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Paper Information

Journal:   UROLOGY JOURNAL   may-june 2019 , Volume 16 , Number 3; Page(s) 279 To 284.

PEDIATRIC UROLOGY: Evaluation of the Intravesical Ureters after Failed Endoscopic Treatment of Vesicoureteral Reflux with Dextranomer/hyaluronic Acid in Children via Light and Transmission Electron Microscopic Analysis. A Matched Case-Control Study

Author(s):  Izol Volkan, Kuyucu Yurdun, Acikalin Arbil, Deger Mutlu*, Atilla Aridogan Ibrahim, Polat Sait, Satar Nihat
* Department of Urology,Faculty of Medicine, University of Çukurova, Adana, Turkey
Introduction: The cytokine profile and the ultrastructural changes of refluxing ureterovesical junctions(UVJs) of children treated with failed dextranomer/hyaluronic-acid (Dx/HA) injections were investigated using immunohistochemical methods and transmission electron microscopy(TEM). Patients and Methods: Eighteen children who had undergone injection for reflux were included the study. The smooth muscle arrangement of the ureteral wall, transforming growth factor-β (TGF-β 1), vascular-endothelial-growth factor (VEGF) and CD34 were evaluated immunohistochemically, and the results were compared with 10 age-matched autopsy specimens as controls. The ultrastructural evaluation and morphological description was made semi-quantitatively and compared with published data. Result: Four of the patients (22%) were male, and 14 (78%) were female. The mean age of the patients was 105. 4 ± 44. 5(48-184) months. There was no correlation between the vesicoureteral reflux (VUR) grade and age (P = 0. 85). The mean VEGF and CD34 scores were 16. 2 ± 9. 6 (0-90) cells per HPF and 10. 2 ± 3. 5 (4-16) vessels per HPF in ureters with reflux; these values were 60. 6± 16. 4 (32-84) cells per HPF and 17. 8 ± 4. 1 (12-24) vessels per HPF in the control group. The amount of VEGF and CD34 were significantly decreased in patients compared with the control group (P < 0. 001, P < 0. 001). The TGF-β 1 levels were significantly higher in patients with VUR compared with the control group (34. 2 ± 19. 9 vs 5. 0± 1. 9; P=0. 001). The amount of VEGF, CD34, and TGF-β 1 were not correlated with the grade of reflux (P = 0. 26, P = 0. 94, and P = 0. 42, respectively). Ultrastructural changes in the muscle cells were observed in all the VUR specimens (Grade II-IV). Conclusion: Refluxing ureters exhibited immune-histopathological abnormalities and ultrastructural changes of the muscle cells in all VUR specimens in the ureterovesical junctions of children treated with failed Dx/HA injections for reflux.
Keyword(s): dextranomer/hyaluronic acid,transmission electron microscopy,ureterovesical junctions,vesicoureteral reflux
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