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Paper Information

Title: 

THE EFFECTS OF BIOCERAMIC INJECTION (CALCIUM HYDROXY APATITE) IN RABBIT BLADDER, FOR USE IN THE ENDOSCOPIC TREATMENT OF URINARY REFLUX

Type: PAPER
Author(s): HOSSEINI M.*,KAJBAFZADEH A.M.
 
 *
 
Name of Seminar: CONGREH ANJOMAN UROLOGY IRAN
Type of Seminar:  CONGRESS
Sponsor:  ANJOMAN OROLOGY
Date:  2005Volume 8
 
 
Abstract: 

INTRODUCTION: URINARY REFLUX LEADS TO PROGRESSIVE RENAL DAMAGE, LEADING ULTIMATELY TO RENAL FAILURE. MAJOR TREATMENTS INCLUDE ANTIBIOTIC PROPHYLAXIS, OPEN SURGERY, AND ENDOSCOPIC SUBMUCOSAL REIMPLANTATION OF THE URETER. THE MAINSTAY FOR ENDOSCOPIC REFLUX CORRECTION IS THE ESTABLISHMENT OF A STRONG SUBMUCOSAL SUPPORT FOR THE INTRAVESICAL PORTION OF THE URETER, THROUGH ENDOSCOPIC INJECTION OF FOREIGN MATERIAL, LEADING FINALLY TO AN INCREASED INTRAMURAL LENGTH OF THE URETER. NON-AUTOLOGOUS MATERIALS USED FOR THIS PURPOSE INCLUDE PARAFFIN, PETROLEUM, SILICON, TEFLON, LANULIN, COLLAGEN, AND DIFLAX.
MATERIALS AND METHODS: 30 ADULT RABBITS WERE SELECTED, 20 FOR THE STUDY AND 10 AS THE CONTROL GROUP. CYSTOGRAPHY, KUB, INTRAVENOUS PYELOGRAPHY, AND SONOGRAPHY OF THE KIDNEYS AND THE BLADDER WERE PERFORMED BEFORE ANY SURGICAL INTERVENTION. AFTERWARDS, THE ABDOMINAL WALL WAS OPENED WITH A MIDLINE INCISION, EXPOSING THE BLADDER, WHICH WAS OPENED IN THE MIDLINE. THE BIOCERAMIC MATERIAL WAS INEJCTED WITH A 1-ML SYRINGE INTO THE BALDDER SUBMUCOSA, AND THE BLADDER WALL REPAIRED. THE RABBITS WERE KEPT IN GOOD CONDITIONS AND WITH APPROPRIATE NUTRITION FOR 6 MONTHS. KUB WAS TAKEN (DUE TO RADIO-OPACITY OF THE BIOCERAMIC) AND THE RABBITS SACRIFICED WITH LETHAL DOSES OF KETAMINE. WITH SIMULTANEOUS LAPAROTOMY AND THORACOTOMY, THE KIDNEYS, URETERS, BLADDER, LIVER, HEART, LUNGS, BRAIN, AND RETROPERITONEAL LYMPH NODES WERE TAKEN OUT AND ASSESSED MACROSCOPICALLY AND MICROSCOPICALLY.
RESULTS: HISTOLOGY REVEALED EDEMA OF THE LAMINA PROPRIA, AS WELL AS FOREIGN BODY GRANULOMA IN THE BLADDER, WITH DARK MATERIAL (BIOCERAMIC) AMONG THE GRANULOMA CELLS. IN THE KIDNEYS, THERE WAS NO CHANGE IN THE GLOMERULI, TUBULES, AND THE MEDULLA, WHILE THE RENAL CAPSULE WAS RUPTURED, WITH LYMPHOCYTES AND A FEW FOREIGN BODY GIANT CELLS AMONG THE CAPSULE BUNDLES, TOGETHER WITH EVENLY DISPERSED DARK MATERIAL, THE BIOCERAMIC. RETROPERITONEAL LYMPH NODES’ VIEW INCLUDED INFLAMMATORY CELLS, WITH EVENLY PRECIPITATED MATERIAL AMONG THEM, AND AT TIME THE INFLAMMATORY REACTION UNRECOGNIZABLE FROM NORMAL CELLS DUE TO LYMPHOCYTE AGGREGATION. FOREIGN BODY GRANULOMA WAS ALSO OBSERVED. CHOLESTASIS WAS THE MOST PROMINENT PATHOLOGIC CHANGE IN THE LIVER, AS YET UNKNOWN TO BE DUE TO BIOCERAMIC OR NOT. NO CHANGES WERE DETECTED IN THE BRAIN, THE HEART AND THE LUNGS.
CONCLUSION: ENDOSCOPIC TREATMENT OF URINARY REFLUX IS A USEFUL METHOD IN THE SELECTED PATIENTS DUE TO SIMPLICITY, LOWER MORBIDITY, AND LOWER COST. BIOCERAMIC IS A MATERIAL USED IN ORTHOPEDIC SURGERY, AS WELL AS IN THE TREATMENT OF URINARY INCONTINENCE IN WOMEN AND IN CHILDREN. ITS LOCAL AND REMOTE REACTIONS IN THE URINARY SYSTEM ARE IN THE FORM OF FOREIGN BODY GRANULOMA AND INFLAMMATORY REACTIONS NOT MORE SEVERE THAN THE MATRIALS IN COMMON USE, SUCH AS TEFLON, COLLAGEN, AND MACROPLASTICS. THEREFORE, BIOCERAMIC IS A MUCH BETTER AND SAFER MATERIAL COMPARED TO THE ONES NAMED ABOVE, WITH A LOWER RATE OF MORBIDITY.

 
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