ABSTRACT
Three distinctive ultrastructural patterns occurring separately or in combination have been described: the degeneration, dysjunction, and myohypertrophy patterns associated with impaired detrusor contractility, detrusor overactivity, and detrusor with bladder outlet obstruction, respectively. An endoscopic cold cup biopsy should be obtained outside of the trigone from the bladder wall. The open biopsy from the bladder wall should be excised by scalpel to obviate tissue destruction and artifacts because of electrocautery. All animals had undergone bladder decentralization by unilateral sacral ventral rhizotomy. The herein observed degenerative changes in axons of the decentralized bladder represent the first example of transsynaptic degeneration in an autonomically innervated mammalian smooth muscle system. Characteristic ultrastructural findings have been described for lower and upper motor neuron bladder dysfunction in animal models or human specimens. The usefulness of the suggested morphologic markers in the clinical management of vesical dysfunction, whether overtly neurogenic or nonneurogenic, remains to be investigated in future studies.
