Detrusor Morphology and Innervation in Bladder Exstrophy

Abstract

The structure of the detrusor in cases of bladder exstrophy has been previously described (Culp, 1964; Engel and Wilkinson, 1970; Rudin et al, 1972) and alterations in the muscularis and an increase in connective tissue have been reported by these workers. It remains uncertain as to whether these structural changes are intrinsic to exstrophy or whether they are secondary to infection or surgical attempts to alleviate the condition. In order to reevaluate these alternatives the present study has employed techniques to examine smooth muscle morphology and its intrinsic autonomic innervation in cases of bladder exstrophy. Particular emphasis has been placed on the distribution of autonomic nerves supplying the detrusor since the nerve supply of bladder smooth muscle in this condition has not been previously described. All specimens were obtained and initially processed by the Division of Pediatric Urology, The Johns Hopkins Medical Institution, Baltimore and then subsequently examined using light microscopy in the Department of Anatomy, Chinese University of Hong Kong, Hong Kong.