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Structural basis of voiding dysfunction in megacystis microcolon intestinal hypoperistalsis syndrome.
[megacystis-microcolon-intestinal hypoperistalsis syndrome]
Megacystis
microcolon
intestinal
hypoperistalsis
syndrome
(
MMIHS
)
is
a
rare
,
congenital
and
usually
fatal
condition
of
unknown
etiology
.
It
is
characterized
by
abdominal
distension
caused
by
a
distended
,
non-obstructed
urinary
bladder
and
intestinal
hypoperistalsis
with
functional
intestinal
obstruction
.
Previous
studies
reported
vacuolar
degenerative
changes
in
the
smooth
muscle
cells
of
bowel
and
bladder
suggesting
that
MMIHS
may
be
due
to
a
visceral
myopathy
.
The
aim
of
this
study
was
to
examine
the
expression
of
contractile
,
cytoskeletal
and
extracellular
matrix
proteins
in
the
detrusor
muscle
of
MMIHS
patients
.
Bladder
specimens
were
obtained
from
six
MMIHS
patients
.
Normal
bladder
specimens
were
obtained
during
partial
cystectomy
and
served
as
controls
.
Single
fluorescence
immunohistochemistry
for
alpha-smooth
muscle
actin
(
SMA
)
,
desmin
,
dystrophin
,
vinculin
and
collagen
types
I
and
III
was
carried
out
.
Specific
connective
tissue
stains
(
trichrome
Masson
,
van
Gieson
)
and
electron
microscopical
investigations
were
also
performed
.
Trichrome
Masson
and
van
Gieson
staining
demonstrated
markedly
increased
dense
connective
tissue
between
the
layers
of
the
detrusor
muscle
in
MMIHS
compared
to
controls
.
Collagen
type
I
immunoreactivity
was
markedly
increased
and
SMA
,
desmin
and
dystrophin
immunoreactivity
was
markedly
reduced
in
the
bladder
muscle
of
MMIHS
compared
to
controls
.
Electron
microscopy
revealed
vacuolar
degenerative
changes
in
smooth
muscle
cells
and
an
abundance
of
connective
tissue
between
these
cells
.
These
data
suggest
that
the
detrusor
muscle
in
MMIHS
is
strikingly
abnormal
and
is
the
likely
cause
of
voiding
dysfunction
.
Diseases
Validation
Diseases presenting
"abdominal distension"
symptom
congenital adrenal hyperplasia
dedifferentiated liposarcoma
hirschsprung disease
megacystis-microcolon-intestinal hypoperistalsis syndrome
primary effusion lymphoma
well-differentiated liposarcoma
This symptom has already been validated