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

Volkan Izol, Yurdun Kuyucu, Arbil Acikalin, Mutlu Deger, Ibrahim Atilla Aridogan, Sait Polat, Nihat Satar



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 underwent ureteroneocystostomy were included the study. The smooth muscle arrangement of the ureteral wall, transforming growth factor-?(TGF-?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.

Results: 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-?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-?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: Subsequently, refluxing ureters exhibits 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.

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DOI: http://dx.doi.org/10.22037/uj.v0i0.4281

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