Morphology and ultrastructure of the aging bladder

Abstract

The functional inconvenience of aging bladder is outlet obstruction, reduced bladder capacity and incontinence. Normal urinary bladder function depends on adequate extensibility during the filling phase without involuntary contractions of the smooth muscles by simultaneously keeping the sphincter closed. For voiding an adequate force of muscle constriction is necessary by simultaneously opening the bladder outlet. This function depends mainly on the smooth muscles of the bladder wall — also called detrusor — and its neural supply and control. Therefore the muscle cells need an adequate force of contraction, a complex architecture arranged in fascicles, and a normal innervation. Impaired bladd er function is either caused by detrusor dysfunction or results from the effect of neurogenic disorders or obstruction. Functional pathology of the urinary bladder therefore focuses on the light and electron microscopic changes of the detrusor. According to the work of Ahmed Elbadawi there is a concept to interpretate these findings and to get relevant information on the kind of voiding dysfunction. The cited literature at the end of this article is restricted mainly to this author because his investigations have a practical diagnostic approach. In a pilot study at our place this concept turned out to be highly useful and reproducible even by pathologists not yet experienced in this diagnostic field.