Altered ‘active’ antireflux mechanism in primary vesico‐ureteric reflux: a morphological and manometric study

Abstract

possibly functions as an 'active' antireflux system, but previous manometric findings on refluxing ureteric units (RUs) have shown altered patterns. In all, 32 RU ends were stained using both picro-Mallory and Sirius Red techniques; in a parallel immunohistochemical procedure, using mast cell tryptase and CD117 antibodies (to identify ICCs), they were compared with eight control ureteric ends. Ureteric manometry of the VUJ was also done during ureteric reimplantation. RESULTSThe histochemical and immunohistochemical results in the RUs showed a replacement of the altered smooth muscle fascicles by collagenous stroma and significant loss of ICCs in RU ends, both correlated with the grade of VUR. Ureteric manometry showed significant impairment of basal and maximum pressure in RUs, correlated, respectively, with histological lesions and loss of ICCs.

Autonomic and sensory nerve modulation of peristalsis in the upper urinary tract

“…Only a couple of studies have established that this Kit staining is negative for various other Kit containing cells such as macrophages or hemopoietic/progenitor stem cells, while Kit + mast cells are often discounted based on their distinctive circular shape (Fig. 5C) (Arena et al, 2007;Metzger et al, 2004;Metzger et al, 2005). In our hands, Kit (CD117 or AK2) staining in acetone-fixed whole mount (Fig.…”

“…Formalin or paraformaldehyde fixed sections taken from these regions of stenosis also display a loss of neuronal (PGP9.5 and peripherin) (Murakumo et al, 1997;Solari et al, 2003;Wang et al, 1995) and ICC markers (CD117, c-kit) (Arena et al, 2007;Schwentner et al, 2005;Solari et al, 2003) markers, particularly in the muscular layer. In our acetone fixed whole mounts it is clear that Kit antibodies (CD117) also stain the intrinsic nerve bundles (Fig.…”

“…In infants with intrinsic ureteropelvic obstruction (Murakumo et al, 1997;Solari et al, 2003;Wang et al, 1995), or vesico-ureteric reflux (Arena et al, 2007;Schwentner et al, 2005), remodelling of the urinary tract presents as an increased expression and bundling of collagen, elastin fibrosis and a reduced number of smooth muscle cells (SMCs) at the site of obstruction (Solari et al, 2003). Formalin or paraformaldehyde fixed sections taken from these regions of stenosis also display a loss of neuronal (PGP9.5 and peripherin) (Murakumo et al, 1997;Solari et al, 2003;Wang et al, 1995) and ICC markers (CD117, c-kit) (Arena et al, 2007;Schwentner et al, 2005;Solari et al, 2003) markers, particularly in the muscular layer.…”

Endoscopic treatment of vesicoureteral refluks in children

“…Budući da su neke studije kod zdrave djece našle manji omjer između intravezikalne dužine uretera i promjera nego je očekivano, smatra se kako bi intrinzični faktor mogao imati ulogu u aktivnom anitirefluksnom mehanizmu 5 . Nekoliko studija pokazalo je da smanjenje u broju glatkih mišićnih fascikula, njihova promijenjena konfiguracija na vezikoureteralnom ušću i gubitak c-kit pozitivnih intersticijskih Cajalovih stanica dovodi do nekoordinirane kontrakcije mišića i time refluksa 6,7 .…”

Sarcoglycan Subcomplex Expression in Refluxing Ureteral Endings

“…1 Historically, passive compression of the roof of the intravesical ureter against the underlying detrusor was considered an efficient antireflux protection, and the length of the intravesical ureter relative to its diameter was judged the crucial point perpetuating the "passive" reflux defense mechanism. 2,3 According to this theory, a lateral intravesical ostium, and the brevity of ureteral transmural and submucosal course were believed to be the main cause of VUR, 4 and the spontaneous resolution of VUR was considered to be due to bladder growth, during which submucosal tunnel elongation occurs.…”