Structural basis of geriatric voiding dysfunction .7. Prospective ultrastructural/urodynamic evaluation of its natural evolution

Purpose: In cross-sectional studies ultrastructure of geriatric detrusors consistently correlates with their urodynamic behavior. This study was conducted to determine whether the ultrastructural observations were stable with time, changed in concert with urodynamic change and predicted or preceded such change. Materials and Methods: Twenty-three elderly subjects underwent clinical and urodynamic evaluation plus endoscopic detrusor biopsy with ultrastructural study. The subjects were grouped according to urodynamic status. All were followed for up to 67 months and the same studies were repeated once in 19 (mean followup 27 months) and twice in 4 (mean followup 42 months) subjects. Biopsies (50) were classified according to their distinctive ultrastructural patterns without knowledge of clinical and urodynamic information. After all cases were studied, ultrastructural and urodynamic observations were correlated. Results: Ultrastructural and urodynamic diagnoses matched in all 23 cases at baseline. After 1 followup period both diagnoses were unchanged in 16 (70%) and both changed concordantly in 7 (30%), as expressed by progression of ultrastructural features with new development or increased severity of the associated dysfunction. Auxiliary ultrastructural features underwent some change as well. One of 4 subjects with 2 followup studies had the same ultrastructural and urodynamic diagnoses, while in the other 3 complete dysjunction pattern developed with detrusor overactivity after the first followup and both remained unchanged after the second study. Conclusions: Ultrastructure of the detrusor corresponds perfectly to its urodynamic behavior with time whether the latter remains stable or changes. Although we cannot as yet determine the temporal sequence of changes in detrusor ultrastructure and function, the change in the former is clearly not a mere result of long-standing change in the latter. Auxiliary ultrastructural features may represent transitional changes that precede development of the ultrastructural patterns and the corresponding urodynamic abnormalities.