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Meher SK, Jena PK, Tripathy PK, Mohanty L, Mohanty PK, Pattnaik K. Role of Interstitial Cells of Cajal in Congenital Ureteropelvic Junction Obstruction. Afr J Paediatr Surg 2024:01434821-990000000-00024. [PMID: 39316030 DOI: 10.4103/ajps.ajps_68_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 01/04/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Although congenital ureteropelvic junction (UPJ) obstruction is the most common cause of neonatal hydronephrosis, aetiopathogenesis is still inconclusive. Recently, the paucity of interstitial cells of Cajal (ICC) at the narrow adynamic part of UPJ has been implicated as a causative factor. MATERIALS AND METHODS This prospective study was conducted between October 2019 and March 2022 to find out the density of ICC by the immunohistochemical method using CD117 (c-kit) antibody, in resected segments of UPJ in obstruction patients and in renal tumour patients as control. ICC/high power field (hpf) was also studied from the margins of the resected segment in the obstruction group. The pre-operative and post-operative sonographic and renal scintigraphic features were compared. RESULTS The median age of patients in the study group (n = 25) was 36 months and in the control group was 39 months. The mean ICC/hpf at the stenotic part of UPJ in the study group was 3.56 ± 1.26 and in the control group was 12.56 ± 1.89 (P = 0.0001). ICC density from the proximal and distal margins of the resected segment was 11.12 ± 2.12 and 11.68 ± 1.62, respectively (P < 0.001). The post-operative antero-posterior diameter of the renal pelvis and differential renal function showed significant improvement in comparison to the pre-operative value (P = 0.0045 and 0.0005, respectively). CONCLUSIONS The significant decrease in the density of ICC at the stenotic part of UPJ compared to controls suggests a pacemaker role of these cells in ureteral peristalsis and the aetiopathogenesis of UPJ obstruction. Histopathological analysis of ICC should not only be limited to the stenotic part of UPJ but also should focus on the anastomosed ends of the ureter, which reflects post-pyeloplasty outcome.
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Affiliation(s)
- Sanjib Kumar Meher
- Department of Pediatric Surgery SVP PGIP, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Pradeep Kumar Jena
- Department of Pediatric Surgery, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Prasanta Kumar Tripathy
- Department of Pediatric Surgery SVP PGIP, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Lity Mohanty
- Department of Pathology, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Pramod Kumar Mohanty
- Department of Pediatric Surgery SVP PGIP, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Kaumudee Pattnaik
- Department of Pathology, Bhima Bhoi Medical College and Hospital, Bolangir, Odisha, India
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Borselle D, Kaczorowski M, Gogolok B, Patkowski D, Polok M, Hałoń A, Apoznański W. Interstitial Cells of Cajal and P 2X 3 Receptors at Ureteropelvic Junction Obstruction and Their Relationship with Pain Response. J Clin Med 2024; 13:2109. [PMID: 38610874 PMCID: PMC11012584 DOI: 10.3390/jcm13072109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/23/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Introduction: Etiopathogenesis and the symptomatology of ureteropelvic junction obstruction (UPJO) in the pediatric population has not yet been definitely clarified, suggesting a multifactorial nature of the condition. The aim was to analyze the association between the number of Interstitial Cells of Cajal (ICCs), as well as P2X3 receptors in ureteropelvic junction (UPJ) and the pain response in pediatric patients with hydronephrosis. Methods: 50 patients with congenital hydronephrosis underwent open or laparoscopic pyeloplasty at one of two departments of pediatric surgery and urology in Poland. Patients were divided into two groups according to the pain symptoms before surgery. A total of 50 samples of UPJ were obtained intraoperatively and underwent histopathological and immunohistochemical (IHC) analysis. Quantitative assessment of ICCs was based on the number of CD117(+) cells of adequate morphology in the subepithelial layer and the muscularis propria. Expression of P2X3 receptors was evaluated as the intensity of IHC staining. Results: Patients with hydronephrosis and accompanying pain were on average 60 months older (77 vs. 17 months) than children with asymptomatic hydronephrosis (p = 0.017). Symptomatic children revealed higher numbers of ICCs in both the subepithelial layer and in the lamina muscularis propria. In particular, symptomatic patients aged 2 years or more exhibited significantly higher numbers of ICCs in the subepithelial layer. Significant differences in the distribution of ICCs between the subepithelial layer and the lamina muscularis propria were observed in both groups. Expression of P2X3 receptors was limited to the urothelium and the muscle layer and correlated between these structures. There was no relationship between pain response and the expression of P2X3 receptors. Conclusions: ICCs and P2X3 receptors may participate in the pathogenesis of UPJO and in the modulation of pain response to a dilatation of the pyelocaliceal system. Explanation of the role of ICCs and P2X3 receptors in propagation of ureteral peristaltic wave and the modulation of pain stimuli requires further studies.
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Affiliation(s)
- Dominika Borselle
- Department of Pediatric Surgery and Urology, Wroclaw Medical University and Hospital, Borowska 213, 50-556 Wroclaw, Poland
| | - Maciej Kaczorowski
- Department of Clinical and Experimental Pathology, Wroclaw Medical University and Hospital, Borowska 213, 50-556 Wroclaw, Poland
| | - Bartosz Gogolok
- Department of Pediatric Surgery and Urology, Wroclaw Medical University and Hospital, Borowska 213, 50-556 Wroclaw, Poland
| | - Dariusz Patkowski
- Department of Pediatric Surgery and Urology, Wroclaw Medical University and Hospital, Borowska 213, 50-556 Wroclaw, Poland
| | - Marcin Polok
- Department of Pediatric Surgery and Urology, Collegium Medicum-University of Zielona Gora, 65-417 Zielona Gora, Poland
| | - Agnieszka Hałoń
- Department of Clinical and Experimental Pathology, Wroclaw Medical University and Hospital, Borowska 213, 50-556 Wroclaw, Poland
| | - Wojciech Apoznański
- Department of Pediatric Surgery and Urology, Wroclaw Medical University and Hospital, Borowska 213, 50-556 Wroclaw, Poland
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Piro E, Colombini F, Brugnoni M, Perilli D, Abati LC, Zocca V, Vallieri L, D'Alessio A. Ureteropelvic junction obstruction in children by polar vessels: histological examination result. LA PEDIATRIA MEDICA E CHIRURGICA 2023; 45. [PMID: 37254943 DOI: 10.4081/pmc.2023.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/15/2023] [Indexed: 06/01/2023] Open
Abstract
In children, ureteropelvic junction obstruction (UPJO) is mostly caused by intrinsic factors (IUPJO) such as abnormal amounts of muscle and collagen deposition; extrinsic UPJO are rare and often due to crossing vessels (CVs). What is not clear is whether there is also intrinsic UPJ pathology in patients with CV. The aim of our study was to compare the histology of the two types of obstruction and to determine whether these histologic features are distinguishable enough to enable to identify the cause of obstruction based on histologic appearance alone. We retrospectively reviewed pathology reports of 38 children with UPJO that underwent surgery in our hospital from 2008 to 2022. The intrinsic and extrinsic groups consisted of 18 and 20 patients, respectively. After ematoxylin-eosin and Gomori's trichrome staining the specimens were scored for fibrosis and muscular hypertrophy in histhopatology, and CD117 antibody were used to detect interstitial Cajal-like cells. In our study, histological analyses revealed no differences between the CV and IUPJO specimens in terms of presence and degree of fibrosis and muscular hypertrophy; likewise, for presence of interstitial Cajal-like cells.
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Affiliation(s)
- Eugenia Piro
- Paediatric Surgery, ASST Ovest Milanese, Legnano Hospital.
| | | | - Marta Brugnoni
- Paediatric Surgery, ASST Ovest Milanese, Legnano Hospital.
| | | | | | - Veronica Zocca
- Paediatric Surgery, ASST Ovest Milanese, Legnano Hospital.
| | - Lucia Vallieri
- athological Anatomy, ASST Ovest Milanese, Legnano Hospital.
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Ashish K, Ratan SK, Sarin YK, Khurana N, Kumar J. Variation in the Expression of Interstitial Cell of Cajal-like Cell (CD117) Across Congenital Pelvic-ureteric Junction Obstruction and its Renal Sonological and Functional Correlation: A Prospective Observational Study. J Indian Assoc Pediatr Surg 2023; 28:116-121. [PMID: 37197239 PMCID: PMC10185035 DOI: 10.4103/jiaps.jiaps_112_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 05/19/2023] Open
Abstract
Aims and Objectives This study aims to study the variation in the expression of CD117-positive interstitial cells of Cajal-like cells (ICC-LC) across the upper urinary tract region in children presenting with pelvic-ureteric junction obstruction (PUJO) and its association with renal functional and sonological parameters of patients. Materials and Methods A prospective observational study was done on 20 children with congenital PUJO who underwent dismembered pyeloplasty. All children underwent renal sonography (anteroposterior pelvic diameter [APPD], pelvicalyceal ratio [P/C ratio], Mid polar renal parenchymal diameter [MPPD]) and functional imaging scan (LLEC scan or DTPA scan). Three specimens were taken intraoperatively from above PUJ, at the level of PUJ, and below PUJ. Those were examined immunohistochemically using CD117 to count ICC-LC using standard criteria. Variation in the expression of CD117-positive ICC-LC was correlated with the abovestated parameters. Results The number of CD117-positive ICC-LC showed a continuous decreasing trend above downward. P/C ratio and APPD showed a parallel trend with ICC-LC distribution, whereas split renal function (SRF) showed an inverse relationship with the expression of ICC-LC. Children with lesser severity of obstruction (APPD <30 mm and SRF >40%) showed a uniform decreasing trend in the number of CD117-positive ICC-LC across PUJ. Children with more severe obstruction (APPD >30 mm and SRF <40%) showed a decrease in the expression of ICC-LC up to the level of PUJO followed by a sudden relatively increased expression of ICC-LC below the obstruction. Conclusion The expression of ICC-LC shows a uniformly decreasing trend across obstruction when the severity of obstruction is less. Resurgence in the number of ICC-LC below PUJ in subjects with severe obstruction hints at the emergence of a new pacemaker area below severely blocked PUJ akin to that seen in complete heart block patients and deserves early attention.
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Affiliation(s)
- Kumar Ashish
- Department of General Surgery, Narayan Medical College and Hospital, Sasaram, Bihar, India
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Simmi K. Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Yogesh Kumar Sarin
- Department of Pediatric Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Jyoti Kumar
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
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Srougi V, Bandeira RASDT, Reis ST, dos Santos GA, Andrade HDS, Leite KRM, Hamilton-Cho D, Mitre AI, Arap MA, Srougi M, Duarte RJ. The influence of interstitial cells of Cajal density in the outcomes of pyeloplasty in adults: A prospective analysis. Urologia 2022; 90:30-35. [PMID: 35765765 DOI: 10.1177/03915603221107470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To evaluate if the density of interstitial cells of Cajal (ICC) in the ureteropelvic junction (UPJ) influences the outcomes of pyeloplasty in adults. Methods: Twenty-three patients with the diagnosis of ureteropelvic junction obstruction (UPJO) that underwent laparoscopic dismembered pyeloplasty were included. ICC density was measured using immunohistochemistry reaction for c-KIT expression in the resected UPJ segment. Pyeloplasty outcome was evaluated by patient self-report pain, urinary outflow using DTPA renogram and hydronephrosis assessment using ultrasound (US) at 12 months of follow-up. A logistic regression analysis was performed to assess the association of pyeloplasty outcomes and ICC density. Results: Low, moderate, and high ICC density were present in 17.4%, 30.4%, and 52.2% of the patients, respectively. Complete pain resolution was observed in 100%, 85.7%, and 75% of patients with low, moderate and high ICC density, respectively ( p = 0.791). DTPA renogram improved in 75%, 85.7%, and 91.7% of patients with low, moderate and high ICC density, respectively ( p = 0.739). Hydronephrosis improved in 25%, 85.7%, and 91.7% of patients with low, moderate and high ICC density, respectively ( p = 0.032). Conclusions: Patients with high ICC density have a significant amelioration of hydronephrosis after pyeloplasty. However, ICC density is not associated with functional outcomes.
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Affiliation(s)
- Victor Srougi
- Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Hospital Moriah, Sao Paulo, Brazil
| | | | - Sabrina Thalita Reis
- Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Minas Gerais State University (UEMG), Campos Passos, Brazil
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Gabriel Arantes dos Santos
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- D’Or Institute for Research and Education (IDOR), Sao Paulo, Brazil
| | | | - Katia Ramos Moreira Leite
- Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - David Hamilton-Cho
- Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Anuar Ibrahim Mitre
- Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Marco Antonio Arap
- Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Hospital Sirio Libanes, Sao Paulo, Brazil
| | - Miguel Srougi
- Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- D’Or Institute for Research and Education (IDOR), Sao Paulo, Brazil
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Li J, Bai J, Tuerdi N, Liu K. Long non-coding RNA MEG3 promotes tumor necrosis factor-alpha induced oxidative stress and apoptosis in interstitial cells of cajal via targeting the microRNA-21 /I-kappa-B-kinase beta axis. Bioengineered 2022; 13:8676-8688. [PMID: 35322738 PMCID: PMC9161977 DOI: 10.1080/21655979.2022.2054501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Interstitial Cells of Cajal (ICC) plays a critical role in the peristaltic contractions of the gastrointestinal and urinary tract. The dysfunction and loss of ICC contributes to hypokinetic disease, such as gallstoneand ureteropelvic junction obstruction . In the present study, we identified the underlying driving molecular signals of oxidative stress and apoptosis in ICC. ICC was isolated from small intestine of Balb/c mice, and stimulated with tumor necrosis factor-alpha (TNF-α). MTT and flow cytometry were performed to assess cell viability, apoptosis, and the level of reactive oxygen species in ICC, respectively. The level of malondialdehyde, superoxide dismutase, and glutathione peroxidase in cells were measured to assess oxidative stress. The expression of inflammatory factors (interleukin, IL-1 and IL-6) and apoptosis-related proteins were detected by western blot. We observed that TNF-αinduced inflammation, oxidative stress and cell apoptosis in ICC. By using quantitative real-time PCR , we verified that the expression of long non-coding RNAMEG3 was elevated by TNF-α in ICC. Silencing MEG3 reversed inflammation, oxidative stress, and cell apoptosisin TNF-α-treated ICC. Subsequently, we confirmed that MEG3 sponged cytoprotective miR-21 to upregulate the expression of I-kappa-B-kinase beta (IKKB) and activate the nuclear factor kappa-B (NF-κB) pathway. Both miR-21 overexpression and IKKB knockdown reduced TNF-α-induced above symptoms in ICC. Taken together, we can conclude that MEG3 mediates inflammation, oxidative stress and apoptosis in TNF-α-treated ICC via the miR-21/IKKB-NF-κB axis. The study improves our understanding of the molecular mechanism of ICC reduction related diseases.
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Affiliation(s)
- Jia Li
- Department of Pediatric Urology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Junbo Bai
- Department of Pediatric Urology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Nafeisha Tuerdi
- Department of Pediatric Urology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Kaifang Liu
- Department of Pediatric Urology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Damasio MB, Sertorio F, Wong MCY, Campo I, Carlucci M, Basso L, Anfigeno L, Bodria M, Pistorio A, Piaggio G, Ghiggeri GM, Mattioli G. Functional Magnetic Resonance Urography in Ureteropelvic Junction Obstruction: Proposal for a Pediatric Quantitative Score. Front Pediatr 2022; 10:882892. [PMID: 35783310 PMCID: PMC9243529 DOI: 10.3389/fped.2022.882892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ureteropelvic junction obstruction (UPJO) is one of the most frequent causes of congenital hydronephrosis. It is essential to distinguish UPJO which needs surgical treatment. fMRU combines high quality morphological details of the kidney and excretory pathways with functional data. OBJECTIVE This study aims to introduce a new radiological score based on fMRU findings to be able to differentiate surgical from non-surgical kidneys. MATERIALS AND METHODS We retrospectively selected patients with hydronephrosis due to UPJO who underwent fMRU (January 2009-June 2018). A multidisciplinary team identified a list of fMRU morpho-functional predictive variables to be included in the analysis. To evaluate the role of different independent variables in predicting the outcome, a multivariable logistic regression model has been performed; the outcome variable was the surgical intervention. For each predictive variable, Odds Ratio and 95% Confidence Intervals were calculated. The likelihood ratio test was used to assess the significance of the variables. Using the regression model, we assigned a numerical value to each predictive variable, rounding up the beta-coefficients. The cut-off value of the total score was obtained from the ROC curve analysis. RESULTS A total of 192 patients were enrolled, corresponding to 200 pathological kidneys. All of them underwent fMRU; 135 were surgically treated, while 65 underwent ultrasound or MRU follow-up. Predictive variables significantly associated with surgery resulted to be the urographic phase, the presence of abnormal vessels, and a baseline anterior-posterior pelvic diameter >23 mm. Beta coefficients of the logistic regression model were then converted in scores. The ROC curve of the score showed high sensitivity (84.3%) and specificity (81.3%) with a cut-off > 2.5. CONCLUSIONS We propose a new fMRU score able to identify surgical vs. non-surgical kidneys with UPJO.
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Affiliation(s)
- Maria Beatrice Damasio
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Fiammetta Sertorio
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Michela Cing Yu Wong
- Pediatric Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Irene Campo
- Radiology Department, Ospedale di Conigliano - Unità Locale Socio-Sanitaria (ULSS) 2 Marca Trevigiana, Conegliano, Italy
| | - Marcello Carlucci
- Pediatric Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Luca Basso
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Lorenzo Anfigeno
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy.,Department of Health Sciences, Radiology Department, University of Genoa, Genoa, Italy
| | - Monica Bodria
- Nephrology and Renal Transplantation Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Angela Pistorio
- Epidemiology and Biostatistics Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Giorgio Piaggio
- Nephrology and Renal Transplantation Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Gian Marco Ghiggeri
- Nephrology and Renal Transplantation Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Girolamo Mattioli
- Pediatric Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
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Nandan R, Jain V, Agarwala S, Das P, Goel P, Kalaivani M, Yadav DK. Evaluation of Interstitial Cells of Cajal-Like Cells at the Pelviureteric Junction in Children with Pelviureteric Junction Obstruction: A Prospective Study and Review of Literature. J Indian Assoc Pediatr Surg 2022; 27:395-401. [PMID: 36238340 PMCID: PMC9552655 DOI: 10.4103/jiaps.jiaps_103_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/02/2021] [Accepted: 08/29/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The etiopathogenesis of pelviureteric junction obstruction (PUJO) has been debated. Recently, the role of interstitial cells of Cajal-like cells (ICC-LC)has been studied and reported to be the cause of this functional obstruction. We studied the histopathology and ICC-LC density at PUJ and compared it with that of PUJ of the control group and distal ureteric margin of the study group. METHODS A prospective study was conducted which included PUJO patients in the study group and the renal tumor patients in the control group. Histopathological examination (muscle hypertrophy and fibrosis) and immunohistochemistry (ICC-LC density) were done. The muscle hypertrophy, fibrosis, and ICC-LC density at the PUJ in both the groups were compared. A similar comparison was performed between the findings at the PUJ and the distal margin in the study group. RESULTS The study and control groups included 37 PUJO patients and 13 Wilms tumor patients. The ICC-LC density at PUJ in the study group was significantly lower than that in the control group (P < 0.001) and that at the distal resected margin of the study group (P < 0.001). Significantly increased muscle hypertrophy (P < 0.001) and fibrosis (P = 0.002) were seen at PUJ in the study group compared to the control group. No significant association was noted between the ICC-LC density and muscle hypertrophy at PUJ and the distal resected margin in the study group. CONCLUSION A significant decrease in the density of ICC-LC and increased fibrosis and muscle hypertrophy at PUJ in children with PUJO play a role in the etiopathogenesis of the disease.
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Affiliation(s)
- Ruchira Nandan
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vishesh Jain
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India,Address for correspondence: Dr. Vishesh Jain, Department of Pediatric Surgery, Room Number-4002, Teaching Block, All India Institute of Medical Sciences, New Delhi - 110 029, India. E-mail:
| | - Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Prabudh Goel
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra Kumar Yadav
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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Samaranayake UMJE, Mathangasinghe Y, Liyanage UA, de Silva MVC, Samarasinghe MC, Abeygunasekera S, Lamahewage AK, Malalasekera AP. Variations in the Density and Distribution of Cajal Like Cells Associated With the Pathogenesis of Ureteropelvic Junction Obstruction: A Systematic Review and Meta-Analysis. Front Surg 2021; 8:721143. [PMID: 34395513 PMCID: PMC8355516 DOI: 10.3389/fsurg.2021.721143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Cajal like cells (CLCs) in the upper urinary tract have an ability to generate coordinated spontaneous action potentials and are hypothesized to help propel urine from renal pelvis into the ureter. The objective of this review was to describe the variations in the density and distribution of CLCs associated with ureteropelvic junction obstruction (UPJO). Materials and Methods: Studies comparing the density and distribution of CLCs in the human upper urinary tract in patients with UPJO and healthy controls were included in this systematic review. We searched online electronic databases; Ovid MEDLINE, Scopus, PubMed and Cochrane reviews for the studies published before October 31, 2020. A meta-analysis was conducted to compare the density of CLCs at the ureteropelvic junction (UPJ) in patients with UPJO and matched controls. Results: We included 20 and seven studies in the qualitative and quantitative synthesis, respectively. In majority (55%) CLCs were located between the muscle layers of the upper urinary tract. The CLC density in the UPJ gradually increased with aging in both healthy subjects and patients with UPJO. The pooled analysis revealed that the density of CLCs at the UPJ was significantly low in patients with UPJO compared to the controls (SMD = -3.00, 95% CI = -3.89 to -2.11, p < 0.01). Conclusions: The reduction in CLC density at the UPJ in patients with UPJO suggests a contribution from CLCs in the pathogenesis of UPJO. Since age positively correlates with CLC density, it is imperative to carefully match age when conducting case control studies comparing the CLC density and distribution. Protocol Registration Number: CRD42020219882.
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Affiliation(s)
- U. M. J. E. Samaranayake
- Department of Anatomy, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Ratnapura, Sri Lanka
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Y. Mathangasinghe
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Proteostasis and Neurodegeneration Laboratory, Australian Regenerative Medicine Institute, Monash University, Clayton, VIC, Australia
| | - U. A. Liyanage
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - M. V. C. de Silva
- Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - M. C. Samarasinghe
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | | | - A. P. Malalasekera
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Tokat E, Gurocak S, Akdemir O, Gonul II, Tan MO. Relation between Cajal Cell Density and Radiological and Scintigraphic Outcomes in Patients with Ureteropelvic Junction Obstruction. Urol Int 2021; 105:1046-1051. [PMID: 34218231 DOI: 10.1159/000516675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In this study, we aimed to investigate the correlation between Cajal cell density and preoperative and postoperative radiological and scintigraphic parameters in ureteropelvic junction obstruction (UPJO). METHODS The study group consisted of 41 renal units (38 consecutive patients; 13 female and 25 male) surgically treated for UPJO. UPJ specimens from patients were immuno-stained with CD117 (c-kit) antibody for interstitial Cajal cells (ICCs). The relation between Cajal cell density and preoperative and postoperative radiological and scintigraphic parameters was evaluated. RESULTS The mean age of the patients was 8.52 ± 8.86 (0-35) years. The density of Cajal cells was defined in 2 groups for convenient analysis as 0-5 cells (low) in 19 (46.3%) patients and >5 cells (moderate-high) in 22 (53.6%). There was significant difference between the preoperative and postoperative anteroposterior diameters of the related kidneys in both Cajal groups (p = 0.001-low, p = 0.000-moderate-high) independent of Cajal cell density. Regression in hydronephrosis postoperatively was determined in both Cajal groups (77.8%-low, 64.7%-moderate-high); however, there was no difference between them (p = 0.39). Preoperative T1/2 was significantly longer in the low Cajal group (p = 0.02). Postoperative T1/2 decreased in both low (p = 0.000) and moderate-high (p = 0.001) Cajal groups, but no difference was found between them (p = 0.24). There was significant improvement in the kidney differential function after surgery in the low Cajal density group (p = 0.015) while there was no correlation between the scintigraphic success or improvement and Cajal cell density (p = 0.51). DISCUSSION/CONCLUSION ICC deficiency/density could not be shown as a predictive factor for the determination of success rate of pyeloplasty. Despite the lack of any evidence for the degree of deficiency as an indicator for the severity of obstruction and prediction of surgical success, further studies are needed for confirmation.
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Affiliation(s)
- Eda Tokat
- Department of Urology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Serhat Gurocak
- Department of Urology, Section of Pediatric Urology, Gazi University School of Medicine, Ankara, Turkey
| | - Ozgur Akdemir
- Department of Nuclear Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Ipek Isik Gonul
- Department of Pathology, Gazi University School of Medicine, Ankara, Turkey
| | - Mustafa Ozgur Tan
- Department of Urology, Section of Pediatric Urology, Gazi University School of Medicine, Ankara, Turkey
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11
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Basu AK. New Horizon in Understanding of Pediatric Surgical Diseases. J Indian Assoc Pediatr Surg 2021; 26:73-75. [PMID: 34083888 PMCID: PMC8152405 DOI: 10.4103/jiaps.jiaps_6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Ashoke Kumar Basu
- Department of Pediatric Surgery, Institute of Child Health, Kolkata, West Bengal, India
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12
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Comparison of different pathological markers in predicting pyeloplasty outcomes in children. J Pediatr Surg 2020; 55:1616-1620. [PMID: 31500874 DOI: 10.1016/j.jpedsurg.2019.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/07/2019] [Accepted: 08/19/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare the efficacy of pathological markers like Interstitial cells of Cajal (ICC), neurons and Collagen to Muscle ratio (CM ratio), in predicting pyeloplasty outcomes. METHODS Histological sections from 31 patients with UPJO were analyzed for ICC & neurons on immuno-histochemistry and CM ratio on Masson's trichrome staining. Post-operative outcomes were analyzed at 1-year follow up; expressed as excellent, moderate or mild improvement, static and deterioration based on the three factors: ultrasound grade, differential renal function and renogram drainage pattern. The pathological findings were correlated with clinical outcomes. RESULTS The study group (n = 31) had a mean age 2.9 (0.6) years (M: F = 22:9). UPJ segment had significantly less ICC/neurons and more collagen compared to normal ureter (p = 0.001). Pathological parameters at the anastomosed end of ureter had a better correlation than those at UPJ with clinical outcome. CM ratio with a stronger correlation (r = - 0.94; p = 0.001) was a better predictor of prognosis than ICC (r = 0.76; p = 0.01) or neuron (r = 0.83; p = 0.01) density. ICC >10/HPF, neurons >6/HPF and CM ratio <1.2 at ureteric end anastomosed were predictors of success. CONCLUSIONS CM ratio analysis at anastomosed ureter is a superior marker for predicting pyeloplasty outcomes. LEVEL OF EVIDENCE Type 2: Development of diagnostic criteria in a consecutive series of patients.
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Pande T, Dey SK, Chand K, Kinra P. Influence of Interstitial Cells of Cajal in Congenital Ureteropelvic Junction Obstruction. J Indian Assoc Pediatr Surg 2020; 25:231-235. [PMID: 32939115 PMCID: PMC7478290 DOI: 10.4103/jiaps.jiaps_115_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/07/2019] [Accepted: 12/14/2019] [Indexed: 12/18/2022] Open
Abstract
Background: The etiopathogenesis of congenital ureteropelvic junction obstruction (UPJO) has been inconclusive in spite of the numerous studies carried out to find the possible causative factor. The results of different studies have been conflicting and contradictory. It has been postulated that the interstitial cells of Cajal (ICC) are the pacemaker cells located in the ureteropelvic junction (UPJ) and regulate the peristalsis in this region. Paucity of these cells may be one of the causative factors for congenital UPJO although there is no clear consensus on this issue. Therefore, the present study has been carried out to ascertain the role of ICC as one of the possible etiological factors for congenital UPJO. The aim of this study is to first identify the presence of ICC at UPJ, second to compare the average number of ICC in congenital UPJO with a control population without UPJO, and third to ascertain whether any correlation exists between the number of ICC and postoperative improvement in function of the affected kidney. Materials and Methods: A total number of 30 patients who underwent dismembered Anderson-Hynes pyeloplasty for congenital UPJO between June 2016 and November 2017, were compared with seven controls who underwent nephroureterectomy for various other reasons. The specimen was subjected to immunohistochemistry (IHC), and a quantitative comparison was made for the ICC between cases and controls. The preoperative and postoperative function was evaluated by renal diuretic scintigraphy. Results: The disease was more common among males in the ratio of 6.5:1, and there was a predominance of the left-sided involvement. In the studied cases, the average number of ICC seen for every high-power field (hpf) was 4.86 ± 0.76/hpf, whereas in control it was 11.74 ± 0.86/hpf (P = 0.04). The postoperative outcome, as measured by the improvement in split renal function, did not have any correlation with the number of ICC. Conclusion: The ICC are present at the UPJ and can be detected by immunohistochemistry due to their CD117 positivity. These cells are significantly low at this site in cases of congenital UPJO when compared to controls without any obstruction. The number of ICC bears no correlation to the postoperative improvement in function.
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Affiliation(s)
- Tanmay Pande
- Department of Surgery, AFMC, Pune, Maharashtra, India
| | - Santosh Kumar Dey
- Department of Pediatric Surgery, Command Hospital (SC), Pune, Maharashtra, India
| | - Karunesh Chand
- Department of PediatricSurgery, Army Hospital (R and R), New Delhi, India
| | - Prateek Kinra
- Department of Pathology, AFMC, Pune, Maharashtra, India
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14
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Morgan MA, El Jack AK. The "balloon on a string" appearance of the renal collecting system and ureter. Abdom Radiol (NY) 2020; 45:257-259. [PMID: 31346743 DOI: 10.1007/s00261-019-02152-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Matthew A Morgan
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, 1 Silverstein, Philadelphia, PA, 19104, USA.
| | - Amr K El Jack
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, 1 Silverstein, Philadelphia, PA, 19104, USA
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15
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Babu R, Vittalraj P, Sundaram S, Pothankulankara Manjusha M, Ramanan V, Sai V. A Rapid Special Staining Technique for Identification of Normal Ureter by Frozen Section in Children With Ureteropelvic Junction Obstruction. Pediatr Dev Pathol 2019; 22:558-565. [PMID: 31315518 DOI: 10.1177/1093526619863538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The exact etiology of ureteropelvic junction obstruction (UPJO) is unknown, and inadequate excision of the narrow segment has been proposed as a cause of failure in 5% to 7% of cases of pyeloplasty. AIMS To study whether frozen section can be useful to detect normal ureter distal to UPJO during pyeloplasty. METHODS Histological sections from 31 patients with UPJO were analyzed for collagen to muscle ratio (CMR) on conventional (formalin) and rapid (frozen section) Masson's trichrome staining. Pathological findings were correlated with postoperative outcomes analyzed at 1-year follow-up and expressed as excellent, moderate, or mild improvement, static and deterioration based on ultrasound grade, differential renal function, and renogram drainage pattern. RESULTS There was a very strong positive correlation (r = .94; P = .001) between CMR by conventional and rapid frozen Masson's trichrome staining. There was a very strong negative correlation between pyeloplasty outcomes and CMR on conventional staining (r = -.94; P = .001) or rapid frozen Masson's trichrome staining (r = -.91; P = .001). Regression analysis revealed that a CMR of 1.2 or less (95% confidence interval: 1.9-0.7) was associated with a successful outcome. CONCLUSIONS It is feasible to intraoperatively identify normal ureter distal to UPJO using CMR analysis on the novel rapid frozen section technique reported.
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Affiliation(s)
- Ramesh Babu
- Department of Pediatric Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Pavithra Vittalraj
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Sandhya Sundaram
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | | | - Venkat Ramanan
- Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Venkata Sai
- Department of Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Lang RJ, Hashitani H. Pacemaker Mechanisms Driving Pyeloureteric Peristalsis: Modulatory Role of Interstitial Cells. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1124:77-101. [PMID: 31183823 DOI: 10.1007/978-981-13-5895-1_3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
The peristaltic pressure waves in the renal pelvis that propel urine expressed by the kidney into the ureter towards the bladder have long been considered to be 'myogenic', being little affected by blockers of nerve conduction or autonomic neurotransmission, but sustained by the intrinsic release of prostaglandins and sensory neurotransmitters. In uni-papilla mammals, the funnel-shaped renal pelvis consists of a lumen-forming urothelium and a stromal layer enveloped by a plexus of 'typical' smooth muscle cells (TSMCs), in multi-papillae kidneys a number of minor and major calyces fuse into a large renal pelvis. Electron microscopic, electrophysiological and Ca2+ imaging studies have established that the pacemaker cells driving pyeloureteric peristalsis are likely to be morphologically distinct 'atypical' smooth muscle cells (ASMCs) that fire Ca2+ transients and spontaneous transient depolarizations (STDs) which trigger propagating nifedipine-sensitive action potentials and Ca2+ waves in the TSMC layer. In uni-calyceal kidneys, ASMCs predominately locate on the serosal surface of the proximal renal pelvis while in multi-papillae kidneys they locate within the sub-urothelial space. 'Fibroblast-like' interstitial cells (ICs) located in the sub-urothelial space or adventitia are a mixed population of cells, having regional and species-dependent expression of various Cl-, K+, Ca2+ and cationic channels. ICs display asynchronous Ca2+ transients that periodically synchronize into bursts that accelerate ASMC Ca2+ transient firing. This review presents current knowledge of the architecture of the proximal renal pelvis, the role Ca2+ plays in renal pelvis peristalsis and the mechanisms by which ICs may sustain/accelerate ASMC pacemaking.
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Affiliation(s)
- Richard J Lang
- School of Biomedical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.
| | - Hikaru Hashitani
- Department of Cell Physiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
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17
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Doğan HT, Canda AE, Gök B, Oğuz U, Gümüştaş S, Atmaca AF, Vargöl E. Is there a difference in the number of interstitial cells, neurons, presence of fibrosis and inflammation in ureteropelvic junction tissues of patients with ureteropelvic junction obstruction with and without crossing vessels? Turk J Urol 2018; 45:302-306. [PMID: 30201079 DOI: 10.5152/tud.2018.08784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 04/10/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We compared the number of interstitial cells (ICs), nerves, presence of fibrosis and inflammation at the level of full-thickness human ureteropelvic junction (UPJ) tissues obtained from normal subjects, and patients with UPJ obstruction with and without crossing vessels. MATERIAL AND METHODS Normal UPJ tissues (n=12) histopathologically confirmed to be without tumor involvement were obtained from subjects who underwent radical nephrectomy for kidney mass. Additional UPJ tissues were obtained from patients who underwent pyeloplasty due to UPJ obstruction. Crossing vessel was identified in 17 patients. In 57 patients, no crossing-vessel was noted. ICs were stained immunohistochemically with anti-human CD117 (c-kit) antibody. Neural tissue was stained with S-100. The numbers of ICs and neurons were compared between the groups: controls with normal UPJ (Group I), Ureteropelvic junction obtruction (UPJO) with crossing vessel (Group II) and UPJ obstruction without crossing vessel (Group III). Groups were also compared in terms of the presence of fibrosis and inflammation. RESULTS The mean age of total population included in the study was 30.5±18.5 years. No significant differences were detected between the three groups regarding mean and median numbers of ICs at the level of UPJ (lamina propria and muscle layer) and mean and median numbers of neurons at the level of lamina propria (p>0.05). Likewise, no significant differences were detected between the three groups regarding the presence of fibrosis and inflammation (p>0.05). CONCLUSION Number of ICs, neurons, presence of fibrosis and inflammation seem to be similar in the intact UPJ and UPJ with obstruction with and without crossing vessel. Cellular function rather than the number ICs might play a role that warrants further research.
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Affiliation(s)
| | | | - Bahri Gök
- Department of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Ural Oğuz
- Department of Urology, Giresun University, Giresun, Turkey
| | - Sinem Gümüştaş
- Department of Pathology, Çukurova Dr. Aşkım Tüfekçi State Hospital, Adana, Turkey
| | - Ali Fuat Atmaca
- Department of Urology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Erdem Vargöl
- Department of Pathology, Sakarya Training and Research Hospital, Sakarya, Turkey
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18
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He F, Yang Z, Dong X, Fang Z, Liu Q, Hu X, Yi S, Li L. The role of HCN channels in peristaltic dysfunction in human ureteral tuberculosis. Int Urol Nephrol 2018; 50:639-645. [PMID: 29460132 PMCID: PMC5878205 DOI: 10.1007/s11255-018-1816-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/02/2018] [Indexed: 11/24/2022]
Abstract
Objective To explore the role of HCN channels in ureteral peristaltic dysfunction by comparing the changes in HCN channel levels between normal and tuberculous ureters. Methods A total of 32 specimens of human upper ureters were collected by nephrectomy from patients with renal tumor (control group, n = 16) or from patients with renal tuberculosis (experimental group, n = 16); the two groups did not receive radiotherapy, chemotherapy, immunotherapy, or any other special treatment before the surgical procedure. An experimental study on smooth muscle strips of human upper ureters showed variation in contraction amplitude and frequency after adding ZD7288, a specific blocker of HCN channels. The expression of HCN channels in the ureter was confirmed by Western blot (WB) and by confocal analysis of double immunostaining for c-kit and HCN channel proteins. Results Before the addition of ZD7288, the experimental and control groups showed significant differences in the frequency and amplitude of the spontaneous contraction of isolated ureteral smooth muscle strips. After ZD7288 was added, the frequency and amplitude of the contractions of the ureteral smooth muscle strips were significantly lower in both groups. The differences observed before and after ZD7288 treatment in each group were significant (P < 0.001), and the difference in contraction amplitude observed between the two groups before ZD7288 was also significantly different (P < 0.001). By using WB technology, we showed that the expression of HCN channels was present in normal human ureters, with the expression of HCN4 and HCN1 being the highest; the expression of HCN4 and HCN1 in the control and experimental groups were both statistically significant (P < 0.001). HCN4 and HCN1 were expressed in the mucosal and smooth muscle layers of human control ureters and tuberculous ureters, as revealed by a confocal analysis of double immunostaining for c-kit and HCNs proteins; there were significant differences between the two groups (P < 0.001). Conclusion Four HCN channels are expressed in the ureter, mainly HCN4 and HCN1, suggesting that HCN channels are involved in the peristaltic contraction of ureteral ICCs, which may be an important reason for peristaltic dysfunction in ureteric tuberculosis.
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Affiliation(s)
- Fan He
- Department of Urology, Xinqiao Hospital, the Third Military Medical University, No. 183 Xinqiao Main Street, Shapinba Dist., Chongqing, 400037, People's Republic of China
| | - Zhenxing Yang
- Department of Urology, Xinqiao Hospital, the Third Military Medical University, No. 183 Xinqiao Main Street, Shapinba Dist., Chongqing, 400037, People's Republic of China
| | - Xingyou Dong
- Department of Urology, Xinqiao Hospital, the Third Military Medical University, No. 183 Xinqiao Main Street, Shapinba Dist., Chongqing, 400037, People's Republic of China
| | - Zhenqiang Fang
- Department of Urology, Xinqiao Hospital, the Third Military Medical University, No. 183 Xinqiao Main Street, Shapinba Dist., Chongqing, 400037, People's Republic of China
| | - Qian Liu
- Department of Urology, Xinqiao Hospital, the Third Military Medical University, No. 183 Xinqiao Main Street, Shapinba Dist., Chongqing, 400037, People's Republic of China
| | - Xiaoyan Hu
- Department of Urology, Xinqiao Hospital, the Third Military Medical University, No. 183 Xinqiao Main Street, Shapinba Dist., Chongqing, 400037, People's Republic of China
| | - Shanhong Yi
- Department of Urology, Xinqiao Hospital, the Third Military Medical University, No. 183 Xinqiao Main Street, Shapinba Dist., Chongqing, 400037, People's Republic of China
| | - Longkun Li
- Department of Urology, Xinqiao Hospital, the Third Military Medical University, No. 183 Xinqiao Main Street, Shapinba Dist., Chongqing, 400037, People's Republic of China.
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Iskander SM, Feeney MM, Yee K, Rosenblum ND. Protein Kinase 2 β Is Expressed in Neural Crest-Derived Urinary Pacemaker Cells and Required for Pyeloureteric Contraction. J Am Soc Nephrol 2018; 29:1198-1209. [PMID: 29436516 DOI: 10.1681/asn.2017090951] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/10/2018] [Indexed: 01/31/2023] Open
Abstract
Nonobstructive hydronephrosis, defined as dilatation of the renal pelvis with or without dilatation of the ureter, is the most common antenatal abnormality detected by fetal ultrasound. Yet, the etiology of nonobstructive hydronephrosis is poorly defined. We previously demonstrated that defective development of urinary tract pacemaker cells (utPMCs) expressing hyperpolarization-activated cyclic nucleotide-gated channel 3 (HCN3) and the stem cell marker cKIT causes abnormal ureteric peristalsis and nonobstructive hydronephrosis. However, further investigation of utPMC development and function is limited by lack of knowledge regarding the embryonic derivation, development, and molecular apparatus of these cells. Here, we used lineage tracing in mice to identify cells that give rise to utPMCs. Neural crest cells (NCCs) indelibly labeled with tdTomato expressed HCN3 and cKIT. Furthermore, purified HCN3+ and cKIT+ utPMCs were enriched in Sox10 and Tfap-2α, markers of NCCs. Sequencing of purified RNA from HCN3+ cells revealed enrichment of a small subset of RNAs, including RNA encoding protein kinase 2β (PTK2β), a Ca2+-dependent tyrosine kinase that regulates ion channel activity in neurons. Immunofluorescence analysis in situ revealed PTK2β expression in NCCs as early as embryonic day 12.5 and in HCN3+ and cKIT+ utPMCs as early as embryonic day 15.5, with sustained expression in HCN3+ utPMCs until postnatal week 8. Pharmacologic inhibition of PTK2β in murine pyeloureteral tissue explants inhibited contraction frequency. Together, these results demonstrate that utPMCs are derived from NCCs, identify new markers of utPMCs, and demonstrate a functional contribution of PTK2β to utPMC function.
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Affiliation(s)
- Samir M Iskander
- Program in Developmental and Stem Cell Biology and.,Departments of Laboratory Medicine and Pathobiology and
| | - Meghan M Feeney
- Program in Developmental and Stem Cell Biology and.,Departments of Laboratory Medicine and Pathobiology and
| | - Kirby Yee
- Program in Developmental and Stem Cell Biology and
| | - Norman D Rosenblum
- Program in Developmental and Stem Cell Biology and .,Departments of Laboratory Medicine and Pathobiology and.,Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada; and.,Paediatrics, University of Toronto, Toronto, Ontario, Canada
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20
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Wong MCY, Piaggio G, Damasio MB, Molinelli C, Ferretti SM, Pistorio A, Ghiggeri G, Degl'Innocenti ML, Canepa A, Incarbone V, Mattioli G. Hydronephrosis and crossing vessels in children: Optimization of diagnostic-therapeutic pathway and analysis of color Doppler ultrasound and magnetic resonance urography diagnostic accuracy. J Pediatr Urol 2018; 14:68.e1-68.e6. [PMID: 29133170 DOI: 10.1016/j.jpurol.2017.09.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 09/22/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Ureteropelvic junction obstruction (UPJO) is one of the most frequent urological diseases affecting the pediatric population. It can be due to both intrinsic stenosis of the junction and extrinsic causes such as the presence of crossing vessels (CVs), which can be detected by color Doppler ultrasound (CD-US). Magnetic resonance urography (MRU) is a good alternative, but sedation and infusion of a contrast agent are required. OBJECTIVE The aim of this study was to analyze the diagnostic accuracy of CD-US and MRU in visualizing CVs in pediatric hydronephrosis, in order to decide the correct diagnostic pathway in the pre-operative phase. MATERIAL AND METHODS A retrospective review was performed of medical records for all patients who underwent surgical treatment for hydronephrosis from August 2006 to February 2016. Ultrasound and scintigraphy had been performed on all patients. Data about CD-US and MRU were collected. A high-level technology ultrasound scanner and a 1.5 T MR scanner were used. The presence of CVs at surgery was considered the gold standard. Sensitivity, specificity, positive and negative predictive values (NPV) were calculated and reported for both of the imaging techniques. RESULTS A total of 220 clinical charts were reviewed. Seventy-three CVs were identified at surgery (33.2% of UPJO). The median age was statistically higher in the group with CVs compared to the group without CVs (P < 0.001). The sensitivity and NPV of CD-US in detecting CVs were higher than MRU (sensitivity 93.3% vs. 71.7%, NPV 95.7% vs. 77.6%, respectively). DISCUSSION According to the data, CD-US had higher sensitivity and NPV than MRU, resulting in superior detection of CVs. It is important for a surgeon to know that a child has a CV, especially in older children in which the incidence of extrinsic UPJO is higher. The main limitation of this study was the presence of incomplete data, due to the retrospectivity. CONCLUSIONS In the pre-operative phase, the CD-US should be considered as the investigation of choice to detect CVs in children with hydronephrosis (Summary Fig). Moreover, CD-US has lower costs than MRU, and sedation with infusion of contrast agent is unnecessary. For the future, it could be useful to lead a prospective comparison between the two imaging techniques.
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Affiliation(s)
- M C Y Wong
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy; DINOGMI, University of Genoa, Genoa, Italy.
| | - G Piaggio
- Nephrology, Dialysis and Renal Transplantation Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - M B Damasio
- Radiology Department, Istituto Giannina Gaslini, Genoa, Italy
| | | | - S M Ferretti
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - A Pistorio
- Epidemiology and Biostatistics Service, Istituto Giannina Gaslini, Genoa, Italy
| | - G Ghiggeri
- Nephrology, Dialysis and Renal Transplantation Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - M L Degl'Innocenti
- Nephrology, Dialysis and Renal Transplantation Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - A Canepa
- Nephrology, Dialysis and Renal Transplantation Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - V Incarbone
- Radiology Department, Istituto Giannina Gaslini, Genoa, Italy
| | - G Mattioli
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy; DINOGMI, University of Genoa, Genoa, Italy
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Inugala A, Reddy RK, Rao BN, Reddy SP, Othuluru R, Kanniyan L, Kumbha N, Srirampur S. Immunohistochemistry in Ureteropelvic Junction Obstruction and Its Correlation to Postoperative Outcome. J Indian Assoc Pediatr Surg 2017; 22:129-133. [PMID: 28694567 PMCID: PMC5473296 DOI: 10.4103/jiaps.jiaps_254_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Aim: To investigate the correlation between the status of interstitial cells of Cajal (ICC) in ureteropelvic junction (UPJ) and the resected ureteric margin and the postoperative outcome of Anderson-Hynes pyeloplasty in UPJ obstruction (UPJO) and to compare the ICC in the UPJ and the resected margin of the normal ureter. Materials and Methods: An observational study was conducted over a period of 2 years at the Department of Pediatric Surgery at Niloufer Institute of Women and Child Health. Children with intrinsic UPJO who underwent Anderson-Hynes dismembered pyeloplasty were included in the study. Six months postoperatively, the patients were divided into two groups based on diuretic isotopic renogram using technetium-99m-labeled diethylene triaminepentaacetic acid. Group 1 comprised patients with good surgical outcome. Group 2 comprised patients with a poor outcome. The histologic specimens were evaluated for ICC, and the immunohistochemical findings were correlated with the outcome. Results: Twenty-five patients were included in this study (19 male and 6 female). Seventy-six percent of patients were under the age of 1 year. Group 1 had 23 cases and Group 2 had 2 cases. Out of the two patients with a poor outcome, one had negative grading at the UPJ and one had positive grading. Both these patients had a negative grading at the lower resected margins. More number of patients (24%) had +++ grading at the lower resected margin when compared to the UPJ (8%). Conclusion: This is the first study which correlates the status of ICC in UPJ with the outcome of pyeloplasty in pediatric patients. Both the cases with bad outcome had no ICC at the lower margin of the resected specimen and one case had no ICC at the UPJ. There is a statistically significant difference (P = 0.001) in the number of ICC at the UPJ and the resected margin.
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Affiliation(s)
- Anusiri Inugala
- Department of Pediatric Surgery, Niloufer Institute of Women and Child Health, Hyderabad, Telangana, India
| | - Ramesh Kota Reddy
- Department of Pediatric Surgery, Niloufer Institute of Women and Child Health, Hyderabad, Telangana, India
| | - Bhuvaneshwar Nadipalli Rao
- Department of Pediatric Surgery, Niloufer Institute of Women and Child Health, Hyderabad, Telangana, India
| | - Sreenivas P Reddy
- Department of Pediatric Surgery, Niloufer Institute of Women and Child Health, Hyderabad, Telangana, India
| | - Radhika Othuluru
- Department of Pathology, Niloufer Institute of Women and Child Health, Hyderabad, Telangana, India
| | - Lavanya Kanniyan
- Department of Pediatric Surgery, Niloufer Institute of Women and Child Health, Hyderabad, Telangana, India
| | - Nagarjuna Kumbha
- Department of Pediatric Surgery, Niloufer Institute of Women and Child Health, Hyderabad, Telangana, India
| | - Srinivas Srirampur
- Department of Pediatric Surgery, Niloufer Institute of Women and Child Health, Hyderabad, Telangana, India
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Reis ST, Leite KRM, Viana NI, Lopes RI, Moura CM, Ivanovic RF, Machado M, Denes FT, Giron A, Nahas WC, Srougi M, Passerotti CC. MMP9 overexpression is associated with good surgical outcome in children with UPJO: Preliminary results. BMC Urol 2016; 16:44. [PMID: 27448803 PMCID: PMC4958283 DOI: 10.1186/s12894-016-0162-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/08/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Ureteropelvic junction obstruction (UPJO) diagnosed prenatally occurs in 1:150 - 1:1200 pregnancies. Although many studies investigating the molecular changes of this obstructed segment have been performed, the underlying mechanisms are still unclear. The role of extracellular matrix (ECM) components remains controversial, and the investigations in the field of ECM changes, might help the better understanding of the pathogenesis of this common condition. The aim of the present study was to investigate for the first time in the literature whether MMP9 and its specific inhibitors, TIMP1 and RECK, are expressed in a reproducible, specific pattern in UPJ. METHODS UPJO specimens were obtained from 16 children at the time of dismembered pyeloplasty due to intrinsic UPJ stenosis. Expression levels of the three genes (MMP9, TIMP1 and RECK) were analyzed by quantitative real-time polymerase chain reaction (qRT-PCR). Then correlated the expression levels of the genes according to grade study population that was divided in 2 categories according to Society of Fetal Urology classification, grade 3 (moderate) and 4 (severe). For DTPA we subdivided the childrens in 2 groups, obstructive (T 1/2 more than 20 min) and partial obstructive (T 1/2 between 10 and 20 min) and success in a surgery was defined as decrease in T 1/2 to less than 20 min, absence of symptoms, improving renal function and decreasing dilatation on successive exams. RESULTS MMP9 was underexpressed and TIMP1 and RECK were overexpressed in children with obstructive DTPA but the differences were not statistically significant. Overexpression of MMP9 was higher among patients with severe grade of UPJ compared to those with moderate grade. Surprisingly expression levels of MMP-9 was three times higher in children who were successfully treated by surgery (n = 10) (p = 0.072), so those who were followed for at least 1 year after surgery and remained with improvement in renal function and decreasing dilation on intravenous urogram and TIMP-1 was underexpressed in 100 % of this cases (p = 0.00). CONCLUSIONS We showed an increase in expression of MMP9 and a decrease in expression of TIMP1 in children who improving renal function and decreasing dilation after surgery. We believe that the higher expression of MMP9 in these cases can reflect an increase in degradation and remodeling process that could be used as a marker for surgical outcome.
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Affiliation(s)
- Sabrina Thalita Reis
- Urology Department, Laboratory of Medical Investigation (LIM55), University of Sao Paulo Medical School, Av. Dr. Arnaldo 455, 2° floor, room 2145, 01246-903, Sao Paulo, Brazil.
| | - Kátia R M Leite
- Urology Department, Laboratory of Medical Investigation (LIM55), University of Sao Paulo Medical School, Av. Dr. Arnaldo 455, 2° floor, room 2145, 01246-903, Sao Paulo, Brazil
| | - Nayara Izabel Viana
- Urology Department, Laboratory of Medical Investigation (LIM55), University of Sao Paulo Medical School, Av. Dr. Arnaldo 455, 2° floor, room 2145, 01246-903, Sao Paulo, Brazil
| | - Roberto Iglesias Lopes
- Urology Department, Laboratory of Medical Investigation (LIM55), University of Sao Paulo Medical School, Av. Dr. Arnaldo 455, 2° floor, room 2145, 01246-903, Sao Paulo, Brazil
| | - Caio Martins Moura
- Urology Department, Laboratory of Medical Investigation (LIM55), University of Sao Paulo Medical School, Av. Dr. Arnaldo 455, 2° floor, room 2145, 01246-903, Sao Paulo, Brazil
| | - Renato F Ivanovic
- Urology Department, Laboratory of Medical Investigation (LIM55), University of Sao Paulo Medical School, Av. Dr. Arnaldo 455, 2° floor, room 2145, 01246-903, Sao Paulo, Brazil
| | - Marcos Machado
- Urology Department, Laboratory of Medical Investigation (LIM55), University of Sao Paulo Medical School, Av. Dr. Arnaldo 455, 2° floor, room 2145, 01246-903, Sao Paulo, Brazil
| | - Francisco Tibor Denes
- Urology Department, Laboratory of Medical Investigation (LIM55), University of Sao Paulo Medical School, Av. Dr. Arnaldo 455, 2° floor, room 2145, 01246-903, Sao Paulo, Brazil
| | - Amilcar Giron
- Urology Department, Laboratory of Medical Investigation (LIM55), University of Sao Paulo Medical School, Av. Dr. Arnaldo 455, 2° floor, room 2145, 01246-903, Sao Paulo, Brazil
| | - William Carlos Nahas
- Urology Department, Laboratory of Medical Investigation (LIM55), University of Sao Paulo Medical School, Av. Dr. Arnaldo 455, 2° floor, room 2145, 01246-903, Sao Paulo, Brazil
| | - Miguel Srougi
- Urology Department, Laboratory of Medical Investigation (LIM55), University of Sao Paulo Medical School, Av. Dr. Arnaldo 455, 2° floor, room 2145, 01246-903, Sao Paulo, Brazil
| | - Carlo C Passerotti
- Urology Department, Laboratory of Medical Investigation (LIM55), University of Sao Paulo Medical School, Av. Dr. Arnaldo 455, 2° floor, room 2145, 01246-903, Sao Paulo, Brazil
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Senol C, Onaran M, Gurocak S, Gonul II, Tan MO. Changes in Cajal cell density in ureteropelvic junction obstruction in children. J Pediatr Urol 2016; 12:89.e1-5. [PMID: 26455635 DOI: 10.1016/j.jpurol.2015.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 08/04/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Congenital ureteropelvic junction obstruction is one the most common causes of neonatal hydronephrosis. The etiology of the ureteropelvic junction (UPJ) obstruction has not been clearly established. The presence of a hypoplastic, adynamic ureteral segment is thought to be the major cause of an UPJ obstruction. OBJECTIVE We evaluated the distribution of Cajal cells using immunohistologic methods coupled with light microscopy of the UPJ tissues in obstructed and normal UPJs. STUDY DESIGN The study group consisted of 19 patients who underwent pyeloplasty for UPJ obstruction. Twelve patients who had been operated on for oncological indications constituted the control group. The sections were stained immunohistochemically using CD117 (c-kit) antibody; the numbers of CD117 (+) interstitial cells of Cajal were counted in 10 consecutive high-power fields under the light microscope and the cell density was determined for each case. RESULTS The mean age of the cases who underwent dismembered pyeloplasty and the control group were 116 ± 116 months (14 male, 5 female; 6-420 months) and 279 ± 312 months (9 male, 3 female; 24-948 months) (p = 0.1), respectively. The mean interstitial Cajal cell number in the UPJ obstruction and the control groups were 2.37 ± 2.19 and 24.5 ± 9.73, respectively (p < 0.0001). Thirteen (68.4%) patients had very few, five (26.3%) patients had few, and one (5.3%) patient had many Cajal cells in the UPJ obstruction group. In the control group, all patients had more than seven cells per high-power field. DISCUSSION We found that in cases of UPJ, obstruction the numbers of interstitial Cajal cells were decreased, being either absent or significantly reduced. Although data about the motility are currently not sufficient, the decrease in the number of Cajal cells in patients with UPJ highlights that they might be responsible for the initiation, coordination, and conduction of peristaltic activity along the pelvicalyceal system. Improvement and enhancement of contraction waves arising from the upper urinary system depend on interstitial cells of Cajal, which are the pacemaker cells in smooth muscles. We think that a decreased number of interstitial cells of Cajal have a close relationship with changing ureteral motility when we compare our UPJ obstruction cases with the limited data in the literature. CONCLUSION Further investigations on these cells will probably give detailed information about the neurophysiology of the urinary system and the diseases that cause congenital hydronephrosis.
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Affiliation(s)
- Cem Senol
- Department of Urology, Gazi University School of Medicine, Ankara, Turkey.
| | - Metin Onaran
- Department of Urology, Gazi University School of Medicine, Ankara, Turkey
| | - Serhat Gurocak
- Department of Urology, Gazi University School of Medicine, Ankara, Turkey
| | - Ipek Isık Gonul
- Department of Pathology, Gazi University School of Medicine, Ankara, Turkey
| | - Mustafa Ozgur Tan
- Department of Urology, Gazi University School of Medicine, Ankara, Turkey
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Laparoscopic pyeloplasty with cephalad translocation of the crossing vessel - a new approach to the Hellström technique. Wideochir Inne Tech Maloinwazyjne 2015; 10:25-9. [PMID: 25960789 PMCID: PMC4414101 DOI: 10.5114/wiitm.2015.48695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/05/2014] [Accepted: 12/11/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction It is believed that lower pole crossing vessels may play an important role in the etiology of ureteropelvic junction obstruction (UPJO). A conventional operative technique, which seems to be widely used in patients with UPJO, is Anderson-Hynes (A-H) plasty with dorsal transposition of the vessel. An attractive alternative to dorsal transposition of the vessel might be its cephalad translocation. Aim To assess the effectiveness of cephalad translocation of the crossing vessel in patients who underwent laparoscopic A-H or Y-V pyeloplasty. Material and methods Eighty-five patients were included in the study. To assess the effectiveness of cephalad translocation of the crossing vessel in patients who underwent laparoscopic pyeloplasty, the results of the procedure were compared to the results of laparoscopic pyeloplasties performed in patients without crossing vessels (control group). Success was defined as the following factors taken collectively: 80% or greater pain relief according to VAS, no sign of obstruction on intravenous urography (patent UPJ), decreasing excretion curve with T1/2 < 12 min, and improved or stable differential renal function on diuretic renography. Results The mean follow-up was 53.7 months. There was no statistically significant difference in the success rate between the compared groups (group 1 – cases with cephalad translocation of the crossing artery, and group 2 – cases without crossing vessels) in patients who underwent A-H plasty or Y-V plasty. Conclusions The analysis of our data seems to indicate that cephalad translocation of the anterior crossing vessel gives good therapeutic results in patients who undergo laparoscopic pyeloplasty.
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Hammad FT. Electrical propagation in the renal pelvis, ureter and bladder. Acta Physiol (Oxf) 2015; 213:371-83. [PMID: 25204732 DOI: 10.1111/apha.12392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/16/2014] [Accepted: 09/03/2014] [Indexed: 12/15/2022]
Abstract
Under normal conditions, following the passage of urine from the collecting duct, the urine is stored briefly in the renal pelvis before being transported through the ureter to the bladder where the urine is stored for a longer time (hours) before being voided through the urethra. The transport of urine from the renal pelvis to the bladder occurs spontaneously due to contractions of the muscles in the wall of the pelvis and ureter. Spontaneous contractions also occur in the detrusor muscle and are responsible for maintaining the bladder shape during the filling phase. These muscle contractions occur as result of electrical impulses, which are generated and propagated through different parts of the urinary tract. The renal pelvis and the ureter differ from the bladder in relation to the origin, characteristics and propagation of these electrical impulses. In the ureter, the electrical impulses originate mainly at the proximal region of the renal pelvis and are transmitted antegradely down the length of the ureter. The electrical impulses in the bladder, on the other hand, originate at any location in the bladder wall and can be transmitted in different directions with the axial direction being the prominent one. In this manuscript, an overview of the current state of research on the origin and propagation characteristics of these electrical impulses in the normal and pathological conditions is provided.
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Affiliation(s)
- F. T. Hammad
- Department of Surgery; College of Medicine & Health Sciences; United Arab Emirates University; Al Ain United Arab Emirates
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Abstract
Urine differs greatly in ion and solute composition from plasma and contains harmful and noxious substances that must be stored for hours and then eliminated when it is socially convenient to do so. The urinary tract that handles this output is composed of a series of pressurizable muscular compartments separated by sphincteric structures. With neural input, these structures coordinate the delivery, collection, and, ultimately, expulsion of urine. Despite large osmotic and chemical gradients in this waste fluid, the bladder maintains a highly impermeable surface in the face of a physically demanding biomechanical environment, which mandates recurring cycles of surface area expansion and increased wall tension during filling, followed by rapid wall compression during voiding. Afferent neuronal inflow from mucosa and submucosa communicates sensory information about bladder fullness, and voiding is initiated consciously through coordinated central and spinal efferent outflow to the detrusor, trigonal internal sphincter, and external urethral sphincter after periods of relative quiescence. Provocative new findings suggest that in some cases, lower urinary tract symptoms, such as incontinence, urgency, frequency, overactivity, and pain may be viewed as a consequence of urothelial defects (either urothelial barrier breakdown or inappropriate signaling from urothelial cells to underlying sensory afferents and potentially interstitial cells). This review describes the physiologic and anatomic mechanisms by which urine is moved from the kidney to the bladder, stored, and then released. Relevant clinical examples of urinary tract dysfunction are also discussed.
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Affiliation(s)
- Warren G Hill
- Laboratory of Voiding Dysfunction, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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Mehrazma M, Tanzifi P, Rakhshani N. Changes in Structure, Interstitial Cajal-like Cells and Apoptosis of Smooth Muscle Cells in Congenital Ureteropelvic Junction Obstruction. IRANIAN JOURNAL OF PEDIATRICS 2014; 24:105-10. [PMID: 25793054 PMCID: PMC4359592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 01/20/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The goal of this study is to evaluate some structural changes in muscular, collagenous and neural components as well as expression of Cajal-like cells and apoptosis of smooth muscle cells in congenital ureteropelvic junction obstruction (UPJO). METHODS Tissue specimens were obtained from 25 patients with UPJO and compared with normal ureteropelvic junction regions of 19 autopsies. In paraffin embedded sections the amount of Cajal-like cells, density of nerve fibers and smooth muscle cell apoptosis (using immunohistochemical staining) were determined. Collagen deposition and muscular components were stained by Trichrome-Masson staining and evaluated by image analysis techniques. Arrangement of muscular bundles was also evaluated qualitatively. Findings : The number of Cajal-like cells was significantly lower in patients than in controls. The apoptotic score and mean number of nerve fibers were not statistically different for the two groups. Arrangement of muscular fibers was more irregular in patients than in controls (P<0.001). Collagen deposition was significantly higher in patients than in controls (P<0.001). The mean amount of muscular component was lower in patients than in normal ones. (P= 0.09) CONCLUSION: We found significant pathologic changes in congenital ureteropelvic junction obstruction such as decrease in Cajal-like cells, increase in collagen deposition and irregular arrangement of muscle fibers.
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Affiliation(s)
| | - Parin Tanzifi
- Department of Pathology,Children’s Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran ,Corresponding Author: Address: Children's Medical Center, No 62, Dr Gharib St., Tehran, Iran
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Eken A, Erdogan S, Kuyucu Y, Seydaoglu G, Polat S, Satar N. Immunohistochemical and electron microscopic examination of Cajal cells in ureteropelvic junction obstruction. Can Urol Assoc J 2013; 7:E311-6. [PMID: 23069698 DOI: 10.5489/cuaj.11293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We examine the ultrastructural configurations of Cajal cells by electron microscopy, as well as the quantitative changes occurring in Cajal cells by light microscopy. METHODS In total, 35 patients with ureteropelvic junction (UPJ) obstruction and 7 patients without obstruction were compared immunohistochemically with c-kit (CD117) to quantify the number of cells. On electron microscopic examination, 7 patients with UPJ obstruction and 3 patients without obstruction were compared to evaluate the changes which occurred in the ultrastructural configuration of the Cajal cells. RESULTS On light microscopic examination, it was determined that the Cajal cells, which demonstrate c-kit (CD117) immunoreactive character, were located near the circular muscle layer and parallel to the muscle cells. The number of Cajal cells in the control group was significantly increased compared to the number of cells in patients with UPJ obstruction (p < 0.001). On electron microscopic examination, the number of interstitial cells was also higher in the control group. A decrease in the number of the caveolae in these cells was seen in the group with UPJ obstruction compared to the control group. CONCLUSION In UPJ obstruction, a decrease in the number of Cajal cells, as well as the changes in the morphologic structure of the Cajal cells, indicates that these cells have a role in the pacemaker system and are associated with ureteral peristalsis.
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Affiliation(s)
- Alper Eken
- Cukurova University, Faculty of Medicine, Department of Urology, Adana, Turkey
| | - Seyda Erdogan
- Cukurova University, Faculty of Medicine, Department of Pathology, Adana, Turkey
| | - Yurdun Kuyucu
- Cukurova University, Faculty of Medicine, Department of Histology and Embryology, Adana, Turkey
| | - Gulsah Seydaoglu
- Cukurova University, Faculty of Medicine, Department of Biostatistics, Adana, Turkey
| | - Sait Polat
- Cukurova University, Faculty of Medicine, Department of Histology and Embryology, Adana, Turkey
| | - Nihat Satar
- Cukurova University, Faculty of Medicine, Department of Urology, Adana, Turkey
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Apoznanski W, Koleda P, Wozniak Z, Rusiecki L, Szydelko T, Kalka D, Pilecki W. The distribution of interstitial cells of Cajal in congenital ureteropelvic junction obstruction. Int Urol Nephrol 2013; 45:607-12. [PMID: 23632879 PMCID: PMC3689466 DOI: 10.1007/s11255-013-0454-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/18/2013] [Indexed: 01/19/2023]
Abstract
Purpose The authors analysed the distribution of c-kit-positive interstitial cells of Cajal (ICCs) in obstructed ureteropelvic junction (UPJ) and its age-related changes. Methods Twenty specimens were obtained from children with intrinsic ureteropelvic junction obstruction (UPJO), at the average age of 8.1 years (8 months–16.8 years), fixed in formalin and embedded in paraffin. Five control samples were taken from children at the average age of 2.3 years (2.4 months–7.4 years). All specimens were analysed by the immunohistochemistry test with light microscopy with respect to c-kit expression. The distribution of c-kit-positive ICCs in the two groups was compared and the correlation between the distribution of c-kit-positive ICCs and the patients’ age in UPJO cases was analysed. The results were examined by Yates’ χ2 test, Mann–Whitney U test, and t test for Pearson’s correlation coefficient. A P value < 0.05 was considered as statistically significant. Results No statistically significant differences were found in the distribution of c-kit-positive ICCs between UPJO and the control group. No correlation was established between the age of patients with UPJO and the distribution of c-kit-positive ICCs. Conclusion No distributional difference found in obstructed and unobstructed UPJ seems to indicate that UPJO is not associated with anomalous distribution of c-kit-positive ICCs. Age-related changes in the expression of c-kit-positive ICCs are equally distributed in obstructed UPJ.
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Affiliation(s)
- Wojciech Apoznanski
- Department and Clinic of Paediatric Surgery and Urology, Wroclaw Medical University, ul. M.Sklodowskiej-Curie 50/52, 50-369, Wrocław, Poland
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Di Benedetto A, Arena S, Nicotina PA, Mucciardi G, Galì A, Magno C. Pacemakers in the upper urinary tract. Neurourol Urodyn 2012; 32:349-53. [DOI: 10.1002/nau.22310] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 08/16/2012] [Indexed: 01/15/2023]
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