Evaluating ESWL related alterations in renal pelvis and proximal ureter by analayting of tissue hydroxyproline levels

Abstract

The aim of the study is to evaluate extracorporeal shock wave lithotripsy (ESWL) related alterations in renal pelvis and proximal ureter by using histopathological methods and analayting hydroxy-proline levels. Twelve New-Zealand rabbits were allocated into two groups (n=6). Right sites of control group (CG, n=6) were harvested without any intervention. In ESWL group (EG), right kidneys of subjects were exposed to 3000 shock waves (14 kV) by using electro-hydraulic type ESWL device three times. Rabbits in EG were sacrificed on day 7. Tissues were examined histopathologically for presence of edema, inflammation, congestion, hemorrhage, fibrosis, vascularization and biochemically for hydroxyproline concentrations. Histopathologically, tissue edema was increased in renal pelvises and inflammation was increased in ureters in the EG compared to that in the CG (p<0.5). There was no difference in other parameters between the groups (p>0.05). Tissue collagen density did not show any significant difference (p>0.05). There was no difference in the tissue hydroxyl-proline levels of ureter samples (p>0.05). Tissue hydroxyproline levels were significantly higher in EG than CG in renal pelvis (p<0.05). In conclusion, although no major histopathological alteration due to ESWL was detected in renal pelvis and proximal ureter, increased hydroxyproline levels in the renal pelvis can be suggested as a finding of tissue injury in collecting system.

Keywords

• Collecting system
• ESWL
• Hydroxyproline
• Renal pelvis
• Ureter

References

1. Baskin, L.S., Constantinescu, S.C., Howard, P.S., McAninch, J.W., Ewalt, D.H., Duckett, J.W., Snyder, H.M., Macarak, E.J., 1993. Biochemical characterization and quantization of the collagenous components of urethral stricture tissue. J. Urol. 150, 642-647.
2. Bergman, I., Loxley, R., 1970. New spectrophotometric method for the determination of proline in tissue hydrolyzates. Anal. Chem. 42, 702-706.
3. Carvalho, M., Freitas Filho, L.G., Carvalho, M., Fagundes, D.J., Ortiz, V., 2009. Effects of repeated extracorporeal shock wave in urinary biochemical markers of rats. Acta. Cirurgica. Brasileira. 24, 496-501.
4. Chaussy, C., Schuller, J., Schmiedt, E., Brandl, H., Jocham, D., Liedl, B., 1984. Extracorporeal shock-wave lithotripsy (ESWL) for treatment of urolithiasis. Urology. 23, 59-66.
5. Clark, D.L., Connors, B.A., Evan, A.P., Willis, L.R., Handa, R.K., Gao, S., 2009. Localization of renal oxidative stress and inflammatory response after lithotripsy. BJU. Int. 103, 1562-1568.
6. Finter, F., Rinnab, L., Simon, J., Volkmer, B., Hautmann, R., Kuefer, R., 2007. Ureteral stricture after extracorporeal shock wave lithotripsy. Case report and overview of the spectrum of rare side effects of modern ESWL treatment. Urologe. 46, 769-772.
7. Gnessin, E., Chertin, L., Chertin, B., 2012. Current management of paediatric urolithiasis. Pediatr. Surg. Int. doi: 10.1007/s00383-012-3096-4.
8. Goktas, C., Coskun, A., Bicik, Z., Horuz, R., Unsal, I., Serteser, M., Albayrak, S., Sarıca, K., 2012. Evaluating ESWL-induced renal injury based on urinary TNF-α, IL-α, and IL-6 levels. Urol. Res. doi: 10.1007/s00240-012-0467-1.

9. Klinge, U., Si, Z.Y., Zheng, H., Schumpelick, V., Bhardwaj, R.S., Klosterhalfen, B., 2000. Abnormal collagen I to III distribution in the skin of patients with incisional hernia. Eur. Surg. Res. 32, 43-48.
10. McAdams, S., Shulka, A.R., 2010. Pediatric extracorporeal shock wave lithotripsy: Predicting successful outcomes. Indian. J. Urol. 26, 544-548.
11. Minevich, E., 2010. Management of ureteric stone in pediatric patients. Indian. J. Urol. 26, 564-567.
12. Serel, T.A., Ozguner, F., Soyupek, S., 2004. Prevention of shock wave-induced renal oxidative stress by melatonin: An experimental study. Urol. Res. 32, 69-71.
13. Skolarikos, A., Alivizatos, G., Rosette, J., 2006. Extracorporeal shock-wave lithotripsy 25 years later: Complications and their prevention. Eur. Urol. 50, 981-990.
14. Somuncu, S., Caglayan, O., Cakmak, M., Caglayan, F., Ulusoy, S., 2006. The effect of indwelling catheter on OH-proline in the urethral wound: An experimental study. J. Pediatr. Urol. 2, 182-184.
15. Williams, C.M., Kaude, J.V., Newman, R.C., Peterson, J.C., Thomas, W.C., 1998. Extracorporeal shock wave lithotripsy: Long-term complications. Am. J. Roentgenol. 150, 311-315.
16. The increased level of OH-proline levels in renal pelvis in
17. EG may be an indicator of shock-wave induced tissue injury
18. in our study. The reason of the inability to confirm this injury
19. with histopathologic examination may be the close time
20. between shock wave exposure and tissue sampling. Some
21. studies showed that the initial renal damage resolves over
22. days to months (Williams et al., 1998; Carvalho et al., 2009).
23. Since we took the samples at 7th day we would be late to show
24. any histopathologic alteration in tissues. The increased level
25. of OH-proline in renal pelvis shows that damage had been
26. occurred after ESWL and the healing process started to take
27. place by increased collagen turnover. However, the effect of
28. this result to the long-term consequences of ESWL should be
29. examined in future studies.
30. In conclusion, although no major histopathologic
31. alteration due to ESWL was detected in renal pelvis and
32. proximal ureter, increased OH-proline levels in renal pelvis
33. can be suggested as a finding of tissue injury in the collecting system.