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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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Görmüş U, Kasap M, Akpınar G, Tuğtepe H, Kanlı A, Özel K. Comparative Proteome Analyses of Ureteropelvic Junction Obstruction and Surrounding Ureteral Tissue. Cells Tissues Organs 2020; 209:2-12. [PMID: 32259813 DOI: 10.1159/000506736] [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: 10/08/2019] [Accepted: 02/23/2020] [Indexed: 12/30/2022] Open
Abstract
Ureteropelvic junction (UPJ) obstruction is a common problem in children, but its etiology remains unclear. In this study, the proteome profiles of the obstructed segment and its surrounding distal and proximal parts were comparatively evaluated. Twelve children younger than 2 years of age with unilateral intrinsic UPJ obstruction were included. The excised operational tissue was divided into three parts immediately after resection: the obstructed part (Obst), the distal normal ureteral part (Dist), and the proximal part of the obstructed segment (Prox). Proteins extracted from the tissue samples were subjected to two-dimensional gel electrophoresis analysis to identify differentially regulated proteins. Spot analysis revealed that four proteins, namely tropomyosin beta and alpha-1 chains, actin and desmin, were upregulated in Obst in comparison to Dist. A similar analysis between Obst and Prox showed that heat shock protein beta-1 and carbonic anhydrase-1 were upregulated in Obst, while tropomyosin alpha 3 chain and ATP synthase beta were upregulated in Prox. The last comparative analysis between Dist and Prox revealed upregulation of annexin-A5 and annexin-A1 in Dist and vimentin, mitochondrial ATP synthase subunit-beta, peroxiredoxin-2, and apolipoprotein-A1 in Prox. Bioinformatics analysis using the STRING server indicated that the differentially regulated proteins, altogether, point to the changes occurring in muscle filament sliding pathway. When regulations occurring in each group were mutually compared, a change in lipase inhibition activity was detected by STRING. This is the first study scrutinizing changes occurring in protein profiles in UPJ.
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Affiliation(s)
- Uzay Görmüş
- Department of Medical Biochemistry, Faculty of Medicine, Istanbul Bilim University, Istanbul, Turkey, .,Division of Biochemistry, Department of Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden,
| | - Murat Kasap
- Department of Medical Biology and Genetics/DEKART Proteomics Laboratory, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Gürler Akpınar
- Department of Medical Biology and Genetics/DEKART Proteomics Laboratory, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Halil Tuğtepe
- Division of Pediatric Urology, Department of Pediatric Surgery, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Aylin Kanlı
- Department of Medical Biology and Genetics/DEKART Proteomics Laboratory, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Kerem Özel
- Department of Pediatric Surgery, Faculty of Medicine, Istanbul Bilim University, Istanbul, Turkey
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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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Babu R, Vittalraj P, Sundaram S, Shalini S. Pathological changes in ureterovesical and ureteropelvic junction obstruction explained by fetal ureter histology. J Pediatr Urol 2019; 15:240.e1-240.e7. [PMID: 30850354 DOI: 10.1016/j.jpurol.2019.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/03/2019] [Indexed: 12/14/2022]
Abstract
UNLABELLED The etiology of ureterovesical junction obstruction (UVJO) and ureteropelvic junction obstruction (UPJO) is obscure with an adynamic narrow segment causing the obstruction. In this study, the authors compared interstitial cells of Cajal (ICC) and collagen-to-muscle ratio (CM ratio) between UVJO, UPJO, and fetal ureters to investigate whether a maturational arrest of the fetal ureter could explain both clinical pathologies. METHODS Group 1 (control) involved specimens of the normal ureter (nephrectomy for trauma/tumor; n = 20), while group 2, specimens of UVJO (n = 14); group 2 was further divided into group 2a, the dilated megaureter above UVJO, and group 2b, UVJO narrow segment; group 3, UPJO narrow segment excised during pyeloplasty (n = 31); and group 4, normal fetal ureters (n = 12). The specimens were analyzed for ICC using immunohistochemistry and CM ratio on Masson's trichrome (stains collagen in blue and muscle in red). RESULTS The median ICC/10 high-power field was 16.1 (8.3) in the normal and 17.3 (7.9) in the dilated segment of the megaureter, with no significant difference, but was significantly less in the narrow segment of UVJO at 4.5 (2.0), narrow segment of UPJO at 5.1 (2.3), and fetal ureter at 5.0 (2.3). The median CM ratio was 0.75 (0.29) in the normal and 0.65 (0.2) in the dilated segment of the megaureter, with no significant difference between them (figure), but was significantly higher in the narrow segment of UVJO at 3.0 (0.8), narrow segment of UPJO at 2.5 (0.71), and fetal ureter at 3.1 (0.61). Overall UVJO, UPJO, and fetal ureter segment had significantly less ICC density and more collagen compared with the normal ureter (P < 0.001 by Mann-Whitney U test). DISCUSSION There are conflicting reports on the etiopathogenesis of UVJO and UPJO, with several authors showing decreased ICC and increased collagen in the narrow segment. In this study, the authors found that the pathological changes at UVJ and UPJ segments resemble fetal ureter morphology. We also found that in fetal ureters, as the gestation progressed, there was an increase in the ICC density/smooth muscle, whereas the collagen content decreased. While the entire ureter has uniform embryological origin, it essentially remains an epithelial tube until the late gestation. The maturational process involves differentiation of smooth muscles cells/ICC to establish the peristaltic machinery required to functionally connect the ureter at both ends. This process, probably, starts at the mid ureter during fetal life and extends toward the UPJ and UVJ, and its failure, probably, results in UPJO or UVJO. The study's limitations are small numbers, and further larger studies are required to validate this hypothesis.
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Affiliation(s)
- R Babu
- Department of Pediatric Urology, Sri Ramachandra Institute of Higher Education and Reseach, Porur, Chennai 600116, India.
| | - P Vittalraj
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Reseach, Porur, Chennai 600116, India
| | - S Sundaram
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Reseach, Porur, Chennai 600116, India
| | - S Shalini
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Reseach, Porur, Chennai 600116, India
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Stringer MD, Yassaie S. Is the pelviureteric junction an anatomical entity? J Pediatr Urol 2013; 9:123-8. [PMID: 21924683 DOI: 10.1016/j.jpurol.2011.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 08/09/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The concept of the pelviureteric junction has existed for more than a century and yet there is no clear anatomical definition of this junction. This systematic review addresses the question of whether the human pelviureteric junction is a discrete anatomical entity. METHODS A systematic literature review was undertaken to investigate the normal gross and microscopic anatomy of the pelviureteric junction using the electronic databases MEDLINE, PubMed, Cochrane Library and Google Scholar. RESULTS In most individuals there is a gradual transition between the renal pelvis and ureter with no external features indicating the presence of a discrete pelviureteric 'junction'. Internally, however, luminal mucosal folds are prominent in this region. There is no consensus on the arrangement of muscle fibers at the pelviureteric junction (which may be age-dependent) although some studies suggest a focal thickening in the muscle wall consistent with physiological observations suggesting a high pressure zone capable of regulating urine flow. Studies of innervation have shown no evidence of specialization at this site. CONCLUSIONS There is some evidence that a pelviureteric region can be delineated anatomically and physiologically. However, although it may be a useful clinical concept, there is no sound anatomical basis for an actual pelviureteric junction.
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Affiliation(s)
- Mark D Stringer
- Department of Anatomy, Otago School of Medical Sciences, University of Otago, PO Box 913, Dunedin, New Zealand.
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Kaselas C, Aggelidou S, Papouis G, Kazakis C, Philippopoulos A. [Thickness of the renal pelvis smooth muscle indicates the postoperative course of ureteropelvic junction obstruction treatment]. Actas Urol Esp 2011; 35:605-9. [PMID: 21831482 DOI: 10.1016/j.acuro.2011.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 05/18/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the relationship between the histopathologic findings and the postoperative course of children surgically treated for ureteropelvic junction (UPJ) obstruction. MATERIAL AND METHODS Twenty-eight patients operated for unilateral UPJ obstruction from 1998 to 2005 with adequate histopathologic specimens and postoperative follow up were retrospectively reviewed. Specimens were stained using elastic van Geisson to differentiate smooth muscle from collagen and elastin. Postoperative follow up included renal ultrasound (U/S) and diuretic renogram studies. RESULTS Twelve patients with mean renal pelvis smooth muscle thickness (mRPSMT) of 136.97 ± 34.17 improved on the 6(th) postoperative month. Nine patients that improved after 9 months postoperatively had mRPSMT=173.61 ± 33.91. The rest 7 patients that improved on the 12(th) postoperative month had mRPSMT=258.78 ± 96.09. Correlation between renal pelvis smooth muscle and time of postoperative improvement was extremely significant (r = 0.7928, p < 0.0001). CONCLUSION The thickness of the renal pelvis smooth muscle is significantly correlated to the postoperative course of patients with UPJ obstruction and can be used as a prognostic tool for the onset of their improvement.
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Affiliation(s)
- C Kaselas
- Servicio Secundario de Cirugía Pediátrica, Hospital Universitario Aristotle, Hospital General Papageorgiou, Thessaloniki, Grecia.
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Ingraham SE, McHugh KM. Current perspectives on congenital obstructive nephropathy. Pediatr Nephrol 2011; 26:1453-61. [PMID: 21327776 DOI: 10.1007/s00467-011-1799-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 12/20/2010] [Accepted: 01/26/2011] [Indexed: 12/29/2022]
Abstract
Congenital obstructive nephropathy is the leading cause of chronic renal disease in children. As a result, it represents a tremendous societal burden in terms of morbidity and mortality, as well as in health care expenses of caring for children with chronic kidney disease and end-stage renal disease. The various diagnostic, prognostic, and therapeutic challenges associated with congenital obstructive nephropathy highlight the importance of developing effective experimental models for studying this disease process. In this review, we define the clinical entity that is congenital obstructive nephropathy, outline the current standards of diagnosis and care, and discuss the utilization of current experimental models designed to help clarify some of the clinical conundrums associated with this important disease.
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Affiliation(s)
- Susan E Ingraham
- Section of Nephrology, Nationwide Children's Hospital, Columbus, Ohio, USA
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Yiee JH, Johnson-Welch S, Baker LA, Wilcox DT. Histologic differences between extrinsic and intrinsic ureteropelvic junction obstruction. Urology 2010; 76:181-4. [PMID: 20394972 DOI: 10.1016/j.urology.2010.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 12/21/2009] [Accepted: 02/06/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Ureteropelvic junction obstruction (UPJ) can be caused by intrinsic disorganization or extrinsic compression from crossing vessels (CV). What is not clear is whether there is also intrinsic UPJ pathology in patients with CV. Recent surgeries, such as the Hellström vascular hitch procedure, move the CV cephalad without resecting the UPJ, which presumes no intrinsic narrowing. Our aim was to determine whether the histologic features of the 2 types of UPJ obstruction are distinct enough to enable a blinded pathologist to histologically identify the cause of obstruction. METHODS We reviewed all patients undergoing pyeloplasties from 2000 to 2006. All CV cases with available pathology were selected. A random selection of intrinsic cases was used as controls. One blinded pathologist reviewed the histology, specifically scoring muscle and collagen density. RESULTS Sixteen patients were reviewed. Seven had CV and 9 had intrinsic obstruction. Muscle density was different between the 2 groups with CV denser compared with intrinsic (P = .005). The pathologist correctly assigned the cause of obstruction in 5/7 (71%) of CV and 7/9 (78%) of intrinsic cases (P = .039). CONCLUSIONS Identification of a significant CV intraoperatively does translate to a discernible appearance histologically.
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Affiliation(s)
- Jenny H Yiee
- Department of Urology, University of Texas Southwestern Medical School, Dallas, TX, USA.
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Özel SK, Emir H, Dervişoğlu S, Akpolat N, Şenel B, Kazez A, Söylet Y, Çetin G, Danişmend N, Büyükünal SNC. The roles of extracellular matrix proteins, apoptosis and c-kit positive cells in the pathogenesis of ureteropelvic junction obstruction. J Pediatr Urol 2010; 6:125-9. [PMID: 19716769 DOI: 10.1016/j.jpurol.2009.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 07/23/2009] [Indexed: 01/12/2023]
Abstract
AIM To investigate histopathological changes in ureteropelvic junction obstruction (UPJO) from an etiological perspective. PATIENTS AND METHODS Medical records of patients with UPJO were reviewed and pathological specimens collected. Nephrectomy materials from forensic autopsies were taken as controls. Specimens were assessed with light microscopy. Fibronectin, type 4 collagen, laminin, Bax and Bcl-2 expression for apoptosis, together with interstitial cells of Cajal determination with c-kit were determined immunohistochemically. Staining scores were evaluated semiquantitatively. Results were evaluated using Mann-Whitney U-test. RESULTS Control group comprised 14 children (median age, 3.5 years; 6 months-17 years). Study group comprised 22 children with UPJO (median age, 9 months; 1 month-10 years). Light microscopy revealed non-specific inflammation, epithelial proliferation and atrophy with fibrosis in the smooth muscle of the UPJ in all patients. Fibronectin, type 4 collagen and laminin were found to be significantly increased in UPJO at the intrafascicular space of smooth muscle and the matrix of stroma. Bcl-2 expression was increased in UPJO. c-Kit was unable to stain interstitial cells of Cajal, but staining for mast cells was significant. CONCLUSIONS High expression of fibronectin, laminin and type 4 collagen may indicate a relation to the pathogenesis of UPJO. Defective kidney morphogenesis, during branching and tubulogenesis of ureteric bud, may be responsible for this congenital pathology.
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Affiliation(s)
- S K Özel
- Fırat University Faculty of Medicine, Department of Pediatric Surgery, Elazığ, Turkey.
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Passerotti CC, Passerotti AMA, Dall'Oglio MF, Leite KR, Nunes RL, Srougi M, Retik AB, Nguyen HT. Comparing the Quality of the Suture Anastomosis and the Learning Curves Associated with Performing Open, Freehand, and Robotic-Assisted Laparoscopic Pyeloplasty in a Swine Animal Model. J Am Coll Surg 2009; 208:576-86. [DOI: 10.1016/j.jamcollsurg.2009.01.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 01/01/2009] [Accepted: 01/07/2009] [Indexed: 10/21/2022]
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Kiratli PO, Orhan D, Gedik GK, Tekgul S. Relation between radionuclide imaging and pathologic findings of ureteropelvic junction obstruction in neonatal hydronephrosis. ACTA ACUST UNITED AC 2008; 42:249-56. [PMID: 18432532 DOI: 10.1080/00365590701874967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE An excessive amount of collagen fibers around the muscle cells in the ureteropelvic junction could be responsible for obstruction in patients with hydronephrosis. We aimed to elucidate the ultrastructure of the ureters and correlate this finding with the prognostic outcome and to correlate the histopathological findings with diuretic radionuclide renography findings. MATERIAL AND METHODS Biopsy specimens of 20 children who underwent dismembered pyeloplasty for ureteropelvic junction obstruction were analyzed. The patients were grouped according to their age: infants (<12 months) and others (>12 months). Diuretic radionuclide imaging was performed using (99m)Tc mercaptylacetyltriglycine in the pre- and postoperative periods. Changes in differential renal function and excretion patterns on diuretic renography were evaluated in relation to the findings noted on histopathological examination of the biopsy specimens. Excretion patterns were classified as follows: A, normal; B, responsive to diuretic; C, minimal response to diuretic with some excretion after postural change; and D, very poor/no drainage despite diuretics. Biopsy materials were analyzed for the presence and extent of inflammation, fibrosis and changes in the smooth muscle layer using Masson's trichrome stain and immunohistochemical staining. Histopathological findings were graded from zero to three, depending on severity. RESULTS In patients aged <12 months, preoperative differential renal function (DRF) was associated with fibrosis (F) and smooth muscle hypertrophy (SMH) [mean (SD) DRF for both F and SMH were Grade 0-1, 47.8% (6.4%); Grade 2-3, 36.2% (11.3%); p<0.05]; and change in DRF was associated with inflammation [Grade 0-1, -0.1% (4.0%); Grade 2-3, 5.8% (3.0%); p<0.05]. Excretion patterns or improvement in excretion were not associated with any of the histopathological features. Change in DRF was significantly associated with inflammation Grade 2-3 (beta coefficient, 5.8; 95% CI 1.4-10.3). CONCLUSIONS Histopathological evaluation of renal parenchymal biopsy specimens obtained during pyeloplasty may be useful to provide an objective method for predicting the recovery of renal function. In addition, this will allow comparison of the types of histopathological alterations with the changes in differential renal function in order to predict the potential final improvement.
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Affiliation(s)
- Pinar O Kiratli
- Department of Nuclear Medicine, Hacettepe University Medical Faculty, Ankara, Turkey.
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Sergi F, Flammia GP, Alcini A, Perrone G, Guaglianone S, Forastiere E, Rabitti C, Gallucci M. Collagen Changes in the Ureteropelvic Junction after Failed Antegrade Endopyelotomy. J Endourol 2007; 21:103-7. [PMID: 17263620 DOI: 10.1089/end.2006.9996] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We evaluated the collagen content and differentiation of the ureteropelvic junction (UPJ) of patients who underwent Anderson-Hynes dismembered pyeloplasty after failure of antegrade endopyelotomy. MATERIALS AND METHODS A total of 12 UPJ obstructions were examined more than 12 months after endopyelotomy with both histochemical staining to analyze total collagen content and immunohistochemical staining to analyze collagen types I and III. The specimens were compared with 12 primary UPJ obstructions and 6 normal UPJs. Statistical analysis was performed using Fisher's test and Wilcoxon matched-pairs signed-rank test. RESULTS Immunohistochemical staining revealed that collagen type I was located in the interfascicular space and collagen type III in the intrafascicular space in all UPJs. We found more collagen in obstructed than in normal UPJs. Collagen type III was more abundant in secondary than in primary UPJ obstructions (P < 0.01). In obstruction after endopyelotomy, the staining intensity of collagen type III was greater than the intensity of collagen type I (P < 0.01). CONCLUSION Our results suggest that the success of antegrade endopyelotomy was impaired by an inflammatory process. This condition determined a shift of collagen differentiation toward type III, which is more fibrous than type I.
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Affiliation(s)
- Federico Sergi
- Urology Unit, Campus Bio-Medico University of Rome, Rome, Italy.
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Kajbafzadeh AM, Payabvash S, Salmasi AH, Monajemzadeh M, Tavangar SM. Smooth Muscle Cell Apoptosis and Defective Neural Development in Congenital Ureteropelvic Junction Obstruction. J Urol 2006; 176:718-23; discussion 723. [PMID: 16813927 DOI: 10.1016/j.juro.2006.03.041] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE We assessed the smooth muscle cell apoptosis along with changes in cellular and extracellular components of the ureteropelvic junction in 23 patients with unilateral obstruction and compared them with 25 autopsies from ureteropelvic junction regions of age matched cadavers. MATERIALS AND METHODS Tissue specimens obtained from pyeloplasty were divided into 3 sections-renal pelvis above the obstruction, obstructed ureteropelvic junction and ureter below the obstructed region. For the control group the normal ureteropelvic junctions of age matched infants were autopsied. In paraffin embedded sections we determined myocyte apoptosis index (using TUNEL assay), and the amount of muscular components and nerve terminals (using image analysis techniques after immunohistochemical staining). The collagen and elastin fibers were specifically stained for evaluation of changes in extracellular matrix. RESULTS Smooth muscle cell apoptosis index was significantly increased at the site of ureteropelvic junction obstruction (5.68 +/- 0.18) compared to normal autopsied ureteropelvic junctions (3.60 +/- 0.11) and 2 other sections of obstructed ureteropelvic junction complex (renal pelvis 4.73 +/- 0.16, and ureter 3.97 +/- 0.16). The number of nerve terminals and the percentage of muscular component were significantly lower at the obstructed segments of affected patients compared to normal ureteropelvic junctions. Meanwhile, collagen fibers formed a significantly higher proportion of ureteral wall at the site of obstruction. Interestingly, there was negative correlation between myocyte apoptosis indices and number of nerve endings as well as amount of muscular components at the site of ureteropelvic junction obstruction. However, positive correlations were found between smooth muscle cell apoptosis and the percentage of collagen and elastin fibers. CONCLUSIONS Our findings suggest an important role for myocyte apoptosis and defective neural development in the pathogenesis of congenital ureteropelvic junction obstruction that could pave the road for the emergence of new therapeutic modalities.
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Kim DS, Noh JY, Jeong HJ, Kim MJ, Jeon HJ, Han SW. ELASTIN CONTENT OF THE RENAL PELVIS AND URETER DETERMINES POST-PYELOPLASTY RECOVERY. J Urol 2005; 173:962-6. [PMID: 15711350 DOI: 10.1097/01.ju.0000157003.04760.c3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluated the collagen-to-smooth muscle tissue matrix ratio and percentage of elastin in the renal pelvis, ureteropelvic junction (UPJ) and ureter, and compared these findings with the degree of obstruction, patient age and post-pyeloplasty renal recovery. MATERIALS AND METHODS We analyzed histological sections from 75 patients with UPJ obstruction. Nine patients were excluded owing to bilateral UPJ obstruction and an improper specimen. We divided the specimen obtained from pyeloplasty into 3 parts, namely the renal pelvis above the obstruction, the obstructed UPJ portion and the ureter below the obstruction. To examine the collagen and smooth muscle, sections were stained using Masson's trichrome, and elastic van Giesson stain was used for elastin, smooth muscle and collagen. Collagen, smooth muscle and elastin populations were identified, and the tissue matrix ratio and percentage of elastin were calculated by color image analysis. RESULTS In patients with lower ratios of collagen-to-smooth muscle in the UPJ proper hydronephrosis was more improved postoperatively (p = 0.049). In patients with a lower percentage of elastin in the renal pelvis, UPJ and ureter hydronephrosis was more improved postoperatively (p <0.0001). CONCLUSIONS Because the UPJ portion was resected during pyeloplasty, the renal pelvis and the ureter remaining after pyeloplasty are likely to be related to improved hydronephrosis. A higher percentage of elastin in the renal pelvis and ureter contributes to inelasticity and low compliance, and results in a slower recovery from hydronephrosis after pyeloplasty.
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Affiliation(s)
- Dong Suk Kim
- Brain Korea 21 Project for Medical Science of the Department of Urology, Yonsei University College of Medicine, Seoul, Korea
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Santos KAN, Kokoua A, Tre-Yavo M, Atrevi N, Diomande MIJM, Darboux R, N'Guessan GGB, Ehouman A. [The uteropelvic junction in children: from the clinical problems to the morphogenetic approach]. Morphologie 2004; 88:196-201. [PMID: 15693424 DOI: 10.1016/s1286-0115(04)98149-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The responsibility of the uteropelvic junction (UPJ) syndrome or abnormalities for renal affections and also for high obstructive uropathy is well-known. But, controversies still remain about the anatomic approach of this clinical feature. Our purpose is to elucidate the developmental anatomy of UPJ and eventually to set the steps of the anatomic approach of the UPJ abnormalities. This study also leads to a better understanding of the mechanism of the intrinsic ureteropelvic junction obstructions. A total number of 122 post-mortem specimens with ages ranging from 1 day to 30 months in both sexes underwent formalin treatment for histological investigation. We performed both transverse and longitudinal sections. Hematein-eosin-safran and Masson's trichrome staining were used. Histological examination revealed that myoarchitecture of UPJ set increasingly up. Circular muscle fibers were first to put in. They had an initial arrangement as a ring in neonates and infants. We conclude that circular layer appears first and sooner than others. On the other hand, coincidence in time between ages of our specimens and ages of patients sufferning from UPJ syndrome leads to further investigations to determine the implication of ring-shaped circular layer in intrinsic ureteropelvic junction obstruction.
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Affiliation(s)
- K A N Santos
- Laboratoire d'Anatomie, UFR-Sciences médicale, Université de Cocody, Service d'Urologie-CHU Treicheville, Abidjan, RCI.
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Alberti C, Tizzani A. Ureteropelvic Junction Obstruction: Some new Acquisitions about Etiology, Pathophysiology and Diagnostics. Urologia 2003. [DOI: 10.1177/039156030307001-402] [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
The etiopathogenesis of uretero-pelvic junction obstruction (UPJO) has been the subject of many speculations and it remains, in some ways, a debatable matter. Some recently reported thorough research refer to neuro-mediated pathogenetic mechanisms rather than (or together with) myogenic ones.Advances in US, radioisotopic functional imaging, CT and RM contribute to differentiate the obstructive conditions from the non-obstructive ones and to afford today a better assessment of renal functional damage. Particularly, diuretic renography is a non-invasive test for characterization of the renal functional abnormalities resulting from UPJO. Helical CT with angiography is a useful technique for identification of crossing vessels (pyelo-vascular tangle) which can be used for the pre-surgical planning of endopyelotomy. Endoluminal ultrasonography can be used to guide the position of the incision for endopyelotomy (US-guided endopyelotomy).Laboratory examinations are important to determine the overall renal function (serum creatinine, acid-base balance, serum electrolytes, etc.), urinary MCP-1 and NAG (markers of tubular damage), and to rule out urinary tract infections.The management of UPJO (watchful waiting; either open or laparoscopic dismembered pyeloplasty; endoluminal procedures) is greatly influenced by the diagnostic evaluation.The paper aims to outline the advances in both physiopathology and diagnostics of UPJO on the basis of a review of the literature.
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Affiliation(s)
- C. Alberti
- Ia Clinica Urologica dell'Università degli Studi di Torino, Torino
| | - A. Tizzani
- Ia Clinica Urologica dell'Università degli Studi di Torino, Torino
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KIM WUNJAE, YUN SEOKJUNG, LEE TAESOO, KIM CHULWOO, LEE HYUNMOO, CHOI HWANG. COLLAGEN-TO-SMOOTH MUSCLE RATIO HELPS PREDICTION OF PROGNOSIS AFTER PYELOPLASTY. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67759-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- WUN-JAE KIM
- From the Departments of Urology, Biomedical Engineering and Pathology, College of Medicine, Chungbuk National University, Cheongju, Chungbuk, and Departments of Urology and Pathology, College of Medicine, Seoul National University, Seoul, Korea
| | - SEOK JUNG YUN
- From the Departments of Urology, Biomedical Engineering and Pathology, College of Medicine, Chungbuk National University, Cheongju, Chungbuk, and Departments of Urology and Pathology, College of Medicine, Seoul National University, Seoul, Korea
| | - TAE SOO LEE
- From the Departments of Urology, Biomedical Engineering and Pathology, College of Medicine, Chungbuk National University, Cheongju, Chungbuk, and Departments of Urology and Pathology, College of Medicine, Seoul National University, Seoul, Korea
| | - CHUL WOO KIM
- From the Departments of Urology, Biomedical Engineering and Pathology, College of Medicine, Chungbuk National University, Cheongju, Chungbuk, and Departments of Urology and Pathology, College of Medicine, Seoul National University, Seoul, Korea
| | - HYUN MOO LEE
- From the Departments of Urology, Biomedical Engineering and Pathology, College of Medicine, Chungbuk National University, Cheongju, Chungbuk, and Departments of Urology and Pathology, College of Medicine, Seoul National University, Seoul, Korea
| | - HWANG CHOI
- From the Departments of Urology, Biomedical Engineering and Pathology, College of Medicine, Chungbuk National University, Cheongju, Chungbuk, and Departments of Urology and Pathology, College of Medicine, Seoul National University, Seoul, Korea
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