Comprehensive evaluation of ureteral healing after electrosurgical endopyelotomy in a porcine model: Original report and review of the literature

Comprehensive evaluation of ureteral healing after electrosurgical endopyelotomy in a porcine model: Original report and review of the literature

Author Andreoni, C. R. Google Scholar
Lin, H. K. Google Scholar
Olweny, E. Google Scholar
Landman, J. Google Scholar
Lee, D. Google Scholar
Bostwick, D. Google Scholar
Clayman, R. V. Google Scholar
Institution Univ Calif Irvine
Universidade Federal de São Paulo (UNIFESP)
Washington Univ
Bostwick Labs
Abstract Purpose: Endopyelotomy (EP) has yet to equal the success achieved with open dismembered pyeloplasty. To understand better the ureteral response to EP we performed a timed histopathological evaluation of the porcine ureter after Acucise (Applied Medical, Rancho Santa Margarita, California) EP.Materials and Methods: in 28 domestic pigs bilateral Acucise EPs were performed and bilateral 7Fr stents were placed. the kidneys, ureters and bladder were harvested after EP at 0, 1, 2, 3, 6, 12 and 18 hours, 1, 3 and 5 days, and 1, 2, 4 and 8 weeks. the stents were removed after 4 weeks. the healing area of the ureter was sectioned. Half was fixed in formalin 10%, stained and evaluated by light microscopy. the other half was frozen and reverse transcriptase-polymerase chain reaction was performed to measure steady state levels of epidermal growth factor, transforming growth factor (TGF)-alpha, TGF-beta1, TGF-beta2, TGF-beta3, keratinocyte growth factor, vascular endothelial growth factor, insulin-like growth factor, platelet derived growth factor, collagen type 1, integrin and fibronectin transcript expression. Immunohistochemistry for actin, desmin and myosin expression was completed. the same studies were applied to the mid portion of the unoperated ureter.Results: Initial sealing of the ureterotomy defect was by blood clot and periureteral fat. Complete healing of the mucosa was observed at 2 weeks in animals without an associated urinoma. However, in no case did the muscle layer bridge the whole circumference of the ureter despite followup out to 8 weeks. in the operated ureter elevated expression of keratinocyte growth factor, vascular endothelial growth factor, TGF-alpha, TGF-beta1, TGF-beta3 and integrin was detected 2 hours after the operation and sustained for 7 to 14 days after the procedure. Immunohistochemistry revealed that most presumed myocytes seen in the defect were actually myofibroblasts. Persistent urinoma formation beyond the first few days appeared to slow the healing process.Conclusions: Urothelium regenerated rapidly over an iatrogenic ureteral defect despite the absence of a lamina propria. Muscle cell coverage failed to occur completely at 8 weeks. in the initial 8 weeks of the healing process myofibroblasts appear to be prevalent. A persistent urinoma negatively impacts the healing process.
Keywords ureter
wound healing
urologic surgical procedures
Language English
Date 2004-02-01
Published in Journal of Urology. Philadelphia: Lippincott Williams & Wilkins, v. 171, n. 2, p. 859-869, 2004.
ISSN 0022-5347 (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent 859-869
Access rights Closed access
Type Review
Web of Science ID WOS:000188319300100

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