Frederick C. Monson

The Effects of Short-term In-vivo Ischemia on the Contractile Function of the Rabbit Urinary Bladder

The proper functioning of any smooth muscle requires adequate perfusion with oxygen and nutrients. Ischemia compromises both these factors and results in dysfunction, the extent depending on the degree and duration of ischemia. This study determined the effects of one, two and four weeks in vivo ischemia on the capacity, compliance and contractile function of the rabbit urinary bladder. Morphological changes were also studied with light microscopy. Different degrees of ischemia were achieved as follows. In the unilateral group the vesical artery was tied on one side and the animals were sacrificed at one week or two weeks. In the bilateral group the vesical arteries on both sides were tied and the animals were sacrificed one week later. In the bilateral staged group the vesical artery was tied on one side and after one week the contralateral artery was ligated, and the animals sacrificed one week after the second procedure. Muscle strips were studied for contractile response, with a distinction being made between the ipsilateral and contralateral side of vessel ligation in the unilateral group. The results were as follows. 1) In the unilateral group there was a 72% reduction in the contractile response of the dome of the bladder to bethanecol on the side of vessel ligation and a 32% reduction on the contralateral side. The response to methoxamine on the base was reduced by 44%, with no difference between the ipsilateral and contralateral side. 2) Bilateral vessel ligation resulted in a 97% reduction in contractile response to bethanechol on the dome and a 75% in the response of the base to methoxamine. 3) Staged bilateral ligation resulted in a 69% reduction in the contractile response of the dome to bethanechol and a 18% reduction in the response of the base to methoxamine. Ischemia caused a marked reduction in the compliance and capacity of the bladder in all the three groups, with the most marked changes in the bilateral group. Multiple spontaneous contractions were noted in the three groups during the filling phase of the cystometrograms. Histological features correlated well with the functional changes in the different groups.

Effect of Outlet Obstruction on 3H-Thymidine Uptake: A Biochemical and Radioautographic Study

Experimental outlet obstruction in the rabbit is characterized by a rapid and substantial increase in urinary bladder mass. Although it is clear that both the smooth muscle and connective tissue compartments are increasing in mass, there is little information on the mechanisms by which this increase in mass occurs. As an initial investigation in this process, urinary bladders from normal and obstructed NZW rabbits were exposed in vitro to tritiated thymidine (3H-TdR) in order to determine which populations of cells are induced to synthesize DNA following outlet obstruction, and when, after obstruction, such synthesis occurs. Biochemical analysis of nucleic acids was performed on each specimen to determine total and radioactive DNA. These analyses showed a marked increase in DNA synthesis at 24 hours following obstruction which remained relatively high through seven days after obstruction. There was a decline in labelling at 14 days. Incorporation of radioactive label peaked at three days and declined to control levels by 14 days. Samples of tissue were taken from each subject and processed for radioautography. At 24 hours after obstruction, significant numbers of cells of the basal cell layer of the urothelium are observed to be actively involved in DNA synthesis, while the other two tissue compartments (muscularis and connective tissue) show no significant changes when compared to normal specimens. Connective tissue, on the other hand, showed significantly increased levels of labelling above control level from three to 14 days after obstruction. Smooth muscle cells were observed to be frequently labelled in only one of the experimental bladders observed three days after obstruction.

Effects of acute in vitro overdistension of the rabbit urinary bladder on DNA synthesis

Urinary bladder outflow obstruction induces a myriad of structural and functional changes in the organ. Among the morphological responses to outlet obstruction is both hyperplasia and hypertrophy of specific cellular elements. The initial event which has been implicated in the initiation of the response to outflow obstruction is an initial period of high intravesical pressure and subsequent distention of the bladder. In a previous study, it was shown that at one day following partial outlet obstruction there was a marked increase in thymidine labelling of the urothelium, at 3-5 days, the labeling shifted from the urothelium to the interstitial and serosal elements. The current study was designed to determine if acute distention of the urinary bladder can induce an increase in DNA synthesis (3H-thymidine incorporation), and localize the increased DNA synthesis via autoradiography of 3H-thymidine. In this study, the bladders of adult male New Zealand white rabbits were mounted in isolated in vitro baths. Each control bladder was filled to either 5 or 20 ml. with saline, or distended to 120% of capacity. The bladders were incubated for 7 hours at which time 3H-thymidine was placed both within and outside the bladder for an additional one hour. At the end of the time the bladder was divided at the ureteral orifices into bladder body and base, and each body and base divided into two sections. One section of bladder body and base was quantitatively analyzed for both labelled and unlabelled DNA; the second section was fixed and prepared for autoradiography. The results can be summarized as follows: 1) Acute overdistention for 8 hours induced a slight decrease in the DNA concentration which was mediated by edema of the bladder wall. 2) Acute overdistention induced a 5-fold increase in 3H-thymidine incorporation in the bladder body and a 3-fold increase in the bladder base. Radioautoradiography of the overdistended bladders showed significant and substantial labelling which was confined to the urothelial basal cells. The control bladders showed little or no labelling. These results are consistent with the theory that acute distention following partial outlet obstruction initiates the proliferative response of the bladder to outlet obstruction, and the urothelium is the initial target of the proliferative response. Functionally, the proliferative response may serve to maintain the structural as well as functional integrity of the bladder.

Bladder Function in Experimental Outlet Obstruction: Pharmacologic Responses to Alterations in Innervation, Energetics, Calcium Mobilization, and Genetics

The two functions of the urinary bladder is to store urine at low intravesical pressures, and to periodically expel the urine through a coordinated contraction of the bladder and relaxation of the urethra. To a large extent, urinary bladder function depends upon the underlying structure of the organ as a whole, particularly on the inter-relationships among the smooth muscle, connective tissue, and neuronal elements. An alteration in the ratio of connective tissue to smooth muscle, for example, can significantly alter compliance and functional capacity, structurally impairing the bladders ability to empty efficiently and fully. Thus, a change in structural compartmentation can affect bladder function independent of autonomic receptor density, response to receptor stimulation, and the contractile capabilities of the smooth muscle elements. Similarly, a selective alteration in either the afferent or efferent innervation of the bladder or urethra can induce significant alterations in the structural interrelationships between smooth muscle and connective elements. In addition, the bladder responds rapidly to alterations in urine volume and urethral resistance with marked changes in bladder and urethral structure and function, and these changes are under the controls of specific genes that are known to control cellular growth, hypertrophy, and hyperplasia. A knowledge of the mechanisms that control the response to specific forms of stress may lead to novel therapies for specific disease states.

The Influence of Acute Overdistension on Rat Bladder Function and DNA Synthesis

Prolonged micturition problems are often encountered after long-term bladder overdistension caused by urinary retention. In animal studies, damage to the bladder wall innervation has been found following overdistension. Experimentally, acute overdistension has also been implicated in the pathogenesis of the response to partial outlet obstruction. In the present study we investigated the influence of overdistension on micturition volume and frequency, on in vitro bladder function using the whole bladder model and on 3H-thymidine uptake, localization and DNA synthesis. Overdistension was induced for 3 hours by forced diuresis and balloon obstruction. Another group of rats was catheterized for 3 hours but received no diuretic, nor was the balloon inflated. An additional group of controls was neither anesthetized nor catheterized. Overdistension caused a gradual increase in bladder mass which was maximal at 7 days. During the first 24 hours following overdistension, the frequency of micturition decreased, but normalized thereafter. A progressive decrease in the response to field stimulation was noted between 16 hours and 7 days following overdistension and remained at this level until 21 days. There were, however, no significant differences in the responses to carbachol, ATP and KCl. There was a 30% reduction in the ability of field stimulation to empty the bladder 16 hours after overdistension, but no impairment of the emptying ability of carbachol. Overdistension was followed by a significant increase in 3H-thymidine uptake, which was maximal at 2 days. 3H-thymidine labelling increased rapidly after overdistension and was maximal within 16 hours in the urothelium. In smooth muscle, connective tissue and lamina propria, maximal labelling occurred at 2 days. Catheterization alone caused a mild distension which was associated with a small, but statistically significant, increase in 3H-thymidine incorporation into DNA within 16 hours. The labelling was located primarily in the urothelium. Overdistension causes a proliferative reaction within the bladder wall. Its initial effects occur within the urothelium, and the later involvement of the subendothelial smooth muscle and connective tissue is directly proportional to the degree of bladder distension. Three weeks following overdistension, the bladders functional state was not completely recovered, although the urinary bladder was found to have a good capacity to adapt and compensate for the stress-induced changes caused by overdistension. It is, therefore, clear that overdistension may have long-lasting effects on the bladder.

Effect of chronic ischemia on glucose metabolism of rabbit urinary bladder.

The effect of chronic ischemia on glucose metabolism of the rabbit urinary bladder was studied. Unilateral ischemia was produced by ligation of one of the two vesical arteries which supply the rabbit bladder. Two weeks after the operation, the in vitro glucose metabolism of normal bladder tissue was compared to the glucose metabolism of tissue isolated from both the ischemic side and contralateral (non-ischemic) side of the ischemic bladder. The results can be summarized as follows: 1) ischemic and contralateral side bladder tissues contained less glycogen than normal; 2) glucose utilization was higher in the ischemic and contralateral side tissues; 3) ischemic and contralateral side tissues incorporated more glucose into lactate and produced more total lactate than normal tissues; 4) whereas contralateral side tissue produced more 14CO2 than ischemic side tissue, the ability of normal bladder tissue to form 14CO2 is significantly higher than both ischemic and contralateral side tissues; 5) the degree of reduced CO2 production correlated well with previous studies on the contractile response of smooth muscle strips isolated from the ischemic and contralateral sides, and the reduced functional ability of the in vitro whole bladder to empty; 6) histologically, smooth muscle degeneration and necrosis is only present on the ischemic side of the bladder although the contralateral side shows signs of generalized degeneration and edema. In general, we conclude that although only the ischemic tissue demonstrated major smooth muscle degeneration and necrosis, unilateral ischemia resulted in marked alterations in glucose metabolism on both the ischemic and contralateral sides.

3H-thymidine uptake by the rat urinary bladder after induction of diabetes mellitus.

Streptozotocin-induced diabetes mellitus causes diuresis, increases in bladder mass and changes in micturition. Temporal changes in micturition and bladder mass after induction of diabetes with streptozotocin were monitored and correlated with DNA synthesis and 3H-thymidine incorporation. There were increases in water consumption, urine excretion, urinary frequency, and mean and maximal micturition volume within 1 day after induction of diabetes. These parameters reached maximal values within 6 to 11 days and were maintained at 30 and 60 days. Bladder mass was significantly elevated by 7 days and did not increase further with increasing duration of diabetes. DNA concentration was decreased in bladders from 4, 7 and 14 day diabetics. 3H-thymidine incorporation into DNA increased within 2 days after induction of diabetes, reached maximal values at 4 to 7 days and declined to control values by 14 days. Autoradiography showed intense labelling of the urothelium one day after induction of diabetes, with labelling remaining high up to day 7. Connective tissue and smooth muscle labelling were slower to develop. Labelling of smooth muscle was transient, appearing only on days 4 and 7. The time course of the events was consistent with the hypothesis that bladder distension or increasing micturition volume stimulates thymidine incorporation into DNA, resulting in an increase in bladder mass.

Hyperplasia in the rabbit bladder urothelium following partial outlet obstruction. Autoradiographic evidence

Previous experiments have shown that adult male rabbits subjected to partial outlet obstruction or overdistension and acutely labeled, 24 h later,in vivo orin vitro with3H-Thymidine(3H-TdR) show high levels of incorporated radioactivity in bladder epithelium when they are visualized with autoradiography. To test the hypothesis that such labeling represents the onset of a wave of proliferation (that is, true hyperplasia), we injected3H-TdR subcutaneously in two normal and three partially obstructed New Zealand White male rabbits on each of days One, Two or Three following obstruction. Bladders were excised on the seventh day(D) following obstruction or the sixth day after injection of normals. Under these conditions, cells labeled with3H-TdR had the opportunity to proliferate, after labelling, for6(OneD and Normals),5(TwoD) or4(ThreeD) days respectively. After processing tissues for autoradiography, normal bladders showed only trace levels of labeling. Animals exposed to3H-TdR one day after obstruction, when large numbers of basal cells of the urothelium are known to incorporate3HTdR (i.e., synthesize DNA), showed labeling in most layers of the urothelium seven days after injection, but levels of labeling in bladders injected TwoD or ThreeD were lower than those injected OneD after obstruction. The smaller numbers of urothelial cells labeled by3H-TdR in TwoD bladders were found in clusters where one or two alternate or adjacent layers of cells were labeled. Obstructed animals injected ThreeD after surgery showed even less labeling. This evidence clearly supports the hypothesis that DNA synthesis that occurs in the urothelium within 24 h after obstruction is followed by proliferation, because by the seventh day, labeling can be found at all levels of the urothelium. The decline of labeling in TwoD and ThreeD animals suggests that the proliferative stimulus probably operates only during the first 24 h after insult. The data suggest that a substantial fraction of the urothelium enters one or more rounds of proliferation following obstruction and support the contention that hyperplasia does occur.

Pharmacological responses of rabbit urinary bladder after subtotal cystectomy.

Partial cystectomy is used clinically in specific circumstances. There have been some reports indicating that the bladder following subtotal cystectomy can regenerate to a certain degree. The present study investigates the physiology and pharmacology of bladder regeneration at eight weeks after resection of a major part of the bladder body in rabbits. The following studies were performed on control and cystectomy bladders: 1) in vivo cystometry (prior to and four weeks after the operation, and before the sacrifice at eight weeks); 2) sequential muscle strip study (the strips were obtained by dividing bladder transversely into upper body, lower body, mid-bladder, upper base and lower base); and 3) in vitro whole bladder studies. The results can be summarized as follows: 1) grossly there was no regeneration of the bladder body; the cystometric capacity was increased slowly after the operation primarily due to increased size and capacity of the bladder base. 2) The contractile response of the subtotal cystectomized bladder body to field stimulation and bethanechol stimulation was less than the response of normal bladder body. 3) The contractile response to epinephrine showed that the ratio of alpha/beta adrenergic response was much greater in the cystectomy bladder than in the normal bladder. 4) In the whole bladder study, the intravesical pressure response to field stimulation was about the same in both groups, the response to bethanechol was less for cystectomized bladder, and the response to methoxamine was greater for the cystectomized bladder. 5) The ability of cystectomy bladder to empty in response to both field stimulation and bethanechol was impaired whereas the control bladder fully emptied to both field stimulation and bethanechol. In conclusion, over the eight week period following subtotal cystectomy the capacity increased via distention (and hypertrophy) of the bladder base area as opposed to regeneration of the bladder body.

Temporal Changes in Rabbit Urinary Bladder Function and DNA Synthesis During Chronic Treatment with Furosemide

In a preliminary study we showed that 14 days of furosemide infusion in rabbits caused increases in bladder mass and contractile responses of bladder body strips to field stimulation, bethanechol, ATP and KCl. The present study investigated the temporal effects of furosemide-induced diuresis on micturition, bladder mass, bladder wall proliferation activity and DNA synthesis. In addition, contractile responses of bladder body strips were monitored. Furosemide-containing osmotic pumps were implanted in male New Zealand White rabbits. Micturition was monitored for 7 days. Biochemical analyses were done 3, 7 and 14 days after implantation. Contractile responses were measured at 3 and 7 days. Polyuria and polydipsia started within 1 day after implantation of furosemide-containing osmotic pumps and continued at the same level for 7 days. Bladder mass was significantly increased at 3 and 7 days. Diuresis stimulated 3H-thymidine uptake and caused an increase in bladder DNA concentration at 3 days. However, both DNA concentrations and 3H-thymidine levels returned to control levels by 7 days. Contractile responses to field stimulation and agonists were increased at 7 days but unchanged at 3 days. The data confirm that modest increases in bladder mass and the ensuing increases in contractile function are a normal and beneficial physiological response to diuresis.