Progressive bladder remodeling due to bladder outlet obstruction: a systematic review of morphological and molecular evidences in humans

Ferdinando Fusco, Massimiliano Creta, Cosimo De Nunzio, Valerio Iacovelli, Francesco Mangiapia, Vincenzo Li Marzi, Enrico Finazzi Agrò, Ferdinando Fusco, Massimiliano Creta, Cosimo De Nunzio, Valerio Iacovelli, Francesco Mangiapia, Vincenzo Li Marzi, Enrico Finazzi Agrò

Abstract

Background: Bladder outlet obstruction is a common urological condition. We aimed to summarize available evidences about bladder outlet obstruction-induced molecular and morphological alterations occurring in human bladder.

Methods: We performed a literature search up to December 2017 including clinical and preclinical basic research studies on humans. The following search terms were combined: angiogenesis, apoptosis, bladder outlet obstruction, collagen, electron microscopy, extracellular matrix, fibrosis, hypoxia, histology, inflammation, innervation, ischemia, pressure, proliferation, remodeling, suburothelium, smooth muscle cells, stretch, urothelium.

Results: We identified 36 relevant studies. A three-stages model of bladder wall remodeling can be hypothesized involving an initial hypertrophy phase, a subsequent compensation phase and a later decompensation. Histological and molecular alterations occur in the following compartments: urothelium, suburothelium, detrusor smooth muscle cells, detrusor extracellular matrix, nerves. Cyclic stretch, increased hydrostatic and cyclic hydrodynamic pressure and hypoxia are stimuli capable of modulating multiple signaling pathways involved in this remodeling process.

Conclusions: Bladder outlet obstruction leads to progressive bladder tissue remodeling in humans. Multiple signaling pathways are involved.

Keywords: Bladder outlet obstruction; Bladder remodeling; Systematic review.

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

Ferdinando Fusco: Speaker and Consultant for Recordati, Bayer, Lilly, Pierre-Fabre.

Massimiliano Creta: Consultant and medical writer for Recordati.

Vincenzo Li Marzi: Invited speaker from Wellspect and Allergan.

Enrico Finazzi Agrò: Consultat for Laborie, Wellspect, Allergan; Speaker honorarium from: Astellas, Coloplast, Glaxo Smith Kline, Wellspect.

Cosimo De Nunzio (SE) and Enrico Finazzi Agrò (AE) are members of the editorial board of BMC Urology.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) flowchart
Fig. 2
Fig. 2
Proposed three-stage model for BOO-induced bladder remodeling in humans

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