Primer Vezikoüreteral Reflülü (VUR) ve Dx/HA ile Başarısız Enjeksiyon Tedavisi Sonrası Primer VUR'lu Çocukların Üreterovezikal Bileşkesinde Sitokin Profillerinin ve Ultrayapısal Değişikliklerinin Karşılaştırılması.

Abstract

Amaç: İmmünohistokimyasal yöntemler ve transmisyon elektron mikroskopisi (TEM) kullanılarak primer vezikoüreteral reflülü (VUR) ve dekstranomer / hyaluronik asit (Dx/HA) ile başarısız enjeksiyon tedavisi sonrası primer VUR'lu çocukların üreterovezikal bileşkesinde sitokin profillerinin ve ultrayapısal değişikliklerinin karşılaştırılması.

Materyal ve Method: Aralık 2011 ve Ağustos 2014 tarihleri arasında, Uluslararası Reflü Çalışmasına göre grade I-V VUR olarak değerlendirilen 41 çocuğa üreteroneosistostomi uygulandı. Dx / HA ile başarısız enjeksiyon tedavisinin ardından 18 çocuğa primer VUR için üreteroneosistostomi uygulandı. Histopatolojik ve ultrayapısal değerlendirmeler için ameliyat sırasında altmış yedi distal intravezikal üreter elde edildi. Üreter duvarı düz kas organizasyonu ve transforme edici büyüme faktörü-β1 (TGF-β1), vasküler endotelyal büyüme faktörü (VEGF) ve CD34 immünohistokimyasal olarak değerlendirildi. Ultrayapısal değerlendirmeler ve morfolojik tanımlar yarı kantitatif olarak yapıldı.

Bulgular: Hastaların 10'u (% 24,3) erkek, 31'i (% 75,7) kadındı. 28 üreterde başarısız Dx/HA enjeksiyon öyküsü mevcuttu. Histopatolojisi; Dx/HA ile başarısız enjeksiyon tedavisini takiben primer VUR hastalarında ve primer VUR hastalarında TGF-β1 ve VEGF ve CD34 düzeyleri aynıydı ancak kontrol grubu ile karşılaştırıldığında farklı idi (sırasıyla p=0.001,p<0.001 ve p<0.001). Ancak farklar reflü derecesi ile ilişkili değildi (sırasıyla p = 0.42, p = 0.26 ve p = 0.94). Tüm VUR örneklerinde kas hücrelerinde ultrayapısal değişiklikler gözlendi.

Sonuç: Çalışmamız, tüm VUR örneklerinde kas hücrelerinin ultra apısal değişikliklerinin gözlendiğini göstermiştir. Primer VUR ve başarısız Dx/HA tedavisi olan primer VUR hastalar arasında sitokin miktarında anlamlı bir fark yoktu. VEGF, CD34 ve TGF-21 düzeyleri her iki primer VUR grubunda da karşılaştırılabilirdi.

Keywords

• dekstranomer/hiyalüronik asit,transmisyon elektron mikroskopisi,üreterovezikal bileşke,vezikoüreteral reflü

Comparison Of The Cytokine Profiles And Ultrastructural Changes In The Ureterovesical Junctions Of Children With Primary Vesicoureteral Reflux And Children With Primary VUR Following Failed Injection Therapy With Dx/HA.

Abstract

Purpose: To compare the cytokine profiles and ultrastructural changes in the ureterovesical junctions of children with primary vesicoureteral reflux(VUR) and children with primary VUR following failed injection therapy with dextranomer/hyaluronic-acid (Dx/HA) using immunohistochemical methods and transmission electron microscopy (TEM).

Materials and Methods: 41 children underwent ureteroneocystostomy for VUR and 18 children underwent ureteroneocystostomy for primary VUR following failed injection therapy with Dx/HA. Sixty-seven distal intravesical ureters were obtained during surgery for histopathological and ultrastructural evaluations. The ureteral wall smooth-muscle organization and transforming growth factor-β1(TGF-β1), vascular endothelial growth factor(VEGF), and CD34 were evaluated immunohistochemically. The ultrastructural evaluations and morphological descriptions were performed semi-quantitatively.

Results: Of the patients, 10(24,3%) were male and 31(75,7%) were female. 28 ureter had a history of failed Dx/HA injections. Histopathology; the amount of TGF-β1, and the VEGF and CD34 levels were same in the patients with primary VUR and patients with primary VUR following failed injection therapy with Dx/HA but different compared with the control group(p=0.001,p<0.001, and p<0.001, respectively), but the differences were not correlated with the grade of reflux(p=0.42, p=0.26 and p=0.94 respectively). Ultrastructural changes in the muscle cells were observed in all the VUR specimens.

Conclusions: Our study demonstrated that ultra-structural changes in the muscle cells were observed in all VUR specimens. There was no significant difference in the quantification of cytokine assays between the patients with primary VUR and primary VUR with failed Dx/HA therapy. The quantification of VEGF, CD34, and, TGF-β1 levels was comparable in both primary VUR groups.

Keywords

• dextranomer/hyaluronic acid,transmission electron microscopy,ureterovesical junctions,vesicoureteral reflux

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