Remodeling of the bladder and its vascular bad in the elderly and old age patients under infravesical obstruction caused by prostate hyperplasia

Introduction. It is known that prolonged bladder obstruction caused by prostatic hypertrophy leads to serious structural changes in the bladder wall. However the detailed morphogenesis of this process, the features of the compensatory-adaptive reactions of the its vascular bed and the role of existing background diseases in this process, as well as age-related changes are still unclear. Aim of our study was to discover the features of the structural rearrangement of the bladder and its vasculature in elderly and senile people with BPH. Materials and methods. Autopsy material from 25 men 60-80 years old who had no urological pathology and from 25 men of the same age who had BPH without signs of urinary bladder decompensation was studied. There were 10 men aged 20-30 who died as a result of injuries in control group. Results. Histological and immunohistochemical studies revealed a pronounced structural reorganization of the bladder wall and its vasculature in patients with BPH. This process is superimposed on the already existing involutive changes in the detrusor such as its atrophy, sclerosis of the inter-muscular stroma and neurodegenerative changes. The compensatory hypertrophy of detrusor and changes in its vasculature to regulate the local hemodynamics develop in men with ifravesical obstruction. Such changes in the arterial bed include bundles of intimate muscles, muscular-elastic sphincters and polypoid pillows formations. They provide a normal blood supply of the intact parts of the detrusor at the cost of deterioration the blood supply of its areas with atrophic and sclerotic changes. Regulatory changes such as muscle "couplings", muscle rollers and valves were also revealed in the veins. The contraction of this musculature imparts an impulse to the movement of venous blood to the heart and relaxation promotes its deposition. The valves are able to prevent the development of blood regurgitation. Conclusions. Prostatic hyperplasia and infravesical obstruction cause the functional load on the detrusor increases, which leads to its local hypertrophy. This process occurs against the background of age-related changes. There is also a structural reorganization of the vascular bed of the bladder, the role of which is to redistribute blood flow in favor of detrusor sites that are subjected to greater functional load.