The prognostic value of histopathological pattern of the pelviureteric junction in the outcome of pyeloplasty in children

Abstract

Background The cause of pyeloplasty failure remains unclear; therefore, increasing interest has been directed to identify the reason for dissatisfactory surgical results. Some studies attempted to investigate the role of the histopathological pattern. The aim of the work is to study the correlation between the histopathological pattern of obstructed pelviureteric junction (PUJ) segment and the outcome of pyeloplasty in children with the PUJ. Methods Fifty-four patients with pelviureteric junction obstruction (PUJO) were included in the study; patients were evaluated preoperative. All patients were operated by the same surgeon using Anderson–Hynes pyeloplasty; the resected obstructed PUJ segment examined histopathological using light microscope and image analyzer system to identify mean renal pelvis smooth muscle thickness (mRPSMT), collagen-to-smooth muscle ratio and elastin content. Results The study includes 50 patients with mean age Mean 24.48 ± 15.3 months. Two patients show no improvement, while 24 improved at 3 months, 16 improved at 6 months, and 8 improved at 12 months. mRPSMT showed significant difference between improvement groups (136.02 ± 44.4, 173.47 ± 49.69 and 258.56 ± 96.82 μm), while elastin content or collagen-to-smooth muscle ratio showed no significant difference. Conclusions Our data showed a clear relationship between mRPSMT and the time over which radiological improvement occurs; increase in mRPSMT is associated with a delay in postoperative radiological improvement time. We found no relation between elastin content nor collagen-to-smooth muscle thickness and postoperative improvement course.

Association between Intraoperative Anatomical Variation and Histopathological Parameters in Cases of Ureteropelvic Junction Obstruction in Children: A Cross-Sectional Study

“…These parameters include collagen content of the renal pelvis, arrangement of muscle fibres and nerve fibres, collagen-to-smooth muscle ratio, mean renal pelvis smooth muscle thickness, elastin content, S-100, neuron-specific enolase, and interstitial cells of Cajal. [ 1 2 3 5 ] In our study, we assessed basic HPE parameters because, in the literature, there is no consensus even on a single finding. Future studies can be planned with the above-mentioned parameters for the IOAF association.…”

“…In the literature, there is no consensus whether it is the same pathogenesis in all UPJO, across all ages and different types of presentation. [ 1 2 3 ] The various theories proposed as the cause of UPJO include an increase in the collagen between the muscle bundles and elastin in the adventitia, abnormal muscle orientation, infolding of ureteral mucosa, CV and a combined neurogenic-myogenic theory for congenital UPJ obstruction. [ 4 5 ]…”

Ureteropelvic Junction Obstruction (UPJO)

“…7 Pyeloplasty is the UPJO gold standard treatment. 3 This surgical technique is successful in more than 95% of UPJO cases. However, the remaining 5% require further interventions to manage the persistent obstruction.…”

“…1 It occurs in 1/1000 to 1/2000 of newborns and may have increased due to the widespread use of maternal ultrasound. [1][2][3] Frequently, UPJO is seen more in boys than in girls, and the left side of the kidney is more often affected than the right side. Most cases of UPJO are congenital; however, some remain asymptomatic into adulthood.…”

“…Early diagnosis and prompt treatment of UPJO are very important to prevent kidney damage and loss. 3,6 Although UPJO is diagnosed clinically, the pathogenesis remains unclear. As a result, a histopathological study from the affected area may broaden the pathogenesis of UPJO.…”