Mechanisms of Disease involvement of the urothelium in.pdfVIP

REVIEW /clinicalpractice/uro Mechanisms of Disease: involvement of the urothelium in bladder dysfunction Lori A Birder* and William C de Groat SUMMARY INTRODUCTION TO THE ANATOMY AND BARRIER FUNCTION OF THE UROTHELIUM Although the urinary bladder urothelium has classically been thought The urothelium is the epithelial lining of the of as a passive barrier to ions and solutes, a number of novel properties urinary tract between the renal pelvis and have been recently attributed to urothelial cells. Studies have revealed the urinary bladder. Urothelium is composed of that the urothelium is involved in sensory mechanisms (i.e. the ability to at least three layers: a basal cell layer attached to express a number of sensor molecules or respond to thermal, mechanical and chemical stimuli) and can release chemical mediators. Localization of a basement membrane, an intermediate layer, afferent nerves next to the urothelium suggests that urothelial cells could and a superficial or apical layer composed of be targets for neurotransmitters released from bladder nerves or that large hexagonal cells (diameters of 25–250 μm) known as ‘umbrella cells’. 1,2 The umbrella cells chemicals released by urothelial cel