G, C., Z, T., G, S. (2025). The Role of Bladder Trabeculation as a Diagnostic Indicator in the Assessment of Bladder Outlet Obstruction. , 31(1), 34-43. doi: 10.33762/basjsurg.2025.157251.1105
Chengalvarayan G; Thanveer Ahamed Z; Sivasankar G. "The Role of Bladder Trabeculation as a Diagnostic Indicator in the Assessment of Bladder Outlet Obstruction". , 31, 1, 2025, 34-43. doi: 10.33762/basjsurg.2025.157251.1105
G, C., Z, T., G, S. (2025). 'The Role of Bladder Trabeculation as a Diagnostic Indicator in the Assessment of Bladder Outlet Obstruction', , 31(1), pp. 34-43. doi: 10.33762/basjsurg.2025.157251.1105
G, C., Z, T., G, S. The Role of Bladder Trabeculation as a Diagnostic Indicator in the Assessment of Bladder Outlet Obstruction. , 2025; 31(1): 34-43. doi: 10.33762/basjsurg.2025.157251.1105

The Role of Bladder Trabeculation as a Diagnostic Indicator in the Assessment of Bladder Outlet Obstruction

Basrah Journal of Surgery
Article 5, Volume 31, Issue 1, 2025, Pages 34-43    PDF (1.28 M)
Document Type: Original Article
DOI: 10.33762/basjsurg.2025.157251.1105
Authors
Chengalvarayan G1; Thanveer Ahamed Z* 2; Sivasankar G3
1Associate Professor, Institute of Urology, Madras Medical College & RGGGH, Chennai, India
2Senior Resident, Institute of Urology, Madras Medical College & RGGGH, Chennai, India
3Dean, Government Chengalpattu Medical College & Hospital, Chengalpattu, India
Abstract
Introduction: Bladder trabeculation is a morphological marker of detrusor hypertrophy, hypothesized to correlate with bladder outlet obstruction (BOO). This study investigates the prevalence, severity, and clinical implications of BOO in patients with and without LUTS.

Methods: A prospective observational study included 96 patients divided into Group 1 (Patient presenting for treatment of BOO symptoms) (BOO, n = 44) and Group 2 (Patient presenting for treatment of some other urological conditions) (non-BOO, n = 52). Trabeculation was graded via urethro-cystoscopy (Grade 0–3). Follow-up revealed previously unreported BOO symptoms in Group 2 patients with trabeculation.

Results: Trabeculation prevalence was significantly higher in Group 1 (70.5% vs. 25.0%, p < 0.001). BOO patients exhibited 7.2-fold higher odds of trabeculation (95% CI: 2.98–17.32). On follow-up, all patients who were initially in Group 2 (non-BOO) with trabeculation (13/13) reported BOO/LUTS symptoms, suggesting underdiagnosis. Severe trabeculation (Grade 3) remained exclusive to Group 1.

Conclusion: By this study, we re-confirm that bladder trabeculation strongly associates with Bladder outlet obstruction. Incidental trabeculation in asymptomatic patients may indicate an undiagnosed Bladder Outlet Obstruction, warranting thorough clinical evaluation.
Keywords
Urology; Bladder outlet obstruction; BOO; LUTS
Supplementary Files
References
 

  1. Cho SY, Bae J, Yoo C, et al. Establishment of a Grading System for Bladder Trabeculation. Urology 2013;81(3):503-507;
    https://doi.org/10.1016/j.urology.2012.11.041
  2. Fry CH, Meng E, Young JS. The physiological function of lower urinary tract smooth muscle. Auton Neurosci 2010;154(1):3-13;
    https://doi.org/10.1016/j.autneu.2009.10.006
  3. Hickling DR, Sun T-T, Wu X-R. Anatomy and Physiology of the Urinary Tract: Relation to Host Defense and Microbial Infection. In: Urinary Tract Infections John Wiley & Sons, Ltd; 2017; pp. 1-25; https://doi.org/10.1128/9781555817404.ch1.
  4. Levin RM, Longhurst PA, Monson FC, et al. Effect of bladder outlet obstruction on the morphology, physiology, and pharmacology of the bladder. The Prostate 1990;17(S3):9-26;
    https://doi.org/10.1002/pros.2990170503
  5. Lee SD, Akbal C, Jung C, et al. Intravesical pressure induces hyperplasia and hypertrophy of human bladder smooth muscle cells mediated by muscarinic receptors. J Pediatr Urol 2006;2(4):271-276; https://doi.org/10.1016/j.jpurol.2005.11.015.
    https://doi.org/10.1016/j.jpurol.2005.11.015.
  6. Deveaud CM, Macarak EJ, Kucich U, et al. MOLECULAR ANALYSIS OF COLLAGENS IN BLADDER FIBROSIS. J Urol 1998;160(4):1518-1527;
    https://doi.org/10.1016/S0022-5347(01)62606-5.
  7. Fusco F, Creta M, Imperatore V, et al. Benign Prostatic Obstruction Relief in Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Enlargement Undergoing Endoscopic Surgical Procedures or Therapy with Alpha-Blockers: A Review of Urodynamic Studies. Adv Ther 2017;34(4):773-783; https://doi.org/10.1007/s12325-017-0504-0.
  8. Mirone V, Imbimbo C, Longo N, et al. The Detrusor Muscle: An Innocent Victim of Bladder Outlet Obstruction. Eur Urol 2007;51(1):57-66; https://doi.org/10.1016/j.eururo.2006.07.050.
  9. Jung JH, Cho SY, Yoo C, et al. Establishment of the Novel Cystoscopic Classification for Bladder Trabeculation of Neurogenic Bladder. Urology 2014;84(3):515-519;
    https://doi.org/10.1016/j.urology.2014.05.015.
  10. Elbadawi A, Yalla SV, Resnick NM. Structural Basis of Geriatric Voiding Dysfunction. IV. Bladder Outlet Obstruction. J Urol 1993;150(5 Part 2):1681-1695;
    https://doi.org/10.1016/S0022-5347(17)35869-X. 
  11. Komninos C, Mitsogiannis I. Obstruction-induced alterations within the urinary bladder and their role in the pathophysiology of lower urinary tract symptomatology. Can Urol Assoc J 2014;8(7-8):524; https://doi.org/10.5489/cuaj.1636.
  12. Levin RM, Haugaard N, O'Connor L, et al. Obstructive response of human bladder to BPH vs. rabbit bladder response to partial outlet obstruction: A direct comparison. Neurourol Urodyn 2000;19(5):609-629; https://doi.org/10.1002/1520-6777(2000)19:5<609::AID-NAU7>3.0.CO;2-H.13. Griffiths DJ. The Mechanics of the Urethra and of Micturition. Br J Urol 1973;45(5):497-507; https://doi.org/10.1111/j.1464-410X.1973.tb06812.x.
  13. Baskin L, Howard PS, Macarak E. Effect of Physical Forces on Bladder Smooth Muscle and Urothelium. J Urol 1993;150(2 Part 2):601-607; https://doi.org/10.1016/S0022-5347(17)35560-X.
  14. Fry CH, Bayliss M, Young JS, et al. Influence of age and bladder dysfunction on the contractile properties of isolated human detrusor smooth muscle. BJU Int 2011;108(2b);
    https://doi.org/10.1111/j.1464-410X.2010.09845.x.
  15. Andersson K-E, Arner A. Urinary Bladder Contraction and Relaxation: Physiology and Pathophysiology. Physiol Rev 2004;84(3):935-986; https://doi.org/10.1152/physrev.00038.2003
Statistics
Article View: 655
PDF Download: 143


Journal Management System. Powered by iJournalPro.com