Is there an association between histopathological changes in the lower ureter and renal functions? Evaluation of patients who underwent ureteroneocystostomy for ureterovesical obstruction or vesicoureteral reflux
We aimed to assess the relationship between the histological changes of the ureterovesical junction (UVJ) and renal functions. Therefore, we evaluated histological changes of the lower ureter and renal scintigraphy findings of patients for whom ureteroneocystostomy was performed because of vesicoureteral reflux (VUR) or ureterovesical junction obstruction (UVO). Materials and methods: UVJ specimens were obtained from 18 children. We investigated the changes in neuronal innervation, muscular morphology, extracellular matrix, and apoptosis rate with renal scintigraphy findings. Results: Seven UVO and 11 VUR patients were treated. Alpha-actin expression in smooth muscle cells was found to be lower (P < 0.001) while neuronal defect was more prominent in the UVO group (P = 0.002). The renal functions decreased as the smooth muscle structural defect increased in the VUR group (P < 0.05). Conclusion: Neuronal tissue and muscle tissue were more defective in the UVO group. The decrease in neuronal fibers and muscle cells explains the pathogenesis of the obstructive group, but no difference was observed regarding the accumulation of collagen type 3 and cellular apoptosis between the VUR and UVO groups. In the VUR group, renal functions decreased while the smooth muscle defect at the distal end of the ureter increased.
Is there an association between histopathological changes in the lower ureter and renal functions? Evaluation of patients who underwent ureteroneocystostomy for ureterovesical obstruction or vesicoureteral reflux
We aimed to assess the relationship between the histological changes of the ureterovesical junction (UVJ) and renal functions. Therefore, we evaluated histological changes of the lower ureter and renal scintigraphy findings of patients for whom ureteroneocystostomy was performed because of vesicoureteral reflux (VUR) or ureterovesical junction obstruction (UVO). Materials and methods: UVJ specimens were obtained from 18 children. We investigated the changes in neuronal innervation, muscular morphology, extracellular matrix, and apoptosis rate with renal scintigraphy findings. Results: Seven UVO and 11 VUR patients were treated. Alpha-actin expression in smooth muscle cells was found to be lower (P < 0.001) while neuronal defect was more prominent in the UVO group (P = 0.002). The renal functions decreased as the smooth muscle structural defect increased in the VUR group (P < 0.05). Conclusion: Neuronal tissue and muscle tissue were more defective in the UVO group. The decrease in neuronal fibers and muscle cells explains the pathogenesis of the obstructive group, but no difference was observed regarding the accumulation of collagen type 3 and cellular apoptosis between the VUR and UVO groups. In the VUR group, renal functions decreased while the smooth muscle defect at the distal end of the ureter increased.
___
- King LR. Megaloureter: definition, diagnosis and management. J Urol 1980; 123: 222–223.
- Oswald J, Brenner E, Schwentner C, Deibl M, Bartsch G, Fritsch H, Radmayr C. The intravesical ureter in children with vesicoureteral reflux: a morphological and immunohistochemical characterization. J Urol 2003; 170: 2423–2427.
- Sofikerim M, Sargon M, Oruc O, Dogan HS, Tekgul S. An electron microscopic examination of the intravesical ureter in children with primary vesico-ureteric reflux. BJU Int 2007; 99: 1127–1131.
- Oswald J, Schwentner C, Brenner E, Deibl M, Fritsch H, Bartsch G, Radmayr C. Extracellular matrix degradation and reduced nerve supply in refluxing ureteral endings. J Urol 2004; 172: 1099–1102.
- Schwentner C, Oswald J, Lunacek A, Schlenck B, Berger AP, Deibl M, Fritsch H, Bartsch G, Radmayr C. Structural changes of the intravesical ureter in children with vesicoureteral reflux - does ischemia have a role? J Urol 2006; 176: 2212–2218.
- Tanagho EA. Intrauterine fetal ureteral obstruction. J Urol 1973; 109: 196–203.