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 bladder's 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.