Bladder surface glycosaminoglycan: efficient mechanism of environmental adaptation.

A series of experiments has indicated that the bladder surface is lined with a sulfated polysaccharide that is capable of acting as a nonspecific antiadherence factor. It is capable of preventing the interaction of the transitional cells with many substances in urine, including bacteria, calcium, protein, and potential carcinogens. This interface of urine and transitional epithelium may be clinically important in many urologic disease states, since a malfunction of this layer could be involved in a spectrum of urologic diseases that includes irritable bladder syndromes (e.g., detrusor instability, interstitial cystitis, urethritis, radiation cystitis, cyclophosphamide-induced cystitis), carcinoma in situ, calculus disease, infections, and even carcinogenesis. It is important to point out that these investigations have shown that the natural surface mucus can be replaced by any of several substitutes that are as capable of preventing adherence as the natural glycosaminoglycans. One such substance, pentosanpolysulfate, is available in an oral form that is excreted in urine. To date, it has been used to successfully treat one disease of the urinary bladder, interstitial cystitis.