Ultrastructural Study of The Detrusor in End Stage Renal Disease
Premsant Sangkum MD*, Panas Charermsanyakorn MD**, Kittinut Kijvikai MD*, Wisoot Kongcharoensombat MD*, Wachira Kochakarn MD*
Affiliation : * Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol Univesity, Bangkok, Thailand ** Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol Univesity, Bangkok, Thailand
Background : After successful renal transplantation, almost 50% of the patients complained of lower urinary tract symptoms.
There is no definite conclusion to explain these voiding symptoms and ultrastructural study of detrusor muscle in end stage
renal disease (ESRD) has never been carried out before.
Objective : To study ultrastructural changes of detrusor muscle in the specific group of patients with end stage renal disease.
Material and Method: Detrusor biopsy of 20 patients, including 15 in end stage renal disease and five in patients with normal
creatinine, was obtained by open technique. Biopsy was done during ureteral reimplantation at the time of kidney transplantation.
In normal renal function group, detrusor biopsy was done at the time of open bladder surgery from other urologic diseases.
The specimens were processed for light microscopy and transmission electron microscopy using standard techniques.
Results : All specimens from open biopsy provided sufficient quality to be examined by electron microscope. The average
creatinine level was 9.2 and 1.0 mg/dl in the ESRD group and control group, respectively. In the ESRD group, all showed
hypertrophy of muscle bundles, fibrosis between muscle bundles, muscle bundle degeneration, and fragmentation of muscle
cells. In ESRD group, 93% had fibrosis around nerve bundles and enlarged muscle cell nuclei. About 60% had enlarged
nerve bundles, and 53% showed amorphous inclusion in muscle cells. The ESRD group displayed many more ultrastructural
changes than in the control group and some appearances were not present in the control group.
Conclusion : There were distinct ultrastructural changes of detrusor muscles in ESRD patients. These ultrastructural
changes of detrusor muscles may be associated with voiding dysfunction after kidney transplantation.
Keywords : Detrusor, Ultrastructural, End stage renal disease
