug therapy
Pubmed
Web of science
Création de la notice
05/11/2014 13:12
Dernière modification de la notice
03/03/2018 22:40
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